Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like R*

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

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
76	Fee-for-Service	1134171564	1134171564	1	1	REEDER, WILLIAM MD	1/3/1995	207RR0500X	NA	Other	026	PHYSICIANS	50653	41	Internal Medicine	0	In state provider	None	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
85	Fee-for-Service	1851700850	1851700850	1	1	RAGHU SUBRAMANIAN,	7/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147409	41	Internal Medicine	0	In state provider	CHARUMATHI MD	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
89	Fee-for-Service	1548914336	1548914336	1	1	ROSE WELLNESS CENTER MARRIAG	2/15/2024	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	E FAMILY THERAPY CORP.	5266 HOLLISTER AVE	STE 205	SANTA BARBARA	CA	93111	2037	42	06083	34.43497016	-119.8071895	Santa Barbara County
176	Fee-for-Service	1912262882	1912262882	1	1	RICKEL, LINDSAY LCSW	10/13/2016	390200000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD BOULEVARD	None	LOS ANGELES	CA	90095	8631	19	06037	34.07067	-118.4432445	Los Angeles County
198	Fee-for-Service	1518452887	1518452887	1	1	RODRIGUEZ, LUCERO LCSW	1/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
210	Fee-for-Service	1518098961	1518098961	1	1	RAMIREZ, LYNN MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	95692	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
256	Fee-for-Service	1619003688	1619003688	1	1	RCCA MONTEVIEW DRIVE	10/31/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME	3842 MONTEVIEW DR	None	MODESTO	CA	95355	1142	50	06099	37.69430856	-120.9754515	Stanislaus County
288	Fee-for-Service	1356394381	1356394381	1	1	RESPIRATORY DIAGNOSTICS LLC	1/4/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	115 ATRIUM WAY	SUITE 224	COLUMBIA	SC	29223	6383	00	None	34.08678331	-80.93768441	Richland County
289	Fee-for-Service	1063726776	1063726776	1	1	RASHID, LEEDA MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124706	08	Family Practice	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
350	Fee-for-Service	1205819935	1205819935	1	1	RAPHAEL, DEBORAH B MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92308	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
360	Fee-for-Service	1356819031	1356819031	1	1	ROSANNA SANTOS MARRIAGE AND	12/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPY, INC.	275 E HILLCREST DR STE 1	None	THOUSAND OAKS	CA	91360	7770	56	06111	34.1812975	-118.8718187	Ventura County
364	Fee-for-Service	1134171564	1134171564	1	1	REEDER, WILLIAM MD	1/3/1995	207RR0500X	NA	Other	026	PHYSICIANS	50653	83	Rheumatology	0	In state provider	None	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
377	Fee-for-Service	1548914336	1548914336	1	1	ROSE WELLNESS CENTER MARRIAG	2/15/2024	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	E FAMILY THERAPY CORP.	5266 HOLLISTER AVE	STE 205	SANTA BARBARA	CA	93111	2037	42	06083	34.43497016	-119.8071895	Santa Barbara County
389	Fee-for-Service	1871618207	1871618207	1	1	REZNIK, YURI MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105767	08	Family Practice	0	In state provider	None	1020 29TH STREET	SUITE 480	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
469	Fee-for-Service	1497774434	1497774434	1	1	ROMICK, BENJAMIN G MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114506	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1261 TRAVIS BLVD	STE 200	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
472	Fee-for-Service	1174719017	1174719017	1	1	RIEGELS, NICHOLAS A MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90377	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3100	01	06001	37.819368	-122.263902	Alameda County
478	Fee-for-Service	1033484233	1033484233	1	1	RAMOS, JULIA G MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127859	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
516	Fee-for-Service	1174059257	1174059257	1	1	REEVES, JAMES J MD	7/31/2024	208600000X	NA	General Surgery	026	PHYSICIANS	160901	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
555	Fee-for-Service	1639208721	1639208721	1	1	REICHMAN, ALEXANDRA I MD	12/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56381	22	Pathology (M.D. only)	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
561	Fee-for-Service	1376516229	1376516229	1	1	RAIKAR, GOYA V MD	8/18/2017	2086S0129X	NA	General Surgery	026	PHYSICIANS	69400	33	Thoracic Surgery	0	In state provider	None	1541 FLORIDA AVE	STE 103	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
565	Fee-for-Service	1801094701	1801094701	1	1	REITER, KENNETH G LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
659	Fee-for-Service	1134486095	1134486095	1	1	RAVICHANDRAN, SANDHYA MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131331	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
668	Fee-for-Service	1043311335	1043311335	1	1	RINARD, DEAN P MD	7/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	33985	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 400	SACRAMENTO	CA	95816	5243	34	06067	38.570076	-121.4657145	Sacramento County
688	Fee-for-Service	1740743905	1740743905	1	1	RUBIN, ASHLEY N DO	2/22/2023	208M00000X	NA	Other	026	PHYSICIANS	20075	None	None	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
689	Fee-for-Service	1750063905	1750063905	1	1	RANDALL, SANDRA LCSW	11/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
720	Fee-for-Service	1588790380	1588790380	1	1	ROCKCREEK INC	4/30/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	501 BOWLING GREEN DR	None	CLAREMONT	CA	91711	2717	19	06037	34.11765587	-117.7222014	Los Angeles County
726	Fee-for-Service	1235170655	1235170655	1	1	ROBERT LORIN TABER JR M.D.	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	908 10TH AVE SW	None	QUINCY	WA	98848	1376	00	None	47.23094665	-119.8691639	Grant County
749	Fee-for-Service	1841227519	1841227519	1	1	ROEDER,JANICE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
750	Fee-for-Service	1477896819	1477896819	1	1	RAMIREZ, ALICE M MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134630	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
791	Fee-for-Service	1205301736	1205301736	1	1	REUSCH, DESIREE R LMFT	10/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
792	Fee-for-Service	1710064688	1710064688	1	1	REED-ESPER, SARAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	47 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.65281106	-73.77466567	Albany County
794	Fee-for-Service	1467678342	1467678342	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	11899 SHAW PLACE	None	HANFORD	CA	93230	6644	16	06031	36.30003132	-119.6312291	Kings County
797	Fee-for-Service	1821430844	1821430844	1	1	RIVER CITY PROSTHETICS &	4/28/2014	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3001 P ST	STE B	SACRAMENTO	CA	95186	6547	34	06067	38.566674	-121.4687745	Sacramento County
800	Fee-for-Service	1790904084	1790904084	1	1	RYNING, FRANK W MD	12/29/2010	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	29459	77	Infectious Disease	0	In state provider	None	1339 4TH AVE	None	SAN FRANCISCO	CA	94122	2615	38	06075	37.76350944	-122.4609575	San Francisco County
817	Fee-for-Service	1902954944	1902954944	1	1	RIVERSIDE-SAN BERNARDINO	4/23/2018	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11555 1/2 POTRERO RD	None	BANNING	CA	92220	6946	33	06065	33.953571	-116.8290655	Riverside County
850	Fee-for-Service	1558147652	1558147652	1	1	RICCOMINI, EMILY PT	12/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
888	Fee-for-Service	1265455505	1265455505	1	1	RAEL, JESSE R MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89384	30	Radiology	0	In state provider	None	3883 AIRWAY DRIVE	STE 100	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
899	Fee-for-Service	1962407593	1962407593	2	1	RAJACICH, GEORGE M MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44103	18	Ophthalmology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
907	Fee-for-Service	1649501446	1649501446	1	1	RAMAN, TANVI S MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110538	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2270	07	06013	37.98417931	-122.0361585	Contra Costa County
910	Fee-for-Service	1932225174	1932225174	1	1	RICHARD, MARIANNE CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	8080 PARKWAY DRIVE	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
917	Fee-for-Service	1851737522	1851737522	1	1	RECINTO, VANESSA G OT	10/22/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
977	Fee-for-Service	1053848879	1053848879	1	1	RADICIC, KASEY M DO	4/8/2021	207R00000X	NA	Other	026	PHYSICIANS	18686	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
1006	Fee-for-Service	1588787014	1588787014	1	1	ROLFE, KEVIN W MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84529	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
1023	Fee-for-Service	1285160820	1285160820	1	1	RICHMEIER, NATALIE A CRNA	7/6/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
1031	Fee-for-Service	1871892257	1871892257	1	1	RHETT MERRITT COOK	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
1079	Fee-for-Service	1467678342	1467678342	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	11899 SHAW PLACE	None	HANFORD	CA	93230	6644	16	06031	36.30003132	-119.6312291	Kings County
1109	Fee-for-Service	1225259609	1225259609	1	1	RYANG, MYUNG K MD	9/1/2000	2084P0804X	NA	Psychiatry	026	PHYSICIANS	33151	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
1136	Fee-for-Service	1891211371	1891211371	1	1	RAY, JULIE LMFT	2/22/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1137	Fee-for-Service	1831292796	1831292796	1	1	RAISINGHANI, AJIT B MD	11/30/1992	207R00000X	NA	Other	026	PHYSICIANS	75914	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
1293	Fee-for-Service	1306913322	1306913322	1	1	RISBUD, MADHAVI A MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	54491	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
1309	Fee-for-Service	1003527037	1003527037	1	1	REDDING REHAB	1/15/2025	106H00000X	NA	Mental Health Outpatient Services	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3580 SANTA ROSA WAY	None	REDDING	CA	96003	1766	45	06089	40.62156409	-122.4017189	Shasta County
1336	Fee-for-Service	1528177706	1528177706	1	1	REED, JOHN B MD	10/21/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	82260	None	None	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
1352	Fee-for-Service	1588765879	1588765879	1	1	ROHRDANZ, DAVID I MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	49843	08	Family Practice	0	In state provider	None	9755 LINCOLN VILLAGE DR	None	SACRAMENTO	CA	95827	3334	34	06067	38.562453	-121.332564	Sacramento County
1367	Fee-for-Service	1467678342	1467678342	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	11899 SHAW PLACE	None	HANFORD	CA	93230	6644	16	06031	36.30003132	-119.6312291	Kings County
1425	Fee-for-Service	1831292796	1831292796	1	1	RAISINGHANI, AJIT B MD	11/30/1992	207R00000X	NA	Other	026	PHYSICIANS	75914	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
1426	Fee-for-Service	1821031261	1821031261	1	1	RYAN, SEAN M MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75120	36	Psychiatry	0	In state provider	8201	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
1466	Fee-for-Service	1104338722	1104338722	1	1	RUBI, JEFFREY PT	3/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8215 ROCHESTER AVE.	SUITE 110	RANCHO CUCAMONGA	CA	91730	0727	36	06071	34.10428657	-117.5456898	San Bernardino County
1476	Fee-for-Service	1811379506	1811379506	1	1	RAY, JENNIFER N LCSW	6/26/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
1507	Fee-for-Service	1306005293	1306005293	1	1	RAY, LHASA M MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117730	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
1545	Fee-for-Service	1043741614	1043741614	1	1	RANA, JASMINE K MD	8/26/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	158558	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1549	Fee-for-Service	1235227943	1235227943	1	1	RAMILO-TORNO, LILIBETH	3/31/1994	2080P0207X	NA	Hematology	026	PHYSICIANS	50517	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
1556	Fee-for-Service	1972556611	1972556611	1	1	RUEHRMUND, SCOTT D MD	9/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185257	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
1563	Fee-for-Service	1093847683	1093847683	1	1	RICHARDS, DAVID C MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99588	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
1570	Fee-for-Service	1750439618	1750439618	1	1	ROMERO, LINA M MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66879	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
1654	Fee-for-Service	1083963839	1083963839	1	1	RUSTAD, LAURETTA M PT	12/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
1655	Fee-for-Service	1467678342	1467678342	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	11899 SHAW PLACE	None	HANFORD	CA	93230	6644	16	06031	36.30003132	-119.6312291	Kings County
1658	Fee-for-Service	1710917711	1710917711	1	1	RICE, REGINALD D JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70357	04	Otology, Laryngology, Rhinology	0	In state provider	None	4300 GOLDEN CENTER DR	STE D	PLACERVILLE	CA	95667	6278	09	06017	38.70657265	-120.82856	El Dorado County
1666	Fee-for-Service	1821798216	1821798216	1	1	ROBERGE, GRACE LMFT	9/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
1684	Fee-for-Service	1043331713	1043331713	1	1	REBECCA, MARCULESCU L	7/23/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
1710	Fee-for-Service	1033464243	1033464243	1	1	RAMASAMY, BALAJI MD	6/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136725	41	Internal Medicine	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
1723	Fee-for-Service	1184688434	1184688434	1	1	RING, ERNEST J MD	1/1/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40234	01	General Practice	0	In state provider	None	350 PARNASSUS AVE	STE 709	SAN FRANCISCO	CA	94117	3622	38	06075	37.76403932	-122.4561371	San Francisco County
1727	Fee-for-Service	1003926767	1003926767	1	1	RALEY'S	6/3/1982	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8852 LAKEWOOD DR	None	WINDSOR	CA	95492	9595	49	06097	38.54864463	-122.805993	Sonoma County
1745	Fee-for-Service	1538452131	1538452131	1	1	REYES, ADRIAN V MD INC	6/15/2011	193400000X	NA	Other	026	PHYSICIANS	51386	05	Anesthesiology	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
1788	Fee-for-Service	1265580294	1265580294	1	1	RO, EDWARD S MD	3/4/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84855	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1804	Fee-for-Service	1700140738	1700140738	1	1	ROSS, ANDREW L MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140430	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
1820	Fee-for-Service	1104972975	1104972975	1	1	REARDEN, C ANN MD	6/30/1982	207ZB0001X	NA	Other	026	PHYSICIANS	26945	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H720	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
1838	Fee-for-Service	1578991691	1578991691	1	1	RAFFLE, DAVID L PHD INC A	8/26/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGICAL CORP	2001 S BARRINGTON AVE	STE 121	LOS ANGELES	CA	90025	5320	19	06037	34.03672191	-118.4500156	Los Angeles County
1845	Fee-for-Service	1346460904	1346460904	1	1	REGENTS OF UNIV OF CALIF	2/17/2006	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
1868	Fee-for-Service	1932526456	1932526456	1	1	ROMA MARKETING	6/22/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12422 CENTRAL AVE	None	CHINO	CA	91710	2603	36	06071	34.02766974	-117.6895554	San Bernardino County
1880	Fee-for-Service	1275626301	1275626301	1	1	ROSE MORAN-KELLY	4/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
1883	Fee-for-Service	1174673990	1174673990	1	1	ROMERO, LUCINDA A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50503	02	General Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
1902	Fee-for-Service	1104853217	1104853217	1	1	ROSE, JOHN B MD	12/21/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	36052	08	Family Practice	0	In state provider	None	PO BOX 609	None	BROWNSVILLE	CA	95919	0609	58	06115	0	0	None
1948	Fee-for-Service	1821110321	1821110321	1	1	ROSS, RANDY RAYMOND MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	68955	01	General Practice	0	In state provider	None	7408 E PINTO WAY	None	ORANGE	CA	92869	4525	30	06059	33.79232408	-117.7748311	Orange County
1957	Fee-for-Service	1467907220	1467907220	1	1	RING, REBECCA L LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1350 HAYES ST	SUITEC-1BB	BENICIA	CA	94510	2945	48	06095	38.04764833	-122.139033	Solano County
1982	Fee-for-Service	1013924802	1013924802	1	1	RODRIGUEZ, AUGUSTO MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45415	08	Family Practice	0	In state provider	None	10234 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2602	19	06037	33.90197379	-118.1144208	Los Angeles County
1987	Fee-for-Service	1326898594	1326898594	1	1	RHEUMATOLOGY ASSOCIATES PC	11/5/2024	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	1335 BUENAVENTURA BLVD	100	REDDING	CA	96001	0000	45	06089	40.58222519	-122.4261823	Shasta County
1995	Fee-for-Service	1033147954	1033147954	1	1	ROWITCH, DAVID H MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87731	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
2012	Fee-for-Service	1326143512	1326143512	1	1	ROBIE, DANIEL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STRAUB CLINIC & HOSPITAL	888 SOUTH KING STREET	None	HONOLULU	HI	96813	0000	00	None	21.30218603	-157.8505732	Honolulu County
2037	Fee-for-Service	1346891827	1346891827	1	1	ROZENBERG, REBECCA NP	11/30/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
2116	Fee-for-Service	1619055423	1619055423	1	1	RIZVI, SEEMA DO	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	7036	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
2118	Fee-for-Service	1295085660	1295085660	1	1	REZNICK, HARRELL M PHD	4/19/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3991 MACARTHUR BLVD	SUITE 200	NEWPORT BEACH	CA	92660	3009	30	06059	33.65957329	-117.8631723	Orange County
2120	Fee-for-Service	1891994281	1891994281	1	1	REIS, GENEVIEVE H LCSW	10/21/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
2130	Fee-for-Service	1275781411	1275781411	1	1	RAHNAMA, NANCY P MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107568	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
2131	Fee-for-Service	1225572746	1225572746	1	1	RUBIO, GABRIELA LMFT	12/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
2176	Fee-for-Service	1710208046	1710208046	1	1	RAFSANJANI, AREF K MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122436	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
2236	Fee-for-Service	1821110321	1821110321	1	1	ROSS, RANDY RAYMOND MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	68955	36	Psychiatry	0	In state provider	None	7408 E PINTO WAY	None	ORANGE	CA	92869	4525	30	06059	33.79232408	-117.7748311	Orange County
2260	Fee-for-Service	1821099169	1821099169	1	1	RO-YIM, SANDY H MD	11/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87753	07	Dermatology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
2280	Fee-for-Service	1578707071	1578707071	1	1	ROY, PUJA MD	4/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134350	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
2283	Fee-for-Service	1710965058	1710965058	1	1	RICH, DANIEL G	11/30/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60828	18	Ophthalmology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
2319	Fee-for-Service	1649252842	1649252842	1	1	ROMERO, MARIA E NP	12/27/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
2362	Fee-for-Service	1669673687	1669673687	1	1	RAMSINGH, HARVINDER S MD	10/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105353	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVENUE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
2388	Fee-for-Service	1376025650	1376025650	1	1	RDA HOME HEALTH SERVICES INC	1/26/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2130 ARROWHEAD AVENUE	SUITE 202 B & D	SAN BERNARDINO	CA	92405	4023	36	06071	34.13450029	-117.289686	San Bernardino County
2459	Fee-for-Service	1295398436	1295398436	1	1	RAFIQ LTD LLC	8/14/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARMACY	6633 COYLE AVE	STE 1	CARMICHAEL	CA	95608	6346	34	06067	38.668275	-121.3097265	Sacramento County
2472	Fee-for-Service	1124363973	1124363973	1	1	REEDER, EMILY LMFT	3/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
2492	Fee-for-Service	1114019379	1114019379	1	1	ROMM, JOHN D MD AMC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	19015	10	Gastroenterology (M.D. only)	0	In state provider	None	8920 WILSHIRE BLVD	#330	BEVERLY HILLS	CA	90211	2007	19	06037	34.06703599	-118.3863456	Los Angeles County
2508	Fee-for-Service	1013041151	1013041151	1	3	RMG MEDICAL GROUP INC	1/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	12291 WASHINGTON BLVD	STE 200	WHITTIER	CA	90606	2550	19	06037	33.96734104	-118.0508773	Los Angeles County
2518	Fee-for-Service	1518216639	1518216639	1	1	REY, ANTONIA M LMFT	8/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	133 D ST	STE J	DAVIS	CA	95616	4695	57	06113	38.54276879	-121.742095	Yolo County
2529	Fee-for-Service	1952722258	1952722258	1	1	ROBERTS, KARA E NP	3/9/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
2571	Fee-for-Service	1710965058	1710965058	1	1	RICH, DANIEL G	11/30/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60828	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
2587	Fee-for-Service	1023575248	1023575248	1	1	ROBLEDO, ELIZABETH	2/19/2025	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
2607	Fee-for-Service	1083054746	1083054746	1	1	RAE ANN WITT ROLFSEN MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
2613	Fee-for-Service	1790946028	1790946028	1	1	RANA, SAMEERA MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115796	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2631	Fee-for-Service	1780152686	1780152686	1	1	RIDE PLUS, LLC	3/1/2020	343800000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7441 LINCOLN WAY	SUITE 200	GARDEN GROVE	CA	92841	1452	30	06059	33.79835588	-118.0020846	Orange County
2634	Fee-for-Service	1255502761	1255502761	1	1	RAMIREZ, ELIZABETH L LMFT	11/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9 W GABILAN STREET	SUITE 18	SALINAS	CA	93901	2723	27	06053	36.67556101	-121.6556155	Monterey County
2638	Fee-for-Service	1356901466	1356901466	1	1	RAJCHEL, ERYN K CCC-SLP	4/13/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
2651	Fee-for-Service	1932155710	1932155710	1	1	RAMSEIER, JAMES A MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
2654	Fee-for-Service	1538210596	1538210596	1	1	RIM OF THE WORLD USD	5/22/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	24740 SAN MORITZ WAY	None	CRESTLINE	CA	92325	0000	36	06071	34.24336037	-117.2639052	San Bernardino County
2669	Fee-for-Service	1073755476	1073755476	1	1	ROBBY T. AYOUB , M.D., PROF.	6/3/2009	207R00000X	NA	Other	026	PHYSICIANS	102841	None	None	0	In state provider	& PULMONARY	8201 NEWMAN AVE	STE 301	HUNTINGTON BEACH	CA	92647	7020	30	06059	33.7048475	-117.9855135	Orange County
2698	Fee-for-Service	1750816252	1750816252	1	1	RAKONJAC, ZORAN	10/29/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
2717	Fee-for-Service	1336191857	1336191857	1	1	RICHARD RUPERT ALARID MD	9/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11111 S 84TH ST	None	PAPILLION	NE	68046	4122	00	None	41.135958	-96.040035	Sarpy County
2722	Fee-for-Service	1295155109	1295155109	1	1	REZAEIAN, PANTEHA MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143802	01	General Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
2773	Fee-for-Service	1386845758	1386845758	1	1	RAMA, KUNKLE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
2781	Fee-for-Service	1114019379	1114019379	1	1	ROMM, JOHN D MD AMC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	19015	41	Internal Medicine	0	In state provider	None	8920 WILSHIRE BLVD	#330	BEVERLY HILLS	CA	90211	2007	19	06037	34.06703599	-118.3863456	Los Angeles County
2797	Fee-for-Service	1013041151	1013041151	1	3	RMG MEDICAL GROUP INC	1/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	12291 WASHINGTON BLVD	STE 200	WHITTIER	CA	90606	2550	19	06037	33.96734104	-118.0508773	Los Angeles County
2816	Fee-for-Service	1730870650	1730870650	1	1	REINHARDT, SAMANTHA K	6/26/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	45	06089	0	0	None
2823	Fee-for-Service	1093062473	1093062473	1	1	REDDY URGENT CARE INC	3/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	44317	66	Emergency Medicine (Urgent Care)	0	In state provider	None	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	19	06037	33.7685184	-118.1850803	Los Angeles County
2839	Fee-for-Service	1922395490	1922395490	1	1	RILEY, MATTHEW H DO	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13448	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
2868	Fee-for-Service	1780607564	1780607564	1	1	RIVETT, JENNAFER L DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	A PERFECT CURVE	1269 PLEASANT GROVE BLVD	STE 2	ROSEVILLE	CA	95747	5858	31	06061	38.77220051	-121.3151385	Placer County
2903	Fee-for-Service	1790946028	1790946028	1	1	RANA, SAMEERA MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115796	05	Anesthesiology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2917	Fee-for-Service	1659468106	1659468106	1	1	RICHTER, HOWARD S MD	1/29/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83849	None	None	0	In state provider	None	1345 PAUL BUNYAN ROAD	UNIT A	SUSANVILLE	CA	96130	3159	18	06035	40.43531297	-120.6557201	Lassen County
2994	Fee-for-Service	1386715050	1386715050	1	1	RICH, DIANE K S	10/20/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
3000	Fee-for-Service	1023651080	1023651080	1	1	ROEBUCK, JANISE M NP	11/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
3029	Fee-for-Service	1003057886	1003057886	1	1	ROLESON, RYAN MD	2/2/2023	390200000X	NA	Other	026	PHYSICIANS	179566	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
3084	Fee-for-Service	1013041151	1013041151	1	3	RMG MEDICAL GROUP INC	1/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12291 WASHINGTON BLVD	STE 200	WHITTIER	CA	90606	2550	19	06037	33.96734104	-118.0508773	Los Angeles County
3130	Fee-for-Service	1801850508	1801850508	1	1	ROOST, KENNETH T MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27727	None	None	0	In state provider	None	1828 EL CAMINO REAL	STE 604	BURLINGAME	CA	94010	3120	41	06081	37.59552262	-122.3838771	San Mateo County
3131	Fee-for-Service	1629116660	1629116660	1	1	RICHARDS, JULIE A NP	10/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3143	Fee-for-Service	1013041151	1013041151	1	1	RMG MEDICAL GROUP INC	1/7/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15082 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91704669	-118.0092197	Los Angeles County
3168	Fee-for-Service	1457659732	1457659732	1	1	REMEDIOS S VASQUEZ	6/3/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	REMEDIOS S VASQUEZ	18245 CHERRY ST	None	HESPERIA	CA	92345	5519	36	06071	34.43184515	-117.2649969	San Bernardino County
3185	Fee-for-Service	1528083128	1528083128	1	1	RALPHS GROCERY CO	5/17/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #729	583 N VENTU PARK RD	None	NEWBURY PARK	CA	91320	2710	56	06111	34.18750333	-118.9113203	Ventura County
3232	Fee-for-Service	1407048861	1407048861	1	1	ROSE, MICHAEL B DO	8/7/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	10592	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
3369	Fee-for-Service	1306862701	1306862701	1	1	RIDGILL, LUCILLE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45977	41	Internal Medicine	0	In state provider	None	231 W VERNON AVE	STE 202	LOS ANGELES	CA	90037	2779	19	06037	34.0038305	-118.2774195	Los Angeles County
3378	Fee-for-Service	1952626830	1952626830	1	1	RAMBO, CHELSEA LCSW	7/26/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	76935	-	NOT APPLICABLE	0	In state provider	None	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
3398	Fee-for-Service	1124718820	1124718820	1	1	ROYAL MEDICAL SUPPLY LLC	10/27/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	21822 SHERMAN WAY	STE 201	CANOGA PARK	CA	91303	1938	19	06037	34.20098953	-118.6037055	Los Angeles County
3431	Fee-for-Service	1013041151	1013041151	1	1	RMG MEDICAL GROUP INC	1/7/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	15082 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91704669	-118.0092197	Los Angeles County
3520	Fee-for-Service	1407048861	1407048861	1	1	ROSE, MICHAEL B DO	8/7/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	10592	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
3537	Fee-for-Service	1245633965	1245633965	1	1	RIOS, JANET OT	4/3/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	357 PIERCY RD	None	SAN JOSE	CA	95138	1403	43	06085	37.25708275	-121.7826703	Santa Clara County
3615	Fee-for-Service	1871527523	1871527523	1	1	ROBERT,MITCHELL R MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118302	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
3664	Fee-for-Service	1790892024	1790892024	1	1	RUSSELL, DAWN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12303 NE 130TH LN	STE 420	KIRKLAND	WA	98034	3042	00	None	47.71664854	-122.1792615	King County
3719	Fee-for-Service	1013041151	1013041151	1	1	RMG MEDICAL GROUP INC	1/7/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15082 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91704669	-118.0092197	Los Angeles County
3720	Fee-for-Service	1205003092	1205003092	1	1	RAMPERSAUD, EDWARD N MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112417	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
3744	Fee-for-Service	1568625796	1568625796	1	1	ROY, ANUKUL R MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55992	None	None	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
3758	Fee-for-Service	1366893190	1366893190	1	1	ROMAN, JESSICA V MSW LCSW	10/22/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
3780	Fee-for-Service	1588862262	1588862262	1	1	REDDY, PRASAD V MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	95784	36	Psychiatry	0	In state provider	None	263 S WEST ST	None	TULARE	CA	93274	3411	54	06107	36.20460711	-119.3668926	Tulare County
3785	Fee-for-Service	1497075469	1497075469	1	1	REYNOLDS, LORI R LMFT	10/5/2020	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
3786	Fee-for-Service	1417149022	1417149022	1	1	ROCHA, FREDERICO G MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154755	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
3794	Fee-for-Service	1518022581	1518022581	1	1	ROSENTHAL, STEVEN J MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34732	41	Internal Medicine	0	In state provider	None	13847 E 14TH ST	STE 201	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
3824	Fee-for-Service	1811428733	1811428733	1	1	RAMACHANDRAN, SWETHA MD	7/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172017	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
3831	Fee-for-Service	1154661544	1154661544	1	1	RICHARD, AURORE DO	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13580	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
3834	Fee-for-Service	1518409820	1518409820	1	1	RIVERA, ADRIANA	10/10/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
3856	Fee-for-Service	1396198958	1396198958	1	4	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NTER	5735 WATT AVENUE	None	NORTH HIGHLANDS	CA	95660	4751	34	06067	38.671749	-121.3838325	Sacramento County
3867	Fee-for-Service	1811939879	1811939879	1	1	ROTH, EMILY MD	6/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63069	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
3871	Fee-for-Service	1881930964	1881930964	1	1	REEDLEY COMMUNITY HOSPITAL	2/1/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2357 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54170344	-119.8338188	Fresno County
3890	Fee-for-Service	1609249408	1609249408	1	2	REGENTS OF THE UIVERSITY	12/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	200 MEDICAL PLAZA	STE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
3912	Fee-for-Service	1659996106	1659996106	1	1	REPOSE HOSPICE CARE INC	11/27/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	STE 109	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
3939	Fee-for-Service	1447359310	1447359310	1	2	RENAL MEDICAL ASSOCIATES	2/13/2023	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 320	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
3961	Fee-for-Service	1588667042	1588667042	1	1	RUTKOWSKI, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 E 2ND ST	STE 210	SCOTTSDALE	AZ	85251	5620	00	None	33.491178	-111.92427	Maricopa County
3977	Fee-for-Service	1174634513	1174634513	1	1	ROBINSON, MICHAEL F	2/8/2015	207RE0101X	NA	Endocrinology	026	PHYSICIANS	40552	41	Internal Medicine	0	In state provider	None	575 E HARDY ST	STE 322	INGLEWOOD	CA	90301	4053	19	06037	33.94909392	-118.3477665	Los Angeles County
4074	Fee-for-Service	1417149022	1417149022	1	1	ROCHA, FREDERICO G MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154755	15	Obstetrics (D.O. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4076	Fee-for-Service	1811386147	1811386147	1	1	RIVERS EDGE SURGERY CENTER	9/11/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	71780 SAN JACINTO DR	BLDG D	RANCHO MIRAGE	CA	92270	5517	33	06065	33.74325198	-116.411769	Riverside County
4104	Fee-for-Service	1023037652	1023037652	1	1	ROBINSON, LAWRENCE D MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	35069	40	Pediatrics	0	In state provider	None	1523 W AVENUE J	STE 7	LANCASTER	CA	93534	2819	19	06037	34.6894773	-118.1577712	Los Angeles County
4111	Fee-for-Service	1811428733	1811428733	1	1	RAMACHANDRAN, SWETHA MD	7/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172017	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
4114	Fee-for-Service	1629367792	1629367792	1	1	ROE, JADA L MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123638	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
4160	Fee-for-Service	1881930964	1881930964	1	1	REEDLEY COMMUNITY HOSPITAL	5/10/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2357 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54170344	-119.8338188	Fresno County
4174	Fee-for-Service	1952459174	1952459174	1	1	REDWOOD CITY ELEM SD	3/12/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	750 BRADFORD ST	None	REDWOOD CITY	CA	94063	1727	41	06081	37.48861098	-122.2273435	San Mateo County
4203	Fee-for-Service	1659996106	1659996106	1	1	REPOSE HOSPICE CARE INC	11/27/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	STE 109	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
4223	Fee-for-Service	1447359310	1447359310	1	2	RENAL MEDICAL ASSOCIATES	2/13/2023	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2100 WEBSTER ST	STE 320	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
4261	Fee-for-Service	1679524904	1679524904	1	1	RICCI,PETER E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC	None	AURORA	CO	80112	5411	00	None	39.689343	-104.832198	Arapahoe County
4263	Fee-for-Service	1073777249	1073777249	1	4	RAGHURAM RAO M.D.	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	251 N ESTRELLA PKWY	None	GOODYEAR	AZ	85338	9334	00	None	33.449436	-112.3919055	Maricopa County
4308	Fee-for-Service	1831674191	1831674191	1	1	RIGBY, LAURA L CNP	5/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
4312	Fee-for-Service	1295806263	1295806263	1	1	ROSTAMI, KHODAM	9/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77123	None	None	0	In state provider	None	5250 SANTA MONICA BLVD	STE 208	LOS ANGELES	CA	90029	1254	19	06037	34.09077051	-118.3046976	Los Angeles County
4313	Fee-for-Service	1407911779	1407911779	1	1	RICHARD D COHAN	11/30/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1303 JEFFERSON STREET	SUITE 600A	NAPA	CA	94559	2473	28	06055	38.30015229	-122.2932731	Napa County
4362	Fee-for-Service	1255755823	1255755823	1	1	REDWOOD RADIOLOGY INC	3/14/2014	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	113062	30	Radiology	0	In state provider	None	3800 JANES ROAD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
4428	Fee-for-Service	1154328466	1154328466	1	1	ROTKIS, THOMAS C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PULMONARY ASSOC OF SO AZ	1951 N WILMONT RD,	BLDG 4	TUCSON	AZ	85712	0000	00	None	32.246379	-110.859084	Pima County
4448	Fee-for-Service	1881930964	1881930964	1	1	REEDLEY COMMUNITY HOSPITAL	5/10/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2357 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54170344	-119.8338188	Fresno County
4461	Fee-for-Service	1952459174	1952459174	1	1	REDWOOD CITY ELEM SD	8/1/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	750 BRADFORD ST	None	REDWOOD CITY	CA	94063	1727	41	06081	37.48861098	-122.2273435	San Mateo County
4462	Fee-for-Service	1558620427	1558620427	1	1	RODAVI HOME HEALTH CARE INC	9/25/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	440 W. COLORADO ST	SUITE 103	GLENDALE	CA	91204	3053	19	06037	34.14249549	-118.2628035	Los Angeles County
4466	Fee-for-Service	1194878512	1194878512	1	1	ROBERTO, LAURO Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49421	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
4532	Fee-for-Service	1376119974	1376119974	1	1	RAUF, HAZIQ	7/30/2024	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
4535	Fee-for-Service	1255763942	1255763942	1	1	RAYMUNDO, PAULYNE NP	5/8/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
4545	Fee-for-Service	1174599435	1174599435	1	1	REIDER, SUSAN C	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
4582	Fee-for-Service	1891753976	1891753976	1	1	REHAB SOLUTIONS	8/1/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	16520 ASTON STREET	None	IRVINE	CA	92606	4805	30	06059	33.70325799	-117.8407289	Orange County
4628	Fee-for-Service	1386645356	1386645356	1	1	RAMPOLLA, REINALDO E	11/11/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	101132	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
4653	Fee-for-Service	1083610018	1083610018	1	1	RICHARDS, KEN EH JR	3/16/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5725 RALSTON ST	STE 103	VENTURA	CA	93003	6053	56	06111	34.26095488	-119.2125269	Ventura County
4655	Fee-for-Service	1235158551	1235158551	1	1	ROWE,MICHAEL B MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79101	41	Internal Medicine	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
4670	Fee-for-Service	1669558193	1669558193	1	1	RAVKIN, INNA MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	51752	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
4674	Fee-for-Service	1558823625	1558823625	1	1	RODRIGUEZ, LOUIE H MD	9/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176144	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
4735	Fee-for-Service	1881930964	1881930964	1	1	REEDLEY COMMUNITY HOSPITAL	12/31/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2357 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54170344	-119.8338188	Fresno County
4742	Fee-for-Service	1942434931	1942434931	1	1	ROBBINS, KIMBERLY S MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101709	05	Anesthesiology	0	In state provider	None	27401 LOS ALTOS	SUITE 180	MISSION VIEJO	CA	92691	8012	30	06059	33.56489118	-117.665546	Orange County
4754	Fee-for-Service	1194878512	1194878512	1	1	ROBERTO, LAURO Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49421	40	Pediatrics	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
4816	Fee-for-Service	1376119974	1376119974	1	1	RAUF, HAZIQ	7/30/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
4869	Fee-for-Service	1235475484	1235475484	1	1	REEDLEY COMMUNITY HOSPITAL	12/10/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1310 HANNA AVENUE	SUITE 1 AND SUITE 3	CORCORAN	CA	93212	2334	16	06031	36.09975818	-119.5641426	Kings County
4920	Fee-for-Service	1801098751	1801098751	1	1	RASHID, NASIR MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
4939	Fee-for-Service	1619932779	1619932779	1	1	RAHAH, R S MD	6/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	29661	41	Internal Medicine	0	In state provider	None	13847 E 14TH ST	STE 112	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
4942	Fee-for-Service	1134222102	1134222102	1	1	ROMEO, LISA MD	10/31/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79809	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
4967	Fee-for-Service	1306829452	1306829452	1	1	RICHARD P. CARR PHYSICAL THE	2/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	605 TENNANT AVE	STE F	MORGAN HILL	CA	95037	5529	43	06085	37.11679099	-121.6331308	Santa Clara County
4983	Fee-for-Service	1477888675	1477888675	1	1	REGINALDO-ROXAS, RITA	12/3/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1644 CHENEY LANE	None	HAYWARD	CA	94545	4331	01	06001	37.63603796	-122.0891177	Alameda County
4985	Fee-for-Service	1922110402	1922110402	1	1	ROTHMAN, JAY ALLEN	1/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	18582	40	Pediatrics	0	In state provider	None	17822 BEACH BLVD	STE 373	HUNTINGTON BEACH	CA	92647	7115	30	06059	33.70331388	-117.9890471	Orange County
5018	Fee-for-Service	1841452059	1841452059	1	1	ROGERS, ADAM M MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103742	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
5043	Fee-for-Service	1194878512	1194878512	1	1	ROBERTO, LAURO Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49421	01	General Practice	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
5069	Fee-for-Service	1306372024	1306372024	1	1	RAY-CONNOLE, BRIANNE LMFT	2/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
5080	Fee-for-Service	1669480026	1669480026	1	1	ROCHA, NENA M MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63349	01	General Practice	0	In state provider	None	897 HYMETTUS AVE	None	ENCINITAS	CA	92024	2151	37	06073	33.06525612	-117.2963257	San Diego County
5101	Fee-for-Service	1528121241	1528121241	1	1	RAD, TALAT K CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
5107	Fee-for-Service	1073988531	1073988531	1	1	ROOK, JORDAN M MD	8/22/2022	208600000X	NA	General Surgery	026	PHYSICIANS	177448	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
5112	Fee-for-Service	1295763845	1295763845	1	1	RODNEY E. VIVIAN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4900 HOUSTON RD	None	FLORENCE	KY	41042	4824	00	None	39.016422	-84.6300285	Boone County
5118	Fee-for-Service	1558700328	1558700328	1	1	RESCHKE, COLE DC	6/30/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	C	2211 E LINCOLN AVE	None	ANAHEIM	CA	92806	4108	30	06059	33.83945699	-117.8858858	Orange County
5133	Fee-for-Service	1255395554	1255395554	1	1	RODE, MARTHA E MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85935	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
5145	Fee-for-Service	1023890464	1023890464	1	1	ROPER, KELSEY PSYD	1/5/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
5152	Fee-for-Service	1487698791	1487698791	1	1	ROGERS, STANLEY J MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76751	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
5156	Fee-for-Service	1235475484	1235475484	1	1	REEDLEY COMMUNITY HOSPITAL	2/1/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1310 HANNA AVENUE	SUITE 1 AND SUITE 3	CORCORAN	CA	93212	2334	16	06031	36.09975818	-119.5641426	Kings County
5178	Fee-for-Service	1205105731	1205105731	1	1	REYNOLDS, JESSICA L MD	8/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119307	01	General Practice	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5180	Fee-for-Service	1326160177	1326160177	1	1	RAVI SIVASANKARA MENON M.D.	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 17TH AVE	None	SEATTLE	WA	98122	5788	00	None	47.60689769	-122.3102467	King County
5209	Fee-for-Service	1043249808	1043249808	1	1	RAJPUT, FARZAN S MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95017	41	Internal Medicine	0	In state provider	None	3300 W COAST HIGHWAY	None	NEWPORT BEACH	CA	92663	4007	30	06059	33.62136043	-117.9274297	Orange County
5215	Fee-for-Service	1053806547	1053806547	1	1	RAMIREZ, DANIEL DO	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22483	10	Gastroenterology (M.D. only)	0	In state provider	None	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
5237	Fee-for-Service	1215972286	1215972286	1	1	RICHARD GRAY	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
5335	Fee-for-Service	1144654880	1144654880	1	1	RAI, ANGAD S MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124265	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
5366	Fee-for-Service	1669480026	1669480026	1	1	ROCHA, NENA M MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63349	08	Family Practice	0	In state provider	None	897 HYMETTUS AVE	None	ENCINITAS	CA	92024	2151	37	06073	33.06525612	-117.2963257	San Diego County
5391	Fee-for-Service	1417054511	1417054511	1	1	RICHARDSON, JAMES A MD	10/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40403	41	Internal Medicine	0	In state provider	None	307 ACADEMY ST	None	BISHOP	CA	93514	2603	14	06027	37.36314147	-118.39743	Inyo County
5403	Fee-for-Service	1568610392	1568610392	1	1	ROSA, MYRYSHA D LCSW	6/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
5439	Fee-for-Service	1396081154	1396081154	1	1	RAMIREZ, JOHANNES MD PC	10/22/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64975	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	650 HOBSON WAY	STE 201	OXNARD	CA	93030	6711	56	06111	34.19585039	-119.1880222	Ventura County
5444	Fee-for-Service	1235475484	1235475484	1	1	REEDLEY COMMUNITY HOSPITAL	6/11/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1310 HANNA AVENUE	SUITE 1 AND SUITE 3	CORCORAN	CA	93212	2334	16	06031	36.09975818	-119.5641426	Kings County
5445	Fee-for-Service	1831393172	1831393172	1	1	RAD, SHAHLA Y MD INC	3/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	48101	01	General Practice	0	In state provider	None	8642 W PICO BLVD	STE A	LOS ANGELES	CA	90035	2314	19	06037	34.05405385	-118.3800535	Los Angeles County
5458	Fee-for-Service	1316971773	1316971773	1	1	ROBERT M COOPER MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
5470	Fee-for-Service	1205105731	1205105731	1	1	REYNOLDS, JESSICA L MD	8/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119307	02	General Surgery	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5480	Fee-for-Service	1275511032	1275511032	1	1	RENNER, ANDREW I MD INC	8/31/1980	208600000X	NA	General Surgery	026	PHYSICIANS	42417	02	General Surgery	0	In state provider	None	2701 W ALAMEDA AVE	STE 300	BURBANK	CA	91505	4408	19	06037	34.15751343	-118.3303715	Los Angeles County
5530	Fee-for-Service	1558320481	1558320481	1	1	ROMANESCHI, KARL B MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83174	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2155 SOUTH AVE	STE 21	SOUTH LAKE TAHOE	CA	96150	7038	09	06017	38.91235187	-119.9983501	El Dorado County
5550	Fee-for-Service	1225025331	1225025331	1	1	RUBIN, BENJAMIN D MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	38558	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
5556	Fee-for-Service	1124473475	1124473475	1	1	RICHLEY, MICHAEL MD	5/15/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168447	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
5578	Fee-for-Service	1487602579	1487602579	1	1	REGENTS OF THE UNIVERSITY OF	11/17/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
5580	Fee-for-Service	1487656021	1487656021	1	1	RUGAMA, ARNOLD MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63350	08	Family Practice	0	In state provider	None	1177 E WARNER AVE	None	FRESNO	CA	93710	4030	10	06019	36.83609842	-119.7679005	Fresno County
5593	Fee-for-Service	1679539837	1679539837	1	1	RAM, PANKAJ P MD	1/1/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	30106	None	None	0	In state provider	None	3752 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
5616	Fee-for-Service	1699935080	1699935080	1	1	RAPOPORT, YUL DO	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14977	13	Neurology (M.D. only)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
5619	Fee-for-Service	1962439331	1962439331	1	1	RUAN, JUAN E MD	5/12/2020	207L00000X	NA	Other	026	PHYSICIANS	161733	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
5642	Fee-for-Service	1750949624	1750949624	1	1	ROTHMAN, JOSHUA M	10/31/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182348	None	None	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
5685	Fee-for-Service	1295157394	1295157394	1	1	RAFAELLA HOSPICE INC	5/28/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3030 W OLYMPIC BLVD	SUITE 213	LOS ANGELES	CA	90006	6509	19	06037	34.05260995	-118.3015825	Los Angeles County
5697	Fee-for-Service	1104807213	1104807213	1	1	RYAN TIMOTHY J	9/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
5698	Fee-for-Service	1992981971	1992981971	1	1	RAHBAN, ALFRED MD AMC	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51095	41	Internal Medicine	0	In state provider	CORPORATION	5901 W OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
5732	Fee-for-Service	1235475484	1235475484	1	1	REEDLEY COMMUNITY HOSPITAL	6/11/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1310 HANNA AVENUE	SUITE 1 AND SUITE 3	CORCORAN	CA	93212	2334	16	06031	36.09975818	-119.5641426	Kings County
5775	Fee-for-Service	1699078030	1699078030	1	12	RIDGE EYE CARE INC	6/7/2021	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1700 BRUCE ROAD	None	CHICO	CA	95928	7384	04	06007	39.73079724	-121.787584	Butte County
5785	Fee-for-Service	1851527089	1851527089	1	1	ROSEN, ROSA S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79811	22	Pathology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
5812	Fee-for-Service	1679716658	1679716658	1	1	RATNAYAKE, KRISTIN J MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113599	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
5835	Fee-for-Service	1164447496	1164447496	1	1	ROBINSON, SHANNON K MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65714	36	Psychiatry	0	In state provider	None	4688 VISTA ST	None	SAN DIEGO	CA	92116	4847	37	06073	32.76304966	-117.1033089	San Diego County
5842	Fee-for-Service	1285632745	1285632745	1	1	ROOHANI, PEGMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 SAINT MARY PL	None	SHREVEPORT	LA	71101	4343	00	None	32.49383899	-93.7510339	Caddo Parish
5865	Fee-for-Service	1487602579	1487602579	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
5936	Fee-for-Service	1972022663	1972022663	1	1	RITTWEGER, SARA M	12/18/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
5948	Fee-for-Service	1215256086	1215256086	1	1	RAKESH KUMAR,MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1423 N JEFFERSON AVE	None	SPRINGFIELD	MO	65802	1917	00	None	37.22492991	-93.28917587	Greene County
5972	Fee-for-Service	1295157394	1295157394	1	1	RAFAELLA HOSPICE INC	5/28/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3030 W OLYMPIC BLVD	SUITE 213	LOS ANGELES	CA	90006	6509	19	06037	34.05260995	-118.3015825	Los Angeles County
5985	Fee-for-Service	1992981971	1992981971	1	1	RAHBAN, ALFRED MD AMC	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51095	45	Nephrology (Renal-Kidney)	0	In state provider	CORPORATION	5901 W OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
6002	Fee-for-Service	1699078030	1699078030	1	6	RIDGE EYE CARE INC	3/5/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5777 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.682756	-121.327839	Sacramento County
6026	Fee-for-Service	1376695775	1376695775	1	1	ROSEBILBERRY, MARCY A LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
6044	Fee-for-Service	1427531813	1427531813	1	1	REUL, EMILY J PT	7/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18231 HWY 18	3	APPLE VALLEY	CA	92307	2113	36	06071	34.54032714	-117.26611	San Bernardino County
6063	Fee-for-Service	1477698116	1477698116	1	1	RIVERA, JOHN (JUAN) R MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	655 S EUCLID AVE	STE 409	NATIONAL CITY	CA	91950	2981	37	06073	32.68353398	-117.082625	San Diego County
6064	Fee-for-Service	1699078030	1699078030	1	12	RIDGE EYE CARE INC	6/7/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 BRUCE ROAD	None	CHICO	CA	95928	7384	04	06007	39.73079724	-121.787584	Butte County
6074	Fee-for-Service	1851527089	1851527089	1	1	ROSEN, ROSA S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79811	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
6077	Fee-for-Service	1699812230	1699812230	1	1	RIVERA, JESSE J CRNA	9/22/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	286 EUCLID AVE	STE 109	SAN DIEGO	CA	92114	3611	37	06073	32.70706919	-117.0850896	San Diego County
6098	Fee-for-Service	1942400379	1942400379	1	1	RAJKUMAR, PRIYA MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127783	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
6102	Fee-for-Service	1679716658	1679716658	1	1	RATNAYAKE, KRISTIN J MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113599	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
6113	Fee-for-Service	1437193315	1437193315	2	1	REEDER, JOHN W MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	35403	40	Pediatrics	0	In state provider	None	140 LITTON DRIVE	STE 100	GRASS VALLEY	CA	95945	5078	29	06057	39.23422354	-121.0525426	Nevada County
6153	Fee-for-Service	1487602579	1487602579	1	1	REGENTS OF THE UNIVERSITY OF	9/25/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
6197	Fee-for-Service	1457409377	1457409377	1	1	RANATUNGE, BANDULA D MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64179	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
6203	Fee-for-Service	1467653485	1467653485	1	1	REGALADO, GUILLERMO A LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
6222	Fee-for-Service	1083792816	1083792816	1	1	RAY, RICHARD A MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	49842	22	Pathology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
6259	Fee-for-Service	1942292917	1942292917	1	1	RAFFI G HARTOUNIAN	5/14/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACIST APC HEART DRU	11120 WHITTIER BLVD	None	WHITTIER	CA	90606	1432	19	06037	33.98709417	-118.0598846	Los Angeles County
6292	Fee-for-Service	1699078030	1699078030	1	6	RIDGE EYE CARE INC	3/5/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5777 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.682756	-121.327839	Sacramento County
6345	Fee-for-Service	1720177306	1720177306	1	1	RAMOS, DAVID E MD INC	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
6363	Fee-for-Service	1689082232	1689082232	1	1	RIVERA, MARTHA E MD INC	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	58728	40	Pediatrics	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 3450	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
6368	Fee-for-Service	1457330797	1457330797	1	1	RITTER, JETHRO T MD	5/27/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	8407	41	Internal Medicine	0	In state provider	None	1250 PEACH STREET	SUITE M	SAN LUIS OBISPO	CA	93401	2877	40	06079	35.28647825	-120.6599674	San Luis Obispo County
6369	Fee-for-Service	1952532194	1952532194	2	1	REGIONAL PHARMACY INC.	6/7/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 JOSE FIGUERES AVE	235	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
6393	Fee-for-Service	1356380737	1356380737	1	1	RAYHAUN, ABRAHAM MD	8/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81933	14	Neurological Surgery	0	In state provider	None	2888 LONG BEACH BLVD	STE 240	LONG BEACH	CA	90806	1570	19	06037	33.809706	-118.189343	Los Angeles County
6399	Fee-for-Service	1538242383	1538242383	1	1	REIF, PAUL MD	7/7/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	31388	41	Internal Medicine	0	In state provider	None	6500 FAIRMOUNT AVE	STE 7	EL CERRITO	CA	94530	3623	07	06013	37.90115255	-122.3007746	Contra Costa County
6410	Fee-for-Service	1134213754	1134213754	1	1	ROSEN, MARK A MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62282	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVE	# 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
6433	Fee-for-Service	1205267242	1205267242	1	1	ROBY, CATHERINE M DO INC	9/16/2013	207L00000X	NA	Other	026	PHYSICIANS	12804	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
6450	Fee-for-Service	1972963114	1972963114	1	1	RUBALCAVA, CINDY V LMFT	7/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
6469	Fee-for-Service	1033257266	1033257266	1	1	RIPON UNIFIED SCHOOL	4/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	304 N ACACIA AVE	None	RIPON	CA	95366	2404	39	06077	37.7421049	-121.1284661	San Joaquin County
6538	Fee-for-Service	1013466820	1013466820	1	1	RED, JACKSON	5/10/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4701 VON KARMAN AVE STE	None	NEWPORT BEACH	CA	92660	8150	30	06059	33.66894215	-117.8600003	Orange County
6590	Fee-for-Service	1215601513	1215601513	1	1	RELY HOME HEALTH, INC	5/25/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 401	GLENDALE	CA	91331	6491	19	06037	34.14652066	-118.2549229	Los Angeles County
6598	Fee-for-Service	1326149816	1326149816	1	1	RASTAWAN, FATHEME R PT	2/22/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1751 W ROMNEYA DR	SUITE M	ANAHEIM	CA	92801	1815	30	06059	33.85068001	-117.9438835	Orange County
6608	Fee-for-Service	1568729580	1568729580	1	1	RAO, SHYAM MD	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129042	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
6630	Fee-for-Service	1972533669	1972533669	1	1	RAJPER, SALEEM MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48592	41	Internal Medicine	0	In state provider	None	1101 FELSPAR ST	None	SAN DIEGO	CA	92109	2925	37	06073	32.7987039	-117.2500974	San Diego County
6638	Fee-for-Service	1093169336	1093169336	1	1	RYBKA, MICHELLE MD	9/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156824	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
6683	Fee-for-Service	1801153572	1801153572	1	1	ROUCH, JOSHUA D MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130079	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
6762	Fee-for-Service	1548590052	1548590052	1	1	ROMO, VERONICA LCSW	12/23/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
6831	Fee-for-Service	1821485947	1821485947	1	1	RAMOS, ROSA Z LMFT	10/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
6893	Fee-for-Service	1073777249	1073777249	1	2	RAGHURAM RAO M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1291 W CAMPBELL RD	None	RICHARDSON	TX	75080	2946	00	None	32.97812649	-96.7629195	Dallas County
6902	Fee-for-Service	1265581540	1265581540	1	1	RODRIGUEZ, NITZA N DPM	5/22/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	# 110	MISSION VIEJO	CA	92691	6407	30	06059	33.55952733	-117.6645199	Orange County
6907	Fee-for-Service	1306366448	1306366448	1	1	RASHID, NAHID MD	10/23/2023	207R00000X	NA	Other	026	PHYSICIANS	190562	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
6916	Fee-for-Service	1578898037	1578898037	1	1	RICKETTS, JOANNE LMFT	9/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
6946	Fee-for-Service	1063503464	1063503464	1	1	ROYSMAN, ANNA MD	2/3/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56391	40	Pediatrics	0	In state provider	None	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	31	06061	38.93485327	-121.0988193	Placer County
6957	Fee-for-Service	1528732005	1528732005	1	1	ROLLAND, TIARA B LMFT	4/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 AZUSA CT	STE 110	RANCHO CUCAMONGA	CA	91730	4933	36	06071	34.09081588	-117.5605461	San Bernardino County
6979	Fee-for-Service	1689695447	1689695447	1	1	RIVERA, ERNESTO S MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52608	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
7007	Fee-for-Service	1871252569	1871252569	1	1	REDDING RANCHERIA	4/4/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	TAL CARE	3110 CHURN CREEK RD	None	REDDING	CA	96002	2101	45	06089	40.562235	-122.3531365	Shasta County
7021	Fee-for-Service	1194732578	1194732578	1	1	REZAPOUR, JOHN G MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77006	41	Internal Medicine	0	In state provider	None	444 S. SAN VICENTE BLVD	STE 1102	LOS ANGELES	CA	90048	4169	19	06037	34.06999878	-118.3755119	Los Angeles County
7044	Fee-for-Service	1326060401	1326060401	1	1	REDDY, KURUGANTI R MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39890	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	530 W BADILLO ST	STE B	COVINA	CA	91722	3787	19	06037	34.08625283	-117.8999625	Los Angeles County
7088	Fee-for-Service	1639168594	1639168594	1	2	REGENTS/UCDPBG/GYNECOLOG	7/3/2020	207VG0400X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
7100	Fee-for-Service	1891714374	1891714374	1	1	RUBIN, SONNY J MD	1/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76500	05	Anesthesiology	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
7116	Fee-for-Service	1699078030	1699078030	1	5	RIDGE EYE CARE INC	2/16/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	901 MAPLE AVE	None	YUBA CITY	CA	95991	3323	51	06101	39.14226664	-121.6223232	Sutter County
7176	Fee-for-Service	1699078030	1699078030	1	11	RIDGE EYE CARE INC	8/12/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2585 OROVILLE DAM BLVD.	None	OROVILLE	CA	95966	6005	04	06007	39.50622164	-121.5461263	Butte County
7177	Fee-for-Service	1609324763	1609324763	1	1	REYES, BERNADETTE B LCSW	3/25/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	349 RICHMOND ST	None	EL SEGUNDO	CA	90245	3729	19	06037	33.91991904	-118.4172874	Los Angeles County
7178	Fee-for-Service	1740514918	1740514918	1	1	REDDY, KURUGANTI A MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126246	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
7179	Fee-for-Service	1609308642	1609308642	1	1	RUSH, STEPHANY MD	2/10/2021	390200000X	NA	Other	026	PHYSICIANS	159498	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
7231	Fee-for-Service	1174822431	1174822431	1	1	RANSOM-BURR, BROOKE S LMFT	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1821 4TH STREET	None	SANTA ROSA	CA	95404	3202	49	06097	38.450619	-122.69781	Sonoma County
7236	Fee-for-Service	1063503464	1063503464	1	1	ROYSMAN, ANNA MD	2/3/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56391	01	General Practice	0	In state provider	None	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	31	06061	38.93485327	-121.0988193	Placer County
7289	Fee-for-Service	1598527020	1598527020	1	1	REBAMONTE, JUMER B	2/9/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	854 DIAMOND DR	None	CHULA VISTA	CA	91911	6718	37	06073	32.61555522	-117.0291672	San Diego County
7295	Fee-for-Service	1871252569	1871252569	1	1	REDDING RANCHERIA	4/4/2022	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	TAL CARE	3110 CHURN CREEK RD	None	REDDING	CA	96002	2101	45	06089	40.562235	-122.3531365	Shasta County
7308	Fee-for-Service	1194732578	1194732578	1	1	REZAPOUR, JOHN G MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77006	18	Ophthalmology	0	In state provider	None	444 S. SAN VICENTE BLVD	STE 1102	LOS ANGELES	CA	90048	4169	19	06037	34.06999878	-118.3755119	Los Angeles County
7333	Fee-for-Service	1326060401	1326060401	1	1	REDDY, KURUGANTI R MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39890	02	General Surgery	0	In state provider	None	530 W BADILLO ST	STE B	COVINA	CA	91722	3787	19	06037	34.08625283	-117.8999625	Los Angeles County
7342	Fee-for-Service	1396198958	1396198958	1	7	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3000 L ST	114	SACRAMENTO	CA	95816	5248	34	06067	38.570517	-121.4672175	Sacramento County
7376	Fee-for-Service	1639168594	1639168594	1	2	REGENTS/UCDPBG/GYNECOLOG	5/1/1999	207VG0400X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
7392	Fee-for-Service	1770051211	1770051211	1	1	REESE, CHELSEY C LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
7401	Fee-for-Service	1699078030	1699078030	1	5	RIDGE EYE CARE INC	2/16/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 MAPLE AVE	None	YUBA CITY	CA	95991	3323	51	06101	39.14226664	-121.6223232	Sutter County
7414	Fee-for-Service	1619295805	1619295805	1	1	RATNAM, REBECCA S MD	9/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116407	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
7434	Fee-for-Service	1699078030	1699078030	1	10	RIDGE EYE CARE INC	4/16/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1751 HARTNELL AVE.	SUITE 1	REDDING	CA	96002	2293	45	06089	40.56370348	-122.3388585	Shasta County
7463	Fee-for-Service	1699078030	1699078030	1	11	RIDGE EYE CARE INC	8/12/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2585 OROVILLE DAM BLVD.	None	OROVILLE	CA	95966	6005	04	06007	39.50622164	-121.5461263	Butte County
7477	Fee-for-Service	1639296932	1639296932	1	1	RALPHS GROCERY COMPANY	8/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #223	25539 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	5348	30	06059	33.59165246	-117.6980478	Orange County
7493	Fee-for-Service	1326286295	1326286295	1	1	RATHMANN, KELLY A LCSW	5/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1821 FOURTH ST.	None	SANTA ROSA	CA	95405	3202	49	06097	38.450619	-122.69781	Sonoma County
7520	Fee-for-Service	1528088549	1528088549	1	1	ROSOVE, MICHAEL H MD	9/11/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	26069	41	Internal Medicine	0	In state provider	None	#450,455,490,290,550,525	None	LOS ANGELES	CA	90095	0001	19	06037	0	0	None
7561	Fee-for-Service	1215927405	1215927405	1	1	ROWE, FREDERICK A MD	2/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81287	10	Gastroenterology (M.D. only)	0	In state provider	INC	5601 NORRIS CANYON RD	STE 320	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
7575	Fee-for-Service	1194852475	1194852475	1	1	RASGON, NATALIA L MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52679	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
7623	Fee-for-Service	1326060401	1326060401	1	1	REDDY, KURUGANTI R MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39890	33	Thoracic Surgery	0	In state provider	None	530 W BADILLO ST	STE B	COVINA	CA	91722	3787	19	06037	34.08625283	-117.8999625	Los Angeles County
7680	Fee-for-Service	1689753188	1689753188	1	1	RAO, SURESH P MD	2/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63778	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 560	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
7685	Fee-for-Service	1649336793	1649336793	1	1	RATTO, ROSEMARIE	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	1042 ALVARADO RD	None	BERKELEY	CA	94705	1548	01	06001	37.86163176	-122.233474	Alameda County
7723	Fee-for-Service	1699078030	1699078030	1	10	RIDGE EYE CARE INC	4/16/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1751 HARTNELL AVE.	SUITE 1	REDDING	CA	96002	2293	45	06089	40.56370348	-122.3388585	Shasta County
7730	Fee-for-Service	1093241093	1093241093	1	1	RAVAL, NEEL J MD	8/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159077	08	Family Practice	0	In state provider	None	5100 W GOLDLEAF CIR	200	LOS ANGELES	CA	90056	1658	19	06037	33.98872349	-118.3661021	Los Angeles County
7736	Fee-for-Service	1407855240	1407855240	1	23	ROCKY MOUNTAIN HOLDINGS, LLC	9/23/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	102 AIRPORT ROAD	None	GLASGOW	KY	42141	3442	00	None	37.03308311	-85.94332404	Barren County
7790	Fee-for-Service	1982615969	1982615969	1	1	ROSE, NORMAN A	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ESC PREMR EYECRE OPT INC	1299 E PENNSYLVANIA AVE	STE B	ESCONDIDO	CA	92027	3027	37	06073	33.12981856	-117.0643728	San Diego County
7814	Fee-for-Service	1750920864	1750920864	1	1	RIVERO, MICHELLE A	1/17/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	36278 MESA VISTA PL	None	YUCAIPA	CA	92399	5810	36	06071	34.00934997	-117.0131495	San Bernardino County
7820	Fee-for-Service	1568718930	1568718930	1	1	REEL, MATTHEW LCSW	8/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
7827	Fee-for-Service	1730779539	1730779539	1	1	ROSS, CANDACE LMFT	9/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 6TH ST	108	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
7833	Fee-for-Service	1346571775	1346571775	1	1	RANKIN LABORATORIES LLC	6/24/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2550 FLOWOOD DR	SUITE 301	FLOWOOD	MS	39232	9303	00	None	32.32419905	-90.10570414	Rankin County
7836	Fee-for-Service	1053596353	1053596353	1	1	RAIKANTI, ANUPAMA MD	12/12/2008	282N00000X	NA	Hospitals	026	PHYSICIANS	104139	41	Internal Medicine	0	In state provider	None	3466 MT DIABLO BLVD	C-100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
7838	Fee-for-Service	1124418835	1124418835	1	1	RICHARDSON, CASEY E MD	5/22/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168585	15	Obstetrics (D.O. only)	0	In state provider	None	1552 COFFEE RD	FL 1	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
7886	Fee-for-Service	1669448429	1669448429	1	1	ROSEN, HARRY MD	1/8/2020	207R00000X	NA	Other	026	PHYSICIANS	86604	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
7932	Fee-for-Service	1811317985	1811317985	1	1	RAI, AJIT MD	8/19/2019	207L00000X	NA	Other	026	PHYSICIANS	140621	05	Anesthesiology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
7945	Fee-for-Service	1093234460	1093234460	1	1	RUSSELL, CRYSTAL E LCSW	6/13/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
7947	Fee-for-Service	1972770626	1972770626	1	1	ROY, MONIKA MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125129	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
7948	Fee-for-Service	1255895686	1255895686	1	1	ROBERTS, MARLENE E CNP	12/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
7951	Fee-for-Service	1255845806	1255845806	1	1	RODRIGUEZ, DESIREE A LMFT	1/30/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	525 NORTH PARKER STREET	None	ORANGE	CA	92868	1323	30	06059	33.7956127	-117.8596317	Orange County
7966	Fee-for-Service	1205033461	1205033461	1	1	ROJAS, MARITZA LCSW	7/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
8011	Fee-for-Service	1336301258	1336301258	1	1	RAO, SHOBA MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116046	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
8050	Fee-for-Service	1699078030	1699078030	1	1	RIDGE EYE CARE INC	6/14/2011	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	7056 SKYWAY	None	PARADISE	CA	95969	3960	04	06007	39.76482102	-121.6183741	Butte County
8056	Fee-for-Service	1326148248	1326148248	1	1	RHINE, CHARMAINE M	3/23/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DRIVE	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
8059	Fee-for-Service	1174687032	1174687032	1	1	RAMIREZ, VIELKA B LCSW	7/3/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
8079	Fee-for-Service	1336173004	1336173004	1	1	RAND, RHONDA E MD	3/1/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	54279	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
8080	Fee-for-Service	1255338851	1255338851	1	1	ROJAS, TIRSO J MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
8101	Fee-for-Service	1750920864	1750920864	1	1	RIVERO, MICHELLE A	1/17/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	36278 MESA VISTA PL	None	YUCAIPA	CA	92399	5810	36	06071	34.00934997	-117.0131495	San Bernardino County
8122	Fee-for-Service	1124418835	1124418835	1	1	RICHARDSON, CASEY E MD	5/22/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168585	09	Gynecology (D.O. only)	0	In state provider	None	1552 COFFEE RD	FL 1	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
8134	Fee-for-Service	1699901017	1699901017	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	628 O'MEARA STREET	None	SAN DIEGO	CA	92114	6731	37	06073	32.699196	-117.0629755	San Diego County
8135	Fee-for-Service	1518928811	1518928811	1	1	RUBENSTEIN, MARTIN D MD	3/29/1995	207RX0202X	NA	Oncology	026	PHYSICIANS	34432	68	Hematology	0	In state provider	None	50 E HAMILTON AVE	STE 200	CAMPBELL	CA	95008	0251	43	06085	37.29415254	-121.948758	Santa Clara County
8138	Fee-for-Service	1417598822	1417598822	1	1	RICHIE, ANELA G LMFT	7/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	31570 RAILROAD CANYON	202	CANYON LAKE	CA	92587	9444	33	06065	33.671169	-117.2529225	Riverside County
8150	Fee-for-Service	1710902317	1710902317	1	1	RALPHS GROCERY COMPANY	11/14/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #235	659 E PALOMAR ST	None	CHULA VISTA	CA	91911	6974	37	06073	32.61438692	-117.0252474	San Diego County
8187	Fee-for-Service	1386852416	1386852416	1	1	RIVERSIDE CO REGIONAL	7/1/2005	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
8221	Fee-for-Service	1407097942	1407097942	1	1	RUTH, NADINE H	11/16/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	159592	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
8236	Fee-for-Service	1972770626	1972770626	1	1	ROY, MONIKA MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125129	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8244	Fee-for-Service	1992726434	1992726434	1	1	RODRIGUEZ, EFREN G MD	6/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52752	40	Pediatrics	0	In state provider	None	1000 S ANAHEIM BLVD	STE 201	ANAHEIM	CA	92805	5803	30	06059	33.82054594	-117.9088937	Orange County
8293	Fee-for-Service	1063446896	1063446896	1	1	RAMIREZ, JOHANNES MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64975	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 N ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
8314	Fee-for-Service	1518140540	1518140540	1	1	RIVERSIDE MEDICAL CLINIC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3987	33	06065	33.94621853	-117.3953655	Riverside County
8337	Fee-for-Service	1699078030	1699078030	1	1	RIDGE EYE CARE INC	6/14/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7056 SKYWAY	None	PARADISE	CA	95969	3960	04	06007	39.76482102	-121.6183741	Butte County
8383	Fee-for-Service	1649200817	1649200817	1	1	REARDON, LEIGH C MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94973	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	72-311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
8390	Fee-for-Service	1114105384	1114105384	1	3	RETINA ASSOCIATES OF ORANGE	6/14/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COUNTY	360 SAN MIGUEL DRIVE	SUITE 407	NEWPORT BEACH	CA	92660	7822	30	06059	33.61321911	-117.8722084	Orange County
8429	Fee-for-Service	1922085430	1922085430	1	1	ROSENBERG, SUZANNE H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
8563	Fee-for-Service	1164486973	1164486973	1	1	REDFIELD, DAVID MD	1/1/1982	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	32547	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
8566	Fee-for-Service	1114218070	1114218070	1	1	REDDY, RAJU M MD	6/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128702	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
8568	Fee-for-Service	1962495986	1962495986	1	1	REGENTS/UCDPBG/PED NEONA	5/1/1983	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
8598	Fee-for-Service	1417018045	1417018045	1	1	ROLLINS, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	855 6TH STREET BOX 661	None	LOVELOCK	NV	89419	0000	00	None	40.17659153	-118.482093	Pershing County
8603	Fee-for-Service	1093074833	1093074833	1	1	ROSE'S AGENCY HOME CARE	8/22/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	585 S. FAIRFAX AVE	None	LOS ANGELES	CA	90036	3128	19	06037	34.06506677	-118.361422	Los Angeles County
8609	Fee-for-Service	1609039288	1609039288	1	1	RANSON, DANIEL LCSW	3/21/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	549 OLD MAMMOTH RD.	SUITE 204	MAMMOTH LAKES	CA	93546	3813	26	06051	37.63801502	-118.9665687	Mono County
8621	Fee-for-Service	1447213251	1447213251	1	1	RIEL, JOHN S MD	11/1/1995	207P00000X	NA	Other	026	PHYSICIANS	79765	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
8624	Fee-for-Service	1699078030	1699078030	1	1	RIDGE EYE CARE INC	10/17/2019	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7056 SKYWAY	None	PARADISE	CA	95969	3960	04	06007	39.76482102	-121.6183741	Butte County
8626	Fee-for-Service	1083877377	1083877377	1	1	RAHGOSHAY, SOROUR MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121709	41	Internal Medicine	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
8633	Fee-for-Service	1750762027	1750762027	1	1	RODRIGUEZ, JACLYN DO	1/21/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17859	08	Family Practice	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
8655	Fee-for-Service	1588996029	1588996029	1	1	ROHDE, JESSE M DO	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13226	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
8661	Fee-for-Service	1164441960	1164441960	1	2	ROSENFELD, KENNETH E MD	10/20/2023	2084H0002X	NA	Psychiatry	026	PHYSICIANS	78614	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8682	Fee-for-Service	1861502239	1861502239	1	1	ROMERO, KAREN M MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77803	08	Family Practice	0	In state provider	None	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	24	06047	37.37992056	-120.7234222	Merced County
8688	Fee-for-Service	1174161251	1174161251	1	1	RICHARD JACOBY M.D. INC.	3/4/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
8690	Fee-for-Service	1245544659	1245544659	1	1	ROMANCHUKEVICH, N	6/24/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
8757	Fee-for-Service	1104141753	1104141753	1	1	RAY, ANNE E MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141981	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
8758	Fee-for-Service	1679713036	1679713036	1	1	ROUTT, DIALYSIS, LLC	1/25/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	665 SIERRA ROSE DR	None	RENO	NV	89511	2060	00	None	39.47367397	-119.7986339	Washoe County
8874	Fee-for-Service	1720590730	1720590730	1	1	RODRIGUEZ, VANESSA J LMFT	1/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
8913	Fee-for-Service	1083877377	1083877377	1	1	RAHGOSHAY, SOROUR MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121709	38	Geriatrics	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
8930	Fee-for-Service	1538272752	1538272752	1	1	RAHMAN, ZAKIA MD	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87903	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8960	Fee-for-Service	1427041698	1427041698	1	1	REGENTS/UCDPBG/SUR VASCU	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
8997	Fee-for-Service	1578053856	1578053856	1	1	ROLFSEN, MARK MD	4/1/2021	390200000X	NA	Other	026	PHYSICIANS	164623	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
9001	Fee-for-Service	1295435980	1295435980	1	1	REID, ELIZABETH PT	1/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
9014	Fee-for-Service	1497706741	1497706741	1	1	ROBERTSON, JAMES S MD	7/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41677	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1265 N DUTTON AVE	None	SANTA ROSA	CA	95401	7101	49	06097	38.448657	-122.7332025	Sonoma County
9027	Fee-for-Service	1568106995	1568106995	1	1	RUANO, JESSICA J NP	2/18/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	127 HOSPITAL DR	204	VALLEJO	CA	94589	2562	48	06095	38.13103371	-122.2387342	Solano County
9056	Fee-for-Service	1669437760	1669437760	1	1	ROZANSKI, JOHN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S ANDREWS AVE	None	FT LAUDERDALE	FL	33316	2510	00	None	26.102142	-80.1408645	Broward County
9063	Fee-for-Service	1497730709	1497730709	1	1	RISON,RICHARD A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61369	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 E BEVERLY BLVD	STE 206	MONTEBELLO	CA	90640	4315	19	06037	34.01556395	-118.0983878	Los Angeles County
9085	Fee-for-Service	1629616370	1629616370	1	1	ROSEWOOD HOSPICE INC	5/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18305 SHERMAN WAY	STE 15	RESEDA	CA	91335	4425	19	06037	34.20121152	-118.5319665	Los Angeles County
9150	Fee-for-Service	1447576723	1447576723	1	1	RADU-RADULESCU, RUXANDRA MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120956	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
9177	Fee-for-Service	1881848521	1881848521	1	1	RUBEN, RICHARD A MD	2/23/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175419	None	None	0	In state provider	None	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
9184	Fee-for-Service	1083656508	1083656508	1	1	RODIBAUGH, DAVID L MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	33122	None	None	0	In state provider	None	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
9213	Fee-for-Service	1285492215	1285492215	1	1	ROMERO, FABIOLA J	3/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95026391	-	NOT APPLICABLE	0	In state provider	None	4439, 4445, 4455 BURNS A	None	LOS ANGELES	CA	90029	2702	19	06037	34.0877373	-118.2910045	Los Angeles County
9249	Fee-for-Service	1427041698	1427041698	1	1	REGENTS/UCDPBG/SUR VASCU	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
9269	Fee-for-Service	1427610633	1427610633	1	1	RX BOUTIQUE PHARMACY INC	9/8/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18425 BURBANK BLVD	STE 414	TARZANA	CA	91356	2810	19	06037	34.17226853	-118.5348151	Los Angeles County
9270	Fee-for-Service	1699571489	1699571489	1	1	RAMIREZ, MARISOL BIRTH DOUL	2/21/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
9293	Fee-for-Service	1992245948	1992245948	1	1	ROSENTHAL, LIMOR	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
9298	Fee-for-Service	1669066742	1669066742	1	1	READLER, TARA C CNP	2/24/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8260 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	2662	37	06073	32.91277002	-117.1459433	San Diego County
9301	Fee-for-Service	1497706741	1497706741	1	1	ROBERTSON, JAMES S MD	7/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41677	45	Nephrology (Renal-Kidney)	0	In state provider	None	1265 N DUTTON AVE	None	SANTA ROSA	CA	95401	7101	49	06097	38.448657	-122.7332025	Sonoma County
9303	Fee-for-Service	1528041779	1528041779	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	16916 5TH STREET	None	HURON	CA	93234	0250	10	06019	36.2004513	-120.101827	Fresno County
9316	Fee-for-Service	1922015999	1922015999	1	1	RAYBURN, WILLIAM F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS NORTHEAST ALB	None	ALBUQUERQUE	NM	87131	0000	00	None	35.08771808	-106.6192188	Bernalillo County
9373	Fee-for-Service	1629616370	1629616370	1	1	ROSEWOOD HOSPICE INC	5/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18305 SHERMAN WAY	STE 15	RESEDA	CA	91335	4425	19	06037	34.20121152	-118.5319665	Los Angeles County
9377	Fee-for-Service	1831266832	1831266832	1	1	RAO, AROOR R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30037	30	Radiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
9396	Fee-for-Service	1164669420	1164669420	1	1	ROYALTY AMBULA SERV INC.	4/30/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ROYALTY AMBULA SERV INC.	3235 N SAN FERNANDO RD	BLDG #6	LOS ANGELES	CA	90065	1434	19	06037	34.11702186	-118.2478925	Los Angeles County
9481	Fee-for-Service	1770799280	1770799280	1	3	ROY SILVER MD INC	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	1414 S GRAND AVENUE	SUITE 400	LOS ANGELES	CA	90015	3078	19	06037	34.03661142	-118.2657227	Los Angeles County
9501	Fee-for-Service	1891252185	1891252185	1	1	RUSHING-HARP, KRISTINA N CNM	2/6/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
9506	Fee-for-Service	1982627956	1982627956	1	1	REID, TARA DO	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	6919	38	Geriatrics	0	In state provider	None	2255 LAKEWOOD BLVD	None	LONG BEACH	CA	90815	2507	19	06037	33.79654624	-118.1432226	Los Angeles County
9559	Fee-for-Service	1629476510	1629476510	1	1	RESTORE MEDICAL INC	4/5/2016	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2160 COURT STREET	B	REDDING	CA	96001	2544	45	06089	40.57698594	-122.3931348	Shasta County
9591	Fee-for-Service	1528041779	1528041779	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	16916 5TH STREET	None	HURON	CA	93234	0250	10	06019	36.2004513	-120.101827	Fresno County
9594	Fee-for-Service	1154736742	1154736742	1	1	RANDHAWA, GAGANDEEP K MD	12/29/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144708	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
9595	Fee-for-Service	1558566448	1558566448	1	1	RICHMOND AREA MULTI-SERVICES	10/25/2016	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1235 MISSION STREET	None	SAN FRANCISCO	CA	94103	2705	38	06075	37.77694643	-122.4137861	San Francisco County
9642	Fee-for-Service	1396701017	1396701017	1	1	ROWE, RICHARD MD	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53785	05	Anesthesiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
9643	Fee-for-Service	1619433448	1619433448	1	1	R & D HOME HEALTH CARE INC	4/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	610 S BROADWAY	STE 307	LOS ANGELES	CA	90014	1810	19	06037	34.04641145	-118.252175	Los Angeles County
9692	Fee-for-Service	1144900150	1144900150	1	1	RAINBOW KIDS URGENT CARE INC	3/15/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	.	1014 RILEY ST STE 5	None	FOLSOM	CA	95630	3264	34	06067	38.669238	-121.168476	Sacramento County
9704	Fee-for-Service	1154409258	1154409258	1	1	REDDY, SAPNA S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68345	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
9711	Fee-for-Service	1568455590	1568455590	1	2	REGENTS/UCDPBG/SUR TRAUM	4/6/2020	2086S0127X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
9723	Fee-for-Service	1578900767	1578900767	1	1	RASHID, MOIRA A MD	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133103	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94556	1639	41	06081	37.53039072	-122.2987772	San Mateo County
9772	Fee-for-Service	1831305366	1831305366	1	1	RANKIN, KATHERINE P PHD	7/17/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9773	Fee-for-Service	1770799280	1770799280	1	3	ROY SILVER MD INC	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	1414 S GRAND AVENUE	SUITE 400	LOS ANGELES	CA	90015	3078	19	06037	34.03661142	-118.2657227	Los Angeles County
9781	Fee-for-Service	1861414906	1861414906	1	1	RABINOVITCH, MARLENE MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86417	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
9791	Fee-for-Service	1982627956	1982627956	1	1	REID, TARA DO	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	6919	08	Family Practice	0	In state provider	None	2255 LAKEWOOD BLVD	None	LONG BEACH	CA	90815	2507	19	06037	33.79654624	-118.1432226	Los Angeles County
9803	Fee-for-Service	1518059773	1518059773	1	1	RISKIN, PAUL MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	71186	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
9815	Fee-for-Service	1295199479	1295199479	1	1	ROY, TAMAL MD	8/23/2019	207P00000X	NA	Other	026	PHYSICIANS	161338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
9822	Fee-for-Service	1730262189	1730262189	1	1	ROBBINS, DANIEL S PHD	9/11/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	26384 CARMEL RANCHO LN	STE 203E	CARMEL	CA	93923	8780	27	06053	36.54048966	-121.9062111	Monterey County
9823	Fee-for-Service	1326448564	1326448564	1	1	RICHARDS, WHITNEY LMFT	7/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 GELLERT BLVD.	280	DALY CITY	CA	94015	2665	41	06081	37.66608413	-122.4686507	San Mateo County
9859	Fee-for-Service	1508836594	1508836594	1	1	REITMAN, STEPHEN L MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	25924	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	5111 GARFIELD ST	STE A	LA MESA	CA	91941	5103	37	06073	32.77192525	-117.0059214	San Diego County
9865	Fee-for-Service	1821075342	1821075342	1	1	RADLAURE, MARK A	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
9877	Fee-for-Service	1528041779	1528041779	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	16916 5TH STREET	None	HURON	CA	93234	0250	10	06019	36.2004513	-120.101827	Fresno County
9881	Fee-for-Service	1801002548	1801002548	1	1	RANDOLPH, KAMALA J MD	9/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91159	40	Pediatrics	0	In state provider	None	1900 GARDEN ROAD	STE 110	MONTEREY	CA	93940	5373	27	06053	36.58681385	-121.8623548	Monterey County
9882	Fee-for-Service	1538179171	1538179171	1	1	RODRIGUEZ, PATICIA I	6/28/2005	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1047 E MARKET ST	None	LONG BEACH	CA	90805	6056	19	06037	33.85438551	-118.1798955	Los Angeles County
9923	Fee-for-Service	1538710207	1538710207	1	1	ROOS, BENJAMIN PSYD	11/28/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
9948	Fee-for-Service	1942741699	1942741699	1	1	REYES, DANIEL NP	7/26/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
9962	Fee-for-Service	1679856827	1679856827	1	2	ROSSETTI, GINA C MD	11/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118518	-	NOT APPLICABLE	0	In state provider	None	5850 S MAIN ST	RM 1017,2010,2017, 203	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
10002	Fee-for-Service	1568455590	1568455590	1	2	REGENTS/UCDPBG/SUR TRAUM	5/1/1999	2086S0127X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
10040	Fee-for-Service	1336179746	1336179746	1	1	ROBERT J. SWANGARD, M.D.,	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	655 E 11TH AVE	STE 2A	EUGENE	OR	97401	3683	00	None	44.04773134	-123.0829171	Lane County
10056	Fee-for-Service	1255365300	1255365300	1	1	ROBERTSON, TIMOTHY WAYNE	6/30/1990	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 SOLANO ST	None	CORNING	CA	96021	3433	52	06103	39.92788727	-122.1705565	Tehama County
10067	Fee-for-Service	1861414906	1861414906	1	1	RABINOVITCH, MARLENE MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86417	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
10092	Fee-for-Service	1760638795	1760638795	1	1	RANADE, AJAY N MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136351	02	General Surgery	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
10094	Fee-for-Service	1063562908	1063562908	1	1	RIBA, PATRICIA A MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72318	40	Pediatrics	0	In state provider	None	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
10121	Fee-for-Service	1609647874	1609647874	1	1	RAMOS, CHRYSTINA DOULA	4/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
10141	Fee-for-Service	1932341203	1932341203	1	1	RAMIREZ, CARLOS D MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116108	08	Family Practice	0	In state provider	None	1300 E COOLEY DRIVE	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
10144	Fee-for-Service	1326022815	1326022815	1	1	ROACH, MICHAEL B MD	6/2/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39269	20	Orthopedic Surgery	0	In state provider	None	555 E TACHEVAH DR	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
10165	Fee-for-Service	1720346398	1720346398	1	1	RODRIGUEZ, AMANDA L MD	4/22/2021	207P00000X	NA	Other	026	PHYSICIANS	171735	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
10167	Fee-for-Service	1528041779	1528041779	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	16916 5TH STREET	None	HURON	CA	93234	0250	10	06019	36.2004513	-120.101827	Fresno County
10174	Fee-for-Service	1538179171	1538179171	1	1	RODRIGUEZ, PATICIA I	8/1/2005	1041C0700X	NA	Mental Health Outpatient Services	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1047 E MARKET ST	None	LONG BEACH	CA	90805	6056	19	06037	33.85438551	-118.1798955	Los Angeles County
10184	Fee-for-Service	1366728842	1366728842	1	1	RICE, VALARIE Y LMFT	9/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2643 APPIAN WAY	STE A3	PINOLE	CA	94564	2263	07	06013	37.98860818	-122.2989385	Contra Costa County
10206	Fee-for-Service	1629817143	1629817143	1	1	ROUSSEL, BRITTANY	8/13/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	29	06057	0	0	None
10243	Fee-for-Service	1063767952	1063767952	1	1	REINERT, ANNA E MD	9/1/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161235	09	Gynecology (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
10254	Fee-for-Service	1699779074	1699779074	1	1	RONALD J HAUPTMAN MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
10319	Fee-for-Service	1225057508	1225057508	1	1	RAJFER, JACOB MD	11/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	24703	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	BLDG 66	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
10322	Fee-for-Service	1902913080	1902913080	2	1	ROBINSON, CRAIG A MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130634	None	None	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
10361	Fee-for-Service	1326060880	1326060880	1	1	ROYER, ROBERT P MD	1/1/1988	207P00000X	NA	Other	026	PHYSICIANS	58656	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
10372	Fee-for-Service	1972556710	1972556710	1	1	RATCLIFFE, ARTHUR P MD	10/12/2021	207L00000X	NA	Other	026	PHYSICIANS	157618	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
10373	Fee-for-Service	1295739845	1295739845	1	1	REINA, ROBERT IGNACIO MD	10/4/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54907	41	Internal Medicine	0	In state provider	None	13975 MONO WAY	STE G	SONORA	CA	95370	2824	55	06109	37.97831488	-120.3396851	Tuolumne County
10381	Fee-for-Service	1770552432	1770552432	1	1	RAPP, JOSEPH H MD	6/1/1993	2086S0129X	NA	General Surgery	026	PHYSICIANS	49963	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10394	Fee-for-Service	1831498393	1831498393	1	1	RYAN, MATTHEW M DO	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11577	36	Psychiatry	0	In state provider	None	1595 SOQUEL DR	STE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
10402	Fee-for-Service	1770631582	1770631582	1	1	ROSHANZAER, SHAHIN DO	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6271	66	Emergency Medicine (Urgent Care)	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
10523	Fee-for-Service	1255845806	1255845806	1	2	RODRIGUEZ, DESIREE A LMFT	5/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	970 S. VILLAGE OAKS DR.	SUITE 104D	COVINA	CA	92868	1323	19	06037	34.07190169	-117.8631545	Los Angeles County
10529	Fee-for-Service	1326195082	1326195082	1	1	REDFIELD, ROBERT R MD	3/28/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184403	None	None	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
10533	Fee-for-Service	1063767952	1063767952	1	1	REINERT, ANNA E MD	9/1/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161235	15	Obstetrics (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
10595	Fee-for-Service	1255328449	1255328449	1	1	RANDOLPH HOSPITAL	1/17/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	364 WHITE OAK ST	None	ASHEBORO	NC	27203	5400	00	None	35.711829	-79.8145965	Randolph County
10607	Fee-for-Service	1225057508	1225057508	1	1	RAJFER, JACOB MD	11/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	24703	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	BLDG 66	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
10632	Fee-for-Service	1689909756	1689909756	1	1	RAMACHANDRAN, RAGESHREE MD	2/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94042	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
10660	Fee-for-Service	1295739845	1295739845	1	1	REINA, ROBERT IGNACIO MD	10/4/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54907	01	General Practice	0	In state provider	None	13975 MONO WAY	STE G	SONORA	CA	95370	2824	55	06109	37.97831488	-120.3396851	Tuolumne County
10669	Fee-for-Service	1770552432	1770552432	1	1	RAPP, JOSEPH H MD	6/1/1993	2086S0129X	NA	General Surgery	026	PHYSICIANS	49963	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10708	Fee-for-Service	1669631743	1669631743	1	1	ROMERO, ARTHUR O MD	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
10711	Fee-for-Service	1174865349	1174865349	1	1	RIDDLE, MATTHEW K MD	6/23/2017	207P00000X	NA	Other	026	PHYSICIANS	149493	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
10714	Fee-for-Service	1730111253	1730111253	1	2	RANI, SWAROOP MD	6/10/2019	207L00000X	NA	Other	026	PHYSICIANS	50490	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
10728	Fee-for-Service	1366405342	1366405342	1	1	RENAL TREATMENT CTRS-	12/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	VACAVILLE DIALYSIS CTR	941 MERCHANT ST	None	VACAVILLE	CA	95688	5315	48	06095	38.34814705	-121.9968806	Solano County
10731	Fee-for-Service	1619460912	1619460912	1	1	REWARD PATH RECOVERY LLC	10/16/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	525 E. MAIN ST	None	SANTA PAULA	CA	93060	2606	56	06111	34.35159506	-119.0675327	Ventura County
10744	Fee-for-Service	1700103520	1700103520	1	1	ROLLINS, AISHA I MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120855	40	Pediatrics	0	In state provider	None	1041 N CHINA LAKE BLVD	STE B	RIDGECREST	CA	93555	3183	15	06029	35.63953945	-117.669891	Kern County
10794	Fee-for-Service	1578776860	1578776860	1	1	RODRIGEUZ, ROBERT L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
10867	Fee-for-Service	1518903400	1518903400	1	1	REHAB MEDICINE	9/5/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	ASSOCIATES INC	340 W EAST AVE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
10874	Fee-for-Service	1750671061	1750671061	1	1	RICALDE, TOMAS P MD	2/25/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
10884	Fee-for-Service	1528092772	1528092772	2	1	RAY J. MOEN	8/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
10929	Fee-for-Service	1649295247	1649295247	1	1	RALPHS GROCERY COMPANY	11/3/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #681	42150 WASHINGTON ST	None	BERMUDA DUNES	CA	92203	9611	33	06065	33.742143	-116.3037545	Riverside County
10969	Fee-for-Service	1033440003	1033440003	1	1	RIO BRAVO FAMILY MEDICINE	2/3/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2601 OSWELL STREET	SUITE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
10973	Fee-for-Service	1467839498	1467839498	1	1	RODRIGUEZ, ILIANA I MD	12/29/2018	207R00000X	NA	Other	026	PHYSICIANS	154762	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
10976	Fee-for-Service	1699078030	1699078030	1	4	RIDGE EYE CARE INC	3/4/2013	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 H ST	STE 4	MARYSVILLE	CA	95901	5834	58	06115	39.13837241	-121.5948806	Yuba County
11004	Fee-for-Service	1689612848	1689612848	1	1	ROSSINI, JOSEPH J MD	6/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7107	08	Family Practice	0	In state provider	None	340 W CENTRAL AVE	STE 110	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
11021	Fee-for-Service	1699211185	1699211185	1	1	RUDDY, PHILIP LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
11024	Fee-for-Service	1568924678	1568924678	1	1	ROSES, STEPHANIE M MD	7/2/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	187790	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11025	Fee-for-Service	1558560664	1558560664	1	1	ROSENBERG, OREN S MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108536	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11031	Fee-for-Service	1770596033	1770596033	1	1	RANSOM, MARK S MD	7/31/1989	207L00000X	NA	Other	026	PHYSICIANS	61882	05	Anesthesiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
11044	Fee-for-Service	1740499177	1740499177	1	1	REGENTS OF THE UNIV CA	7/1/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER-SAN DIEGO	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
11073	Fee-for-Service	1811980634	1811980634	1	1	RAMOS, CLAUDIA MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52678	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2621 S BRISTOL ST	STE 301	SANTA ANA	CA	92704	5719	30	06059	33.711876	-117.885371	Orange County
11110	Fee-for-Service	1780670323	1780670323	1	1	RICHTER,SETH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ALBANY MEDICAL COLLEGE	47 NEW SCOTLAND AVE	None	ALBANY	NY	12208	0000	00	None	42.65281106	-73.77466567	Albany County
11142	Fee-for-Service	1730745662	1730745662	1	1	RODRIGUEZ-AVILA, ILCE M CCC-	2/7/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
11163	Fee-for-Service	1942510813	1942510813	1	1	ROBERTSON, SHERRILYN PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
11186	Fee-for-Service	1295107456	1295107456	1	1	ROSENBERG, SHILO MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
11205	Fee-for-Service	1982796207	1982796207	1	1	REZVANI, FARHAD MD	11/16/2009	207R00000X	NA	Other	026	PHYSICIANS	74244	45	Nephrology (Renal-Kidney)	0	In state provider	None	158 WEST COLLEGE STREET	None	COVINA	CA	91723	2007	19	06037	34.08742904	-117.8917387	Los Angeles County
11213	Fee-for-Service	1104003920	1104003920	1	1	RIVERSTONE-HOWE, LIBBY S LCS	10/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	1775 WOODSIDE RD	STE 203	REDWOOD CITY	CA	94061	3454	41	06081	37.45382723	-122.2289725	San Mateo County
11219	Fee-for-Service	1013012368	1013012368	1	1	RUBIN, LAWRENCE I DPM	2/13/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	STE 250	GARDENA	CA	90247	4183	19	06037	33.89247044	-118.2931941	Los Angeles County
11246	Fee-for-Service	1700043361	1700043361	1	1	RAMANATHAN, ANUSHA MD	3/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115365	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
11257	Fee-for-Service	1508025628	1508025628	1	1	RICO ERB, CHRISTINE J NP	10/29/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11265	Fee-for-Service	1699078030	1699078030	1	4	RIDGE EYE CARE INC	3/4/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	320 H ST	STE 4	MARYSVILLE	CA	95901	5834	58	06115	39.13837241	-121.5948806	Yuba County
11268	Fee-for-Service	1285155234	1285155234	1	1	ROBERTS, RICHARD V MD	7/25/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	187661	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11313	Fee-for-Service	1558560664	1558560664	1	1	ROSENBERG, OREN S MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108536	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11404	Fee-for-Service	1285765107	1285765107	1	1	RUSTON LOUISIANA HOSP	6/26/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	401 E VAUGHN AVE	None	RUSTON	LA	71270	5950	00	None	32.51563565	-92.63286455	Lincoln Parish
11406	Fee-for-Service	1770799280	1770799280	1	1	ROY SILVER MD INC	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	8631 W THIRD STREET	SUITE 444E	LOS ANGELES	CA	90048	5908	19	06037	34.07361928	-118.3803143	Los Angeles County
11435	Fee-for-Service	1548306954	1548306954	1	1	ROSALES, GUSTAVO A MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41475	01	General Practice	0	In state provider	None	5385 FRANKLIN BLVD	STE K	SACRAMENTO	CA	95820	4717	34	06067	38.526282	-121.471398	Sacramento County
11440	Fee-for-Service	1528844636	1528844636	1	1	REBECCA R. BOENING, MD, INC.	1/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	263 NORTH VILLA AVENUE	None	WILLOWS	CA	95988	2607	11	06021	39.52254122	-122.2089532	Glenn County
11450	Fee-for-Service	1548406515	1548406515	1	1	ROBERTSON, CHRISTA A NP	8/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
11456	Fee-for-Service	1619488525	1619488525	1	1	RENO BEHAVIORAL HEALTHCARE H	3/31/2018	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	1	Border provider	OSPITAL, LLC	6940 SIERRA CENTER PARKW	None	RENO	NV	89511	2209	00	None	39.46326037	-119.777135	Washoe County
11491	Fee-for-Service	1982796207	1982796207	1	1	REZVANI, FARHAD MD	11/16/2009	207R00000X	NA	Other	026	PHYSICIANS	74244	41	Internal Medicine	0	In state provider	None	158 WEST COLLEGE STREET	None	COVINA	CA	91723	2007	19	06037	34.08742904	-117.8917387	Los Angeles County
11554	Fee-for-Service	1023287281	1023287281	1	1	RUFF, JENNIFER LEE PHD	7/15/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	03702	2907	10	06019	36.7382512	-119.7543688	Fresno County
11567	Fee-for-Service	1134564263	1134564263	1	1	REDDY, H KIRAN MD	2/27/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	140413	None	None	0	In state provider	None	1114 W 6TH ST STE 102	None	HANFORD	CA	93230	4902	16	06031	36.32405752	-119.662551	Kings County
11597	Fee-for-Service	1962408427	1962408427	1	1	REAVES, HAROLD E MD	1/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	33835	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90017	3985	19	06037	34.05270508	-118.2641005	Los Angeles County
11617	Fee-for-Service	1780028555	1780028555	1	1	REGNER, MICHAEL F MD	6/17/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160095	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11626	Fee-for-Service	1992893986	1992893986	1	1	RAYBIN, DANIEL M MD	5/18/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2250 HAYES ST	STE 505	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
11668	Fee-for-Service	1730561879	1730561879	1	1	RAJAEE, SEAN S MD	10/30/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	135376	20	Orthopedic Surgery	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
11672	Fee-for-Service	1659791309	1659791309	1	1	RADLER, DAVID G MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138968	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
11680	Fee-for-Service	1659799278	1659799278	1	1	ROSS, JAMES T MD	8/1/2022	208600000X	NA	General Surgery	026	PHYSICIANS	142020	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
11682	Fee-for-Service	1215660568	1215660568	1	1	ROGACHEVSKY, COURTNEY N LCSW	10/16/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
11688	Fee-for-Service	1053352302	1053352302	1	1	ROBERTSON, PATRICIA MD	1/31/1992	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36091	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# M1490	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
11692	Fee-for-Service	1285765107	1285765107	1	1	RUSTON LOUISIANA HOSP	6/26/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	401 E VAUGHN AVE	None	RUSTON	LA	71270	5950	00	None	32.51563565	-92.63286455	Lincoln Parish
11695	Fee-for-Service	1770799280	1770799280	1	1	ROY SILVER MD INC	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	8631 W THIRD STREET	SUITE 444E	LOS ANGELES	CA	90048	5908	19	06037	34.07361928	-118.3803143	Los Angeles County
11729	Fee-for-Service	1528844636	1528844636	1	1	REBECCA R. BOENING, MD, INC.	1/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	263 NORTH VILLA AVENUE	None	WILLOWS	CA	95988	2607	11	06021	39.52254122	-122.2089532	Glenn County
11737	Fee-for-Service	1669565222	1669565222	1	1	ROGERS, ERICA J MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137026	07	Dermatology	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
11738	Fee-for-Service	1205858677	1205858677	1	1	RAM, ANANT MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	38643	20	Orthopedic Surgery	0	In state provider	None	1535 W MERCED AVE	STE 207	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
11752	Fee-for-Service	1619488525	1619488525	1	1	RENO BEHAVIORAL HEALTHCARE H	3/31/2018	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	OSPITAL, LLC	6940 SIERRA CENTER PARKW	None	RENO	NV	89511	2209	00	None	39.46326037	-119.777135	Washoe County
11759	Fee-for-Service	1407905359	1407905359	1	1	RAS MEDICAL SUPPLIES INC	8/17/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1024 S LA BREA AVE	None	LOS ANGELES	CA	90019	6901	19	06037	34.05665421	-118.3455894	Los Angeles County
11771	Fee-for-Service	1093063638	1093063638	1	1	RODRIGUEZ, MARITZA LCSW	11/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
11780	Fee-for-Service	1780609776	1780609776	1	1	RAJIV NAIR, M.D.	6/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	42557 WOODWARD AVE	STE 200	BLOOMFLD HLS	MI	48304	5206	00	None	42.6002658	-83.26130526	Oakland County
11863	Fee-for-Service	1083078851	1083078851	1	1	RIGALI, SARAH M LMFT	8/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
11877	Fee-for-Service	1700464237	1700464237	1	1	REALYVASQUEZ, JOHN MD	3/19/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
11937	Fee-for-Service	1821327602	1821327602	1	1	REYNOLDS, RYLAN R CRNA	11/19/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
11951	Fee-for-Service	1407128119	1407128119	1	1	RAMOS-POBLETE, JADE L MD	7/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118032	41	Internal Medicine	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
11963	Fee-for-Service	1659497659	1659497659	1	1	RIDDER, CATHERINE A LMFT	6/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	595 E COLORADO BLVD	#618	PASADENA	CA	91101	2039	19	06037	34.14588202	-118.1380722	Los Angeles County
11965	Fee-for-Service	1447733308	1447733308	1	1	RUMI SUNRISE, LLC	9/14/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4345 ALLOTT AVENUE	None	SHERMAN OAKS	CA	91423	3813	19	06037	34.14891153	-118.4279969	Los Angeles County
11967	Fee-for-Service	1215171467	1215171467	1	1	RAHIMIAN, RAMIN MD	1/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114463	05	Anesthesiology	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
11999	Fee-for-Service	1003085218	1003085218	1	1	REYNOLDS, CECILY M MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95693	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
12006	Fee-for-Service	1548292642	1548292642	1	1	REYNOSO, RAFAEL A DC	4/9/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	928 GARDEN ST	STE 1	SANTA BARBARA	CA	93101	1432	42	06083	34.42446707	-119.6981316	Santa Barbara County
12036	Fee-for-Service	1619488525	1619488525	1	1	RENO BEHAVIORAL HEALTHCARE H	3/31/2018	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	OSPITAL, LLC	6940 SIERRA CENTER PARKW	None	RENO	NV	89511	2209	00	None	39.46326037	-119.777135	Washoe County
12055	Fee-for-Service	1174572572	1174572572	1	1	REINER, DAVID P MD	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80102	None	None	0	In state provider	None	1624 W OLIVE AVE	STE F	BURBANK	CA	91506	2459	19	06037	34.1673422	-118.3229985	Los Angeles County
12059	Fee-for-Service	1275941346	1275941346	1	1	RODRIGUEZ, CHRISTINE M G	5/12/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
12104	Fee-for-Service	1720181670	1720181670	1	1	RICE, MICHAEL M LMFT	8/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	204 W MAIN ST	SUITE 119	GRASS VALLEY	CA	95945	4710	29	06057	39.21913023	-121.0631635	Nevada County
12131	Fee-for-Service	1700560737	1700560737	1	1	ROSE MARRIAGE & FAMILY THERA	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PY, A PROFESSIONAL COPOR	1600 SHATTUCK AVE	STE 200	BERKELEY	CA	94709	1601	01	06001	37.87811709	-122.2691431	Alameda County
12133	Fee-for-Service	1568140390	1568140390	1	1	RX CENTRAL CARE PHARMACY INC	9/29/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2625 W ALAMEDA AVE	STE 110	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
12185	Fee-for-Service	1033281878	1033281878	1	1	RAUL GALVEZ-TREVINO, M.D	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
12189	Fee-for-Service	1912909474	1912909474	1	1	ROESSLER, SUSANNE	2/28/1989	207L00000X	NA	Other	026	PHYSICIANS	67195	05	Anesthesiology	0	In state provider	None	3939 J ST	STE 310	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
12190	Fee-for-Service	1912013111	1912013111	1	1	RIPARETTI, NANNETTE S PT	6/20/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
12208	Fee-for-Service	1275718397	1275718397	1	1	RAHMAN, INSHA B LCSW	8/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSI	STE 300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
12227	Fee-for-Service	1255473609	1255473609	1	1	RYAN, CHRISTOPHER M PT	5/23/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
12266	Fee-for-Service	1225142490	1225142490	1	1	ROTHSCHILD, JENNIFER G MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122785	34	Urology and Urological Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
12279	Fee-for-Service	1497148035	1497148035	1	1	RO, YOJIN K	9/22/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 WEST CERRITOS AVENUE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
12314	Fee-for-Service	1265581151	1265581151	1	1	RASMUSSEN, MARIJA	10/28/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
12329	Fee-for-Service	1932460615	1932460615	1	1	ROGERS, DARYL P	12/11/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1150 W ORANGEBURG AVE	None	MODESTO	CA	95350	4042	50	06099	37.66396236	-121.0095829	Stanislaus County
12345	Fee-for-Service	1265457592	1265457592	1	1	ROBINSON, PATRICIA F MD	7/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81469	08	Family Practice	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
12351	Fee-for-Service	1467893750	1467893750	1	1	RAINE-MUSTAIN, ZOE LMFT	12/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 RIVER STREET	SUITE 11	SANTA CRUZ	CA	95060	2748	44	06087	36.98383328	-122.0296395	Santa Cruz County
12370	Fee-for-Service	1780115642	1780115642	1	1	RIGGS, PATRICIA K	7/11/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	17290	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12383	Fee-for-Service	1326061383	1326061383	1	1	RUBINO, MICHELANGELO A DC	4/21/2014	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD	STE 4400	WHITTIER	CA	90605	1823	19	06037	33.9505367	-118.0054552	Los Angeles County
12418	Fee-for-Service	1083060487	1083060487	1	1	RENTERIA, IVETT G MD	7/2/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158338	40	Pediatrics	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
12483	Fee-for-Service	1790852713	1790852713	1	1	ROTH, ROBERT S MD	1/20/1984	207R00000X	NA	Other	026	PHYSICIANS	48505	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
12488	Fee-for-Service	1689745663	1689745663	1	1	RUIDERA, JULIUS D MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86295	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
12491	Fee-for-Service	1982041620	1982041620	1	1	RAUL TORRES DO	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 2ND AVE NE	None	JAMESTOWN	ND	58401	3373	00	None	46.91115	-98.7070725	Stutsman County
12500	Fee-for-Service	1942290382	1942290382	1	1	REMBETSKI, THOMAS E MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6554 S MCCARRAN BLVD	STE B	RENO	NV	89509	6149	00	None	39.47663442	-119.7992969	Washoe County
12506	Fee-for-Service	1003026220	1003026220	1	1	RX STAFFING AND HOME CARE	1/1/2004	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4640 MARCONI AVE	SUITE 8	SACRAMENTO	CA	95821	4355	34	06067	38.617164	-121.3560405	Sacramento County
12508	Fee-for-Service	1669575197	1669575197	1	1	REX, STEVEN OD	10/3/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	WILSHIRE EYE CARE CENTER	3442 WILSHIRE BLVD	STE 101	LOS ANGELES	CA	90010	2204	19	06037	34.06172649	-118.299546	Los Angeles County
12580	Fee-for-Service	1205836996	1205836996	1	1	ROBERTS, ARIELLA C MD	1/14/2022	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	97295	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
12588	Fee-for-Service	1053474528	1053474528	1	2	RAMIREZ, MARK A MD	12/8/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	44346	-	NOT APPLICABLE	0	In state provider	None	236 E THIRD ST	SUITE B	PERRIS	CA	92570	2260	33	06065	33.7834135	-117.224982	Riverside County
12615	Fee-for-Service	1598819898	1598819898	1	1	RITCHKEN AND FIRST	8/31/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	SIMON M RITCHKEN PTR	4282 GENESEE AVE	STE 103	SAN DIEGO	CA	92117	4961	37	06073	32.82092667	-117.1828683	San Diego County
12618	Fee-for-Service	1093706590	1093706590	1	1	RUETENIK, BRAD W DPM	8/25/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 DEVONSHIRE DR	STE F	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
12626	Fee-for-Service	1558463927	1558463927	1	1	REGENTS OF THE UNIVERSITY OF	2/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12637	Fee-for-Service	1578588174	1578588174	1	1	RALPHS GROCERY COMPANY	11/4/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPH STORE #292	1644 CLOVERFIELD BLVD	None	SANTA MONICA	CA	90404	4006	19	06037	34.02770177	-118.4729912	Los Angeles County
12658	Fee-for-Service	1679700686	1679700686	1	1	REEDY, AMARYAH S LMFT	10/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
12693	Fee-for-Service	1073586632	1073586632	1	1	REBECCA MOEN	12/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6110 S MINNESOTA AVE	None	SIOUX FALLS	SD	57108	2571	00	None	43.488918	-96.726294	Lincoln County
12761	Fee-for-Service	1861805848	1861805848	1	1	ROBERTS-KELLY, JENNIFER L DO	11/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14326	None	None	0	In state provider	None	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
12768	Fee-for-Service	1790984730	1790984730	1	1	RICO, WILFRED M M MD	12/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100750	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
12774	Fee-for-Service	1235562158	1235562158	1	2	ROHLFING, JAMES R MD	1/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151904	None	None	0	In state provider	None	200 S WELLS RD	100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
12778	Fee-for-Service	1225324148	1225324148	1	1	RENTERIA, LAURA L LMFT	5/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7121 MAGNOLIA AVE	J	RIVERSIDE	CA	92504	3805	33	06065	33.9455319	-117.4027101	Riverside County
12794	Fee-for-Service	1285816736	1285816736	1	1	RASHID, SELMA MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141458	41	Internal Medicine	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
12813	Fee-for-Service	1669551636	1669551636	1	1	RODGERS, VANCE D MD	1/1/2001	174400000X	NA	Other	026	PHYSICIANS	44433	10	Gastroenterology (M.D. only)	0	In state provider	None	1551 BISHOP ST	STE 230	SAN LUIS OBISPO	CA	93401	4661	40	06079	35.27475609	-120.6454494	San Luis Obispo County
12815	Fee-for-Service	1912054941	1912054941	1	1	RENAL TREATMENT CENTERS	4/19/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CA INC	777 S HAM LN	STE L	LODI	CA	95242	3593	39	06077	38.125224	-121.2882885	San Joaquin County
12905	Fee-for-Service	1598819898	1598819898	1	1	RITCHKEN AND FIRST	8/31/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SIMON M RITCHKEN PTR	4282 GENESEE AVE	STE 103	SAN DIEGO	CA	92117	4961	37	06073	32.82092667	-117.1828683	San Diego County
12952	Fee-for-Service	1437207404	1437207404	1	1	REYNOSO, STEFAN T MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85033	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
12957	Fee-for-Service	1568521912	1568521912	1	1	ROGERS, FRANCESCA M MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
12971	Fee-for-Service	1528732963	1528732963	1	1	RUSSELL-GOODSON, HANNAH E CN	4/25/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	M	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
12978	Fee-for-Service	1518362474	1518362474	1	1	ROSALES, ANTOLYN LMFT	3/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
13011	Fee-for-Service	1831119387	1831119387	1	1	RAZA ANWAR S MD	1/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53168	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
13027	Fee-for-Service	1679896203	1679896203	1	1	ROSSINGTON, SHAUNA LMFT	3/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
13031	Fee-for-Service	1477880177	1477880177	1	1	RUBIN, JOAN LMFT	12/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 BERKELEY PARK BLVD	SUITE 3	KENSINGTON	CA	94707	1248	07	06013	37.90004748	-122.2869388	Contra Costa County
13036	Fee-for-Service	1407855240	1407855240	1	11	ROCKY MOUNTAIN HOLDINGS, LLC	11/12/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	2755 SILVERCREEK RD	None	BULLHEAD CITY	AZ	86442	7904	00	None	35.110494	-114.553638	Mohave County
13056	Fee-for-Service	1790984730	1790984730	1	1	RICO, WILFRED M M MD	12/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100750	41	Internal Medicine	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
13100	Fee-for-Service	1669551636	1669551636	1	1	RODGERS, VANCE D MD	1/1/2001	174400000X	NA	Other	026	PHYSICIANS	44433	01	General Practice	0	In state provider	None	1551 BISHOP ST	STE 230	SAN LUIS OBISPO	CA	93401	4661	40	06079	35.27475609	-120.6454494	San Luis Obispo County
13105	Fee-for-Service	1922010941	1922010941	1	1	ROWBERRY, RONALD D MD	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68985	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
13130	Fee-for-Service	1790850238	1790850238	1	1	RELIANT RADIOLOGY	6/27/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	31	Roentgenology, Radiology (M.D. only)	0	In state provider	MEDICAL GROUP APC	14900 IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
13146	Fee-for-Service	1609806348	1609806348	1	1	RICHARD ALLEN SCOTT NP	4/25/2021	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	950 E MAIN ST	BLDG B	SOMERTON	AZ	85350	7409	00	None	32.597487	-114.7004955	Yuma County
13177	Fee-for-Service	1871671446	1871671446	1	1	ROBINSON,KELLY D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64400	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1180 N INDIAN CANYON DR	STE E321	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
13184	Fee-for-Service	1497306898	1497306898	1	1	ROSENBERG, JILL S LCSW	10/31/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17301	-	NOT APPLICABLE	0	In state provider	None	8831 VENICE BLVD	None	LOS ANGELES	CA	90034	3223	19	06037	34.03056062	-118.3863512	Los Angeles County
13192	Fee-for-Service	1801976287	1801976287	2	2	RADIOLOGY ASSOCIATES OF THE	2/22/2022	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DESERT, A MEDICAL CORPOR	1555 SPRINGFIELD DR	None	CHICO	CA	95928	6398	04	06007	39.73089101	-121.8089267	Butte County
13300	Fee-for-Service	1902008709	1902008709	1	1	RAHAL, ANDRES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DRIVE	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
13404	Fee-for-Service	1922318617	1922318617	1	1	RODRIGUEZ, RAUL DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11879	40	Pediatrics	0	In state provider	None	25845 BARTON ROAD	SUITE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
13417	Fee-for-Service	1790850238	1790850238	1	1	RELIANT RADIOLOGY	6/27/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP APC	14900 IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
13419	Fee-for-Service	1801967153	1801967153	1	1	ROMERO, ANNA NP	1/1/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
13420	Fee-for-Service	1629352455	1629352455	1	1	ROBERTSON, NICHOLAS B MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126045	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
13451	Fee-for-Service	1366410367	1366410367	1	1	REINBOLT, RUSSELL L MD	6/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
13512	Fee-for-Service	1275775447	1275775447	1	1	RAI CARE CENTERS OF NORTHERN	2/3/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA II, LLC	811 STERLING PKWY	BUILDING 11	LINCOLN	CA	95648	7329	31	06061	38.870001	-121.293621	Placer County
13551	Fee-for-Service	1043691389	1043691389	1	1	RODRIGUEZ, JOHANA MD	3/14/2024	207R00000X	NA	Other	026	PHYSICIANS	147089	None	None	0	In state provider	None	10000 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4020	19	06037	33.94833058	-118.1166411	Los Angeles County
13578	Fee-for-Service	1407944176	1407944176	1	1	RUIZVELASCO, RODOLFO MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	30119	01	General Practice	0	In state provider	None	102 MILE OF CARS WAY	None	NATIONAL CITY	CA	91950	6603	37	06073	32.66148939	-117.1033907	San Diego County
13579	Fee-for-Service	1518963016	1518963016	1	1	ROSENBLOOM, BARRY E MD	2/28/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	22745	41	Internal Medicine	0	In state provider	None	465 N ROXBURY DR	STE 100	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
13593	Fee-for-Service	1083221840	1083221840	1	1	ROUNSAVALL, BING CNP	2/14/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13303 E SOUTH ST	None	CERRITOS	CA	90703	7308	19	06037	33.85877648	-118.048464	Los Angeles County
13596	Fee-for-Service	1902393721	1902393721	1	1	RENECLE, MICHAEL MD	12/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22036	None	None	0	In state provider	None	45 CASTRO STREET	SUITE 421	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
13602	Fee-for-Service	1699928457	1699928457	1	1	RAI CARE CENTERS SO CA	9/10/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	II LLC	1536 EAST SIXTH ST	None	BEAUMONT	CA	92223	2508	33	06065	33.92947702	-116.9530826	Riverside County
13659	Fee-for-Service	1073960522	1073960522	1	1	RIVERA, JUSTIN J DPM	5/1/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	123 MARGARET LN	STE A-1	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
13673	Fee-for-Service	1164293106	1164293106	1	1	RADIANT ONCOLOGY MEDICAL GRO	6/12/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	UP	40055 BOB HOPE DR	STE. B	RANCHO MIRAGE	CA	92270	3940	33	06065	33.75735051	-116.4082747	Riverside County
13676	Fee-for-Service	1427183003	1427183003	1	1	RAHIMI, SHOLEH MD	6/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98424	41	Internal Medicine	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
13691	Fee-for-Service	1952780827	1952780827	1	1	RICHMAN, LOUIS D MD	9/23/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
13698	Fee-for-Service	1336414135	1336414135	1	1	RICE, MADIE C NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
13716	Fee-for-Service	1952373904	1952373904	1	1	RYAN, JANIS	4/1/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
13751	Fee-for-Service	1669091039	1669091039	1	1	REICHERT, ZACHARY M MD	5/16/2023	207P00000X	NA	Other	026	PHYSICIANS	184515	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
13760	Fee-for-Service	1962033894	1962033894	1	1	RUMBO, DIANA CNM	7/28/2023	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
13786	Fee-for-Service	1427248954	1427248954	1	1	RAHMAN, FAREEN S MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119896	41	Internal Medicine	0	In state provider	None	975 FAIRMONT AVENUE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
13797	Fee-for-Service	1801430939	1801430939	1	1	RUBENSTEIN, SCOTT A	4/21/2020	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	15035 E. 14TH STREET	SUITE C	SAN LEANDRO	CA	94578	1901	01	06001	37.70496067	-122.1281915	Alameda County
13803	Fee-for-Service	1851533855	1851533855	1	1	RAZAVI, BABAK MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115797	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	ROOM A 343	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
13811	Fee-for-Service	1235141441	1235141441	1	1	RONSTIN INC	4/5/2006	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7119 SEVILLE AVE	STE D	HUNTINGTON PARK	CA	90255	4997	19	06037	33.97493756	-118.2224857	Los Angeles County
13860	Fee-for-Service	1003251034	1003251034	1	1	RAMA, ASHEEN MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134193	05	Anesthesiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
13872	Fee-for-Service	1487602546	1487602546	1	1	REGENTS OF THE UNIVERSITY OF	3/14/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ATES	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
13916	Fee-for-Service	1952034811	1952034811	1	1	RESENDIZ RIOS, FAUSTINO R MD	12/1/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	MD	1101 CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
13959	Fee-for-Service	1679766075	1679766075	1	1	ROGERS, LAURA	5/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
14017	Fee-for-Service	1750752457	1750752457	1	1	RUIZ, MICAH K LMFT	3/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
14030	Fee-for-Service	1386176063	1386176063	1	1	RAYNOWSKA, JENELLE MD	1/18/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	159827	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14145	Fee-for-Service	1356336887	1356336887	1	1	RICH, JONATHAN D PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7545 IRVINE CENTER DR	STE 200	IRVINE	CA	92618	2933	30	06059	33.662781	-117.75096	Orange County
14161	Fee-for-Service	1487602546	1487602546	1	1	REGENTS OF THE UNIVERSITY OF	12/21/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ATES	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
14190	Fee-for-Service	1417059874	1417059874	1	1	REGENTS OF THE UNIVERSITY OF	4/10/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14203	Fee-for-Service	1013274380	1013274380	1	1	RICHARDS, MISTY C MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130354	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
14262	Fee-for-Service	1477530988	1477530988	1	1	RAUMER, SHEILA L MD	2/8/2015	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	40888	08	Family Practice	0	In state provider	None	130 BANDO CT	None	ALAMO	CA	94507	2681	07	06013	37.87026851	-122.0532204	Contra Costa County
14285	Fee-for-Service	1326139106	1326139106	1	1	RENWICK, BARBARA MD	7/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70305	08	Family Practice	0	In state provider	None	111 GRANT AVE	None	WINTERS	CA	95694	1617	57	06113	38.52423328	-121.973085	Yolo County
14334	Fee-for-Service	1144386137	1144386137	1	1	RICHTER, JACQUELINE M MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49286	01	General Practice	0	In state provider	None	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
14449	Fee-for-Service	1487602546	1487602546	1	1	REGENTS OF THE UNIVERSITY OF	10/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ATES	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
14458	Fee-for-Service	1235562158	1235562158	1	1	ROHLFING, JAMES R MD	5/25/2018	390200000X	NA	Other	026	PHYSICIANS	151904	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
14475	Fee-for-Service	1952742751	1952742751	1	1	RUDRARAJU, AVANTIKA MD	3/27/2024	207RS0012X	NA	Other	026	PHYSICIANS	177500	None	None	0	In state provider	None	1801 E MARCH LN	STE C310	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
14478	Fee-for-Service	1417059874	1417059874	1	1	REGENTS OF THE UNIVERSITY OF	9/1/1991	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14515	Fee-for-Service	1215474390	1215474390	1	1	RECIO, MARK NP	6/15/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
14547	Fee-for-Service	1902068059	1902068059	1	1	ROBERT E LEININGER	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 6TH ST SW	None	CANTON	OH	44710	1702	00	None	40.79684788	-81.40409211	Stark County
14549	Fee-for-Service	1912175886	1912175886	1	1	REAM, ERIC J MD	11/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
14550	Fee-for-Service	1922502103	1922502103	1	1	RAHAL, HARMAN K MD	9/23/2024	390200000X	NA	Other	026	PHYSICIANS	166800	41	Internal Medicine	0	In state provider	None	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
14572	Fee-for-Service	1952349417	1952349417	1	1	RIGGS, JOHN J OD	9/15/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7750 EL CAMINO REAL	STE P	CARLSBAD	CA	92009	8518	37	06073	33.08192042	-117.2665612	San Diego County
14580	Fee-for-Service	1629137252	1629137252	1	1	ROBINS, ERIC B MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49469	34	Urology and Urological Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
14594	Fee-for-Service	1720586175	1720586175	1	1	ROBLES, RUBEN I LMFT	12/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
14604	Fee-for-Service	1922240035	1922240035	1	2	REHABFOCUS HOME HEALTH INC	7/23/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1245 S WINCHESTER	STE 200	SAN JOSE	CA	95128	3908	43	06085	37.30286479	-121.9500795	Santa Clara County
14615	Fee-for-Service	1811048291	1811048291	1	1	REPISHTI, MALTIN MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52417	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
14627	Fee-for-Service	1508692963	1508692963	1	1	RUBIO, FABIOLA L NP	11/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
14644	Fee-for-Service	1720392442	1720392442	1	1	RALEIGH, LINDSAY A MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117841	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
14654	Fee-for-Service	1477268209	1477268209	1	1	REDWOOD CENTER STREET ONE	3/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OPCO LLC	2431 CENTER STREET	None	BAKERSFIELD	CA	93306	5105	15	06029	35.37217103	-118.963384	Kern County
14705	Fee-for-Service	1457637514	1457637514	1	1	ROGERS, PAMILA E NP	8/1/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
14734	Fee-for-Service	1487602546	1487602546	1	1	REGENTS OF THE UNIVERSITY OF	6/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ATES	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
14797	Fee-for-Service	1477709855	1477709855	1	1	RATANASEN, RUTT M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110797	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
14850	Fee-for-Service	1912435355	1912435355	1	1	RICHARDSON, JUSTICE DO	10/4/2021	207L00000X	NA	Other	026	PHYSICIANS	18689	None	None	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
14890	Fee-for-Service	1609003516	1609003516	1	1	RAM KAFLE M.D.	5/16/2016	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1245 WASHINGTON AVE	None	DETROIT LAKES	MN	56501	3905	00	None	46.80973455	-95.84572968	Becker County
14902	Fee-for-Service	1558774612	1558774612	1	1	RICKERT, CHARLES G MD	7/20/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172075	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
14945	Fee-for-Service	1073721411	1073721411	1	1	RIGGS, CATHLEEN D	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	700 A-5 REGAL RD	None	ENCINITAS	CA	92024	4620	37	06073	33.04312059	-117.2814631	San Diego County
14959	Fee-for-Service	1952306136	1952306136	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
14969	Fee-for-Service	1104026012	1104026012	1	1	ROBY, JERRAD W DO	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12308	05	Anesthesiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	9961	50	06099	37.51052943	-120.8386573	Stanislaus County
14970	Fee-for-Service	1811924434	1811924434	1	1	ROITSHTEYN, MISHA G MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51685	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
14976	Fee-for-Service	1649343187	1649343187	1	1	RANYARD, JOHN R LMFT	12/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	205 AVENIDA DEL NORTE	None	REDONDO BEACH	CA	90277	5702	19	06037	33.8183257	-118.3877982	Los Angeles County
14985	Fee-for-Service	1598850141	1598850141	1	1	REIS, BRIJIT B MD	11/22/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
14989	Fee-for-Service	1699078030	1699078030	1	16	RIDGE EYE CARE INC	2/1/2024	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	460 PLUMAS BLVD	SUITE 102	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
14996	Fee-for-Service	1578721551	1578721551	1	1	ROEN, JOSEPHINE A MD	12/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98703	40	Pediatrics	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
15008	Fee-for-Service	1730394131	1730394131	1	1	RYAN ARNOLD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
15012	Fee-for-Service	1639305519	1639305519	1	1	REID, CATHERINE S MD	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113276	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15048	Fee-for-Service	1538523758	1538523758	1	1	ROBINSON, FREESIA P DO	1/8/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	16217	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
15087	Fee-for-Service	1285833962	1285833962	1	1	ROEDEL, JOHN C LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
15106	Fee-for-Service	1053938175	1053938175	1	1	ROELOFS, KELSEY A MD	4/22/2021	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	169221	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
15124	Fee-for-Service	1730243676	1730243676	1	1	RAPHAEL, JENNY MD	1/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76422	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
15213	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	3/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
15234	Fee-for-Service	1871652503	1871652503	1	1	RUSSELL, LINDA H OD	2/17/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
15241	Fee-for-Service	1528657483	1528657483	1	1	RENAISSANCE HOME HEALTH	8/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	512 E. WILSON AVE	STE 203	GLENDALE	CA	91206	4351	19	06037	34.14813015	-118.2494202	Los Angeles County
15243	Fee-for-Service	1023299898	1023299898	1	1	RODRIGUEZ MASON, CARIDAD LM	3/12/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
15253	Fee-for-Service	1679981575	1679981575	1	1	ROSADO, JESUS MD	6/17/2022	204F00000X	NA	General Surgery	026	PHYSICIANS	179424	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
15278	Fee-for-Service	1699078030	1699078030	1	16	RIDGE EYE CARE INC	2/1/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	460 PLUMAS BLVD	SUITE 102	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
15308	Fee-for-Service	1881796811	1881796811	1	1	REGENTS OF THE UNIVERSITY OF	9/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
15328	Fee-for-Service	1326112483	1326112483	1	1	RAGAB, DINA T MD	6/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82060	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 LOMITA BLVD	STE 101	TORRANCE	CA	90505	4913	19	06037	33.81309744	-118.3448635	Los Angeles County
15372	Fee-for-Service	1134897630	1134897630	1	1	ROKAI, SHIWA OT	5/20/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
15500	Fee-for-Service	1801976287	1801976287	2	1	RADIOLOGY ASSOCIATES OF THE	2/22/2022	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DESERT, A MEDICAL CORPOR	44227 MONTEREY AVE	None	PALM DESERT	CA	92270	1056	33	06065	33.727239	-116.391279	Riverside County
15501	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	11/21/2024	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
15512	Fee-for-Service	1174772032	1174772032	1	2	RESPICARE INC	8/18/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5470 SPRUCE AVE	STE 104	FRESNO	CA	93722	2115	10	06019	36.83857109	-119.890315	Fresno County
15526	Fee-for-Service	1073689303	1073689303	1	1	RODRIGUEZ, CARLOS MA OTR	6/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
15535	Fee-for-Service	1972970432	1972970432	1	1	RICHESON, CHELSEY	2/24/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
15545	Fee-for-Service	1538142021	1538142021	1	1	RING, ROBERT MD III	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	24774	30	Radiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
15562	Fee-for-Service	1447781414	1447781414	1	1	ROSSER, CASEY L MD	10/11/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172666	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
15565	Fee-for-Service	1558525378	1558525378	1	1	RAO, USHA S MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117090	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	#4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
15577	Fee-for-Service	1336335157	1336335157	1	1	RUNGE, NATASCHA M MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
15697	Fee-for-Service	1376767624	1376767624	1	1	RICHARDSON, SARA E	7/15/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HIGHW	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
15698	Fee-for-Service	1255106522	1255106522	1	1	ROGERS, JULIA	8/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
15704	Fee-for-Service	1841483609	1841483609	1	1	RIZVI, AMNA A MD	8/2/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	101920	41	Internal Medicine	0	In state provider	None	1335 CYPRESS ST	STE 205	SAN DIMAS	CA	91773	3539	19	06037	34.09583252	-117.834134	Los Angeles County
15708	Fee-for-Service	1225213655	1225213655	1	1	REGENTS OF THE UNIVERSIT	5/13/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	Y OF CALIFORNIA UCSD DEP	8929 UNIVERSITY CTR LN	STE 101	SAN DIEGO	CA	92122	1007	37	06073	32.87036657	-117.2263573	San Diego County
15710	Fee-for-Service	1962601054	1962601054	1	1	RASHEED, AMY E LMFT	11/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
15723	Fee-for-Service	1548829799	1548829799	1	1	RAJESHUNI, NITYA MD	9/14/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	189781	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
15783	Fee-for-Service	1407802119	1407802119	1	1	RAPP, KADISHA B MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132495	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
15787	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	1/3/2022	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
15791	Fee-for-Service	1225050214	1225050214	1	1	RIVERA, SETH	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72432	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
15798	Fee-for-Service	1073777249	1073777249	1	3	RAGHURAM RAO M.D.	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 W BELT LINE RD	None	DESOTO	TX	75115	4907	00	None	32.58968548	-96.8758875	Dallas County
15828	Fee-for-Service	1184982027	1184982027	1	1	REXACH, JESSICA E MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130353	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
15844	Fee-for-Service	1952443061	1952443061	1	1	ROCKSON, STANLEY G MD	5/31/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60999	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
15885	Fee-for-Service	1063964641	1063964641	1	1	ROYAL LIVING HOME, INC	12/20/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	321 ROYAL AVE	None	SIMI VALLEY	CA	93065	4129	56	06111	34.26443346	-118.791414	Ventura County
15928	Fee-for-Service	1720183833	1720183833	2	1	ROEHRIG, GINGER A H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71287	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
15995	Fee-for-Service	1841483609	1841483609	1	1	RIZVI, AMNA A MD	8/2/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	101920	45	Nephrology (Renal-Kidney)	0	In state provider	None	1335 CYPRESS ST	STE 205	SAN DIMAS	CA	91773	3539	19	06037	34.09583252	-117.834134	Los Angeles County
16029	Fee-for-Service	1467985143	1467985143	1	1	RUKSTELO, ALEXANDRA M DO	3/23/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20612	None	None	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
16069	Fee-for-Service	1538152541	1538152541	1	1	REGENTS/UCDPBG/PED PULM	1/12/2023	2080P0214X	NA	Pulmonology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
16077	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	1/26/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
16078	Fee-for-Service	1306199153	1306199153	1	1	ROBINSON, TAMIRA E NP	8/22/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
16088	Fee-for-Service	1417192782	1417192782	1	1	RHO, AMBER C	4/14/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
16091	Fee-for-Service	1982679585	1982679585	1	1	RAMI, PARAG M MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102453	30	Radiology	0	In state provider	None	16506 LAKEWOOD BLVD	STE 200	BELLFLOWER	CA	90706	5123	19	06037	33.88470916	-118.1424401	Los Angeles County
16106	Fee-for-Service	1093965279	1093965279	1	1	RIVERA, JESSICA H LMFT	6/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
16145	Fee-for-Service	1942444849	1942444849	1	1	RAMIREZ, AIRISHA P MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120725	08	Family Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
16153	Fee-for-Service	1417191537	1417191537	1	1	ROUPEN YAGHSEZIAN MD INC	8/30/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1159 POMONA ROAD UNIT E	SUITE 1	CORONA	CA	92882	6926	33	06065	33.8837786	-117.5834846	Riverside County
16165	Fee-for-Service	1639606130	1639606130	1	1	ROGERS, MATTHEW W MD	3/4/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18400	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
16212	Fee-for-Service	1942658034	1942658034	1	2	RAJU, MINA DO INC	2/3/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
16216	Fee-for-Service	1275612715	1275612715	1	1	REYES, SUSAN W LMFT	3/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2039 1/2 MONTROSE AVE	None	MONTROSE	CA	91020	1666	19	06037	34.20590391	-118.2247902	Los Angeles County
16221	Fee-for-Service	1043260540	1043260540	1	1	REDDY, GEETHA R MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63321	08	Family Practice	0	In state provider	None	12401 HESPERIA RD	None	VICTORVILLE	CA	92395	7707	36	06071	34.4771995	-117.2911483	San Bernardino County
16249	Fee-for-Service	1427085281	1427085281	1	1	REESE A VERNER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3399 E LOUISE DR	STE 400	MERIDIAN	ID	83642	5047	00	None	43.601373	-116.352495	Ada County
16289	Fee-for-Service	1316028806	1316028806	1	1	RUIZ, JAMES A MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63137	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
16301	Fee-for-Service	1023295748	1023295748	1	1	RAYAS, PENELOPE LMFT	4/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
16348	Fee-for-Service	1235125634	1235125634	1	1	RAVESSOUD, FERNANDO A MD	1/1/1990	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34999	20	Orthopedic Surgery	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1553	19	06037	33.809706	-118.189343	Los Angeles County
16350	Fee-for-Service	1164757605	1164757605	1	1	ROGERS, TIMOTHY LMFT	10/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
16359	Fee-for-Service	1538152541	1538152541	1	1	REGENTS/UCDPBG/PED PULM	5/1/1983	2080P0214X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
16363	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	1/1/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
16393	Fee-for-Service	1619920006	1619920006	1	1	ROBINS, JON M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	12717	30	Radiology	0	In state provider	None	25405 HANCOCK AVE	STE 107	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
16413	Fee-for-Service	1124312475	1124312475	1	1	REISIAN, NILOUFAR MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119241	90	Pathology-Forensic	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
16414	Fee-for-Service	1043228661	1043228661	1	1	RODRIGUEZ, JOSE M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80303	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
16417	Fee-for-Service	1720410582	1720410582	1	1	RABER, DUSTIN A MD INC	12/28/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94854	01	General Practice	0	In state provider	None	870 W 7TH ST	None	HANFORD	CA	93230	4926	16	06031	36.32522548	-119.6583345	Kings County
16424	Fee-for-Service	1366934663	1366934663	1	1	ROYAL CONGREGATE LIVING, LLC	5/8/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7354 DE SOTO AVENUE	None	CANOGA PARK	CA	91303	1703	19	06037	34.20432	-118.588434	Los Angeles County
16432	Fee-for-Service	1295773505	1295773505	1	1	RYAN CLIFFORD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 S 5TH ST	None	DOUGLAS	WY	82633	2434	00	None	42.75895693	-105.3812254	Converse County
16444	Fee-for-Service	1437157914	1437157914	1	1	ROBINSON, KENNETH L MD	5/1/1995	207P00000X	NA	Other	026	PHYSICIANS	29889	01	General Practice	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
16465	Fee-for-Service	1932657103	1932657103	1	1	RESTORE MEDICAL INC.	3/9/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 MASON ST	SUITE 115	VACAVILLE	CA	95688	4647	48	06095	38.35504697	-121.983852	Solano County
16516	Fee-for-Service	1225661796	1225661796	1	1	ROCCO PHARMACY INC	3/13/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1491 E LA PALMA AVE	SUITE A	ANAHEIM	CA	92805	1564	30	06059	33.84730519	-117.8982466	Orange County
16521	Fee-for-Service	1750029617	1750029617	1	1	RAMOS, ASHLEY LMFT	8/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
16558	Fee-for-Service	1952547440	1952547440	1	1	RADU, CINDERELLA C MD	10/13/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	145467	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
16579	Fee-for-Service	1417984931	1417984931	1	1	RAEBER, KIRK DO	11/30/1995	207P00000X	NA	Other	026	PHYSICIANS	4463	66	Emergency Medicine (Urgent Care)	0	In state provider	None	492 3RD AVE	STE 105	CHULA VISTA	CA	91910	4614	37	06073	32.63490965	-117.0774465	San Diego County
16587	Fee-for-Service	1821870833	1821870833	1	1	ROWLANDS, KRYSTLE NP	3/15/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16652	Fee-for-Service	1538143029	1538143029	1	1	RABE, MARIA C MD	9/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89611	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
16653	Fee-for-Service	1215917810	1215917810	1	1	REGENTS OF THE UNIV CA	4/12/2022	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
16676	Fee-for-Service	1114022076	1114022076	1	1	ROBERTS, SUZANNE MD	1/10/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63849	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
16685	Fee-for-Service	1902526189	1902526189	1	1	ROSS-HOLLAND, JOHAN OT	2/7/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	848 LANCASTER BLVD	STE 102	LANCASTER	CA	93534	2347	19	06037	34.69727236	-118.1462398	Los Angeles County
16696	Fee-for-Service	1477506822	1477506822	1	1	REICHER, MURRAY MD	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48038	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
16706	Fee-for-Service	1528019536	1528019536	1	1	ROBERTSON, JOHN A MD	5/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	54428	41	Internal Medicine	0	In state provider	None	4361 LATHAM ST	STE 150	RIVERSIDE	CA	92501	1768	33	06065	34.00212634	-117.3743133	Riverside County
16726	Fee-for-Service	1295977957	1295977957	1	1	RAGSDALE, MARY I MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130408	20	Orthopedic Surgery	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
16736	Fee-for-Service	1669553970	1669553970	1	1	RAVI PANJABI INC	6/20/2024	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	EHAB MEDICAL GROUP	3160 CASTRO VALLEY BLVD	SUITE A	CASTRO VALLEY	CA	94546	5565	01	06001	37.69558946	-122.0802885	Alameda County
16764	Fee-for-Service	1407855240	1407855240	1	18	ROCKY MOUNTAIN HOLDINGS, LLC	4/27/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1001 W MINGUS AVE	BLDG O	COTTONWOOD	AZ	86326	4092	00	None	34.734618	-112.0395735	Yavapai County
16806	Fee-for-Service	1902023773	1902023773	1	1	ROSS BRIGHAM DASTRUP, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CITY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
16834	Fee-for-Service	1265624167	1265624167	1	1	RUTLEDGE, MICHAEL R MD	6/5/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	166106	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	292 EUCLID AVENUE	SUITE 210	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
16870	Fee-for-Service	1861976243	1861976243	1	1	RAPPAPORT, KELLY M RCP	11/2/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
16910	Fee-for-Service	1912084856	1912084856	1	1	REITMAN, RICHARD E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39723	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
16926	Fee-for-Service	1073695094	1073695094	1	1	RUIZ, JAIME A MD	6/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80442	40	Pediatrics	0	In state provider	None	2340 CLAY ST	STE 300	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
16950	Fee-for-Service	1841957800	1841957800	1	1	RUZIC, SOPHIE PSYD	6/30/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
16955	Fee-for-Service	1194892091	1194892091	1	1	RICHARDS, DOUGLAS C MD	8/21/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69578	01	General Practice	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
16971	Fee-for-Service	1033479282	1033479282	1	1	RAWSON, ROBIN A MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107715	22	Pathology (M.D. only)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
16991	Fee-for-Service	1528019536	1528019536	1	1	ROBERTSON, JOHN A MD	5/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	54428	45	Nephrology (Renal-Kidney)	0	In state provider	None	4361 LATHAM ST	STE 150	RIVERSIDE	CA	92501	1768	33	06065	34.00212634	-117.3743133	Riverside County
16998	Fee-for-Service	1336368331	1336368331	1	1	RUDENBERG, MURRAY B PHD	12/4/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2423 CAMINO DEL RIO S	SUITE 101	SAN DIEGO	CA	92108	3702	37	06073	32.76759179	-117.1387533	San Diego County
17013	Fee-for-Service	1518963958	1518963958	1	1	ROBLES, ROBERT L MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64631	41	Internal Medicine	0	In state provider	SFGH MEDICAL GROUP	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
17048	Fee-for-Service	1295725448	1295725448	1	1	RETINA & VITREOUS CENTER	12/5/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	1	Border provider	OF SOUTHERN OREGON, PC	246 CATALINA DR	STE 1	ASHLAND	OR	97520	1624	00	None	42.20502036	-122.7240515	Jackson County
17076	Fee-for-Service	1194767988	1194767988	1	1	RUO, WINNIE Y MD	3/7/2022	207L00000X	NA	Other	026	PHYSICIANS	127748	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
17086	Fee-for-Service	1386821460	1386821460	1	1	ROUGH, STEVEN J	9/11/2013	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	124001	None	None	0	In state provider	None	1615 SWEETWATER RD	SUITE D	NATIONAL CITY	CA	91950	7655	37	06073	32.6613311	-117.0829803	San Diego County
17095	Fee-for-Service	1316148836	1316148836	1	1	ROSENFELD,JUSTIN E MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	0000	00	None	44.933211	-123.0355125	Marion County
17104	Fee-for-Service	1083639686	1083639686	1	1	RALPHS GROCERY COMPANY	12/10/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #118	23801 WASHINGTON AVE	None	MURRIETA	CA	92562	2264	33	06065	33.57158313	-117.2336685	Riverside County
17112	Fee-for-Service	1114032208	1114032208	1	2	ROMERO, JESUSA N MD APC	10/4/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34299	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7136 PACIFIC BLVD	STE 225	HUNTINGTON PARK	CA	90255	4767	19	06037	33.97474083	-118.2251149	Los Angeles County
17130	Fee-for-Service	1326054594	1326054594	1	1	RAO, SHANTI MD	4/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53815	40	Pediatrics	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
17136	Fee-for-Service	1073523916	1073523916	1	1	REDDY, MANTHANI P MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	49497	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
17212	Fee-for-Service	1568562684	1568562684	1	1	RODRIGUEZ, MIGUEL A MD	9/30/1995	193400000X	NA	Other	026	PHYSICIANS	81285	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
17238	Fee-for-Service	1164468658	1164468658	1	1	REDDING ENT HEAD AND NECK	10/7/1985	193400000X	NA	Other	026	PHYSICIANS	42026	04	Otology, Laryngology, Rhinology	0	In state provider	SURGERY INC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
17243	Fee-for-Service	1407812449	1407812449	1	1	RADIN, MICHAEL M MD	1/1/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56739	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1300 N VERMONT AVE	# 610	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
17253	Fee-for-Service	1912590597	1912590597	1	3	RSN TRANSPORTATION SERVICES	9/24/2024	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1181 GREENFIELD DR	None	EL CAJON	CA	92021	3315	37	06073	32.81331421	-116.9408356	San Diego County
17258	Fee-for-Service	1184611220	1184611220	1	1	RINGER, MICHAEL J MD	1/31/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51823	41	Internal Medicine	0	In state provider	None	3808 W RIVERSIDE DR	STE 506	BURBANK	CA	91505	4325	19	06037	34.15252315	-118.3412174	Los Angeles County
17259	Fee-for-Service	1699969121	1699969121	1	1	ROSE, CASSONDRA M LMFT	4/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
17263	Fee-for-Service	1891770798	1891770798	1	1	ROBINSON, SETH P MD	12/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87048	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
17267	Fee-for-Service	1184948119	1184948119	1	1	RAHI, GAGANDEEP S MD	5/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111097	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2106	50	06099	37.51052943	-120.8386573	Stanislaus County
17304	Fee-for-Service	1518963958	1518963958	1	1	ROBLES, ROBERT L MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64631	78	Neoplastic Diseases/Oncology	0	In state provider	SFGH MEDICAL GROUP	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
17329	Fee-for-Service	1063998557	1063998557	1	1	ROBBINS, CHLOE	3/28/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
17332	Fee-for-Service	1720231632	1720231632	1	1	RODRIGUEZ, PAOLA G MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112285	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
17334	Fee-for-Service	1346278116	1346278116	1	1	RUDAS, ROBERT J MD	3/31/1980	207P00000X	NA	Other	026	PHYSICIANS	38302	08	Family Practice	0	In state provider	None	1617 BROADWAY ST	None	VALLEJO	CA	94590	2406	48	06095	38.12454745	-122.2499877	Solano County
17371	Fee-for-Service	1730286600	1730286600	1	1	RANCHO MIRAGE PAIN ASSOC	11/15/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	39300 BOB HOPE DR	BANNAN BLDG STE 1203	RANCHO MIRAGE	CA	92270	3203	33	06065	33.764175	-116.401977	Riverside County
17424	Fee-for-Service	1073523916	1073523916	1	1	REDDY, MANTHANI P MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	49497	77	Infectious Disease	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
17435	Fee-for-Service	1295901072	1295901072	1	1	REETZ, HEIDI J MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	111001	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
17471	Fee-for-Service	1841261849	1841261849	1	1	REICH, HARVEY M MD	7/11/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70445	40	Pediatrics	0	In state provider	None	3444 KEARNY VILLA RD	STE 206	SAN DIEGO	CA	92123	1960	37	06073	32.80561721	-117.150059	San Diego County
17499	Fee-for-Service	1396802245	1396802245	1	1	REIMERS, PAUL L OD	1/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5600 STONERIDGE DR	None	PLEASANTON	CA	94588	8501	01	06001	37.68867756	-121.8852934	Alameda County
17509	Fee-for-Service	1245286426	1245286426	1	1	REIFENBERG, JOHN J DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
17525	Fee-for-Service	1235380437	1235380437	1	1	RICKS, KYNAN A MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112535	None	None	0	In state provider	None	6655 ALVARADO ROAD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
17526	Fee-for-Service	1407812449	1407812449	1	1	RADIN, MICHAEL M MD	1/1/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56739	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	# 610	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
17528	Fee-for-Service	1164468658	1164468658	1	1	REDDING ENT HEAD AND NECK	10/7/1985	193400000X	NA	Other	026	PHYSICIANS	42026	01	General Practice	0	In state provider	SURGERY INC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
17551	Fee-for-Service	1891770798	1891770798	1	1	ROBINSON, SETH P MD	12/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87048	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
17574	Fee-for-Service	1083764708	1083764708	1	1	RYPINS, ERIC MD APC	2/9/2010	174400000X	NA	Other	026	PHYSICIANS	47250	02	General Surgery	0	In state provider	None	161 THUNDER DR	STE 210	VISTA	CA	92083	6052	37	06073	33.18638925	-117.2882216	San Diego County
17649	Fee-for-Service	1033268016	1033268016	1	1	ROEBUCK, RODNEY W OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
17673	Fee-for-Service	1790436269	1790436269	1	2	REDWOOD COMMUNITY PHARMACY,	7/22/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1567 CITY CENTER RD.	None	MCKINLEYVILLE	CA	95519	3600	12	06023	40.94311258	-124.1035874	Humboldt County
17713	Fee-for-Service	1073523916	1073523916	1	1	REDDY, MANTHANI P MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	49497	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
17747	Fee-for-Service	1720475379	1720475379	1	1	REZVANI, DIANA C DO	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13868	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
17774	Fee-for-Service	1255427324	1255427324	2	1	RANDOLPH, LINDA M MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	56326	01	General Practice	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
17780	Fee-for-Service	1427067735	1427067735	1	1	RYAN, MINHUEY C MD	2/4/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105887	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	0000	48	06095	38.38851772	-121.9382798	Solano County
17792	Fee-for-Service	1063437556	1063437556	1	1	RICHMAN, NEIL M MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84884	20	Orthopedic Surgery	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
17805	Fee-for-Service	1104864875	1104864875	1	1	RICHLING,STEPHANIE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
17817	Fee-for-Service	1164468658	1164468658	1	1	REDDING ENT HEAD AND NECK	10/7/1985	193400000X	NA	Other	026	PHYSICIANS	42026	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	SURGERY INC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
17839	Fee-for-Service	1336645514	1336645514	1	1	ROGAWSKI, DAVID S MD	6/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	166836	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
17844	Fee-for-Service	1750387692	1750387692	1	2	ROTHFELD, JOEL M	1/1/1994	2084N0400X	NA	Neurology	026	PHYSICIANS	73166	13	Neurology (M.D. only)	0	In state provider	None	120 INDEPENDENCE CIR	STE G	CHICO	CA	95973	4925	04	06007	39.77238185	-121.8739834	Butte County
17868	Fee-for-Service	1962433821	1962433821	1	1	RICHARDS, ILENE CRNA	8/24/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
17892	Fee-for-Service	1306905518	1306905518	1	1	RIVER CITY RECOVERY CENTER,	3/25/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	12490 ALTA MESA ROAD	None	HERALD	CA	95638	8409	34	06067	38.300265	-121.229739	Sacramento County
17899	Fee-for-Service	1225741051	1225741051	1	1	RANTAEL, BRIAN C	7/9/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
17907	Fee-for-Service	1033317094	1033317094	1	1	RITTER, BETHANY	9/26/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
17914	Fee-for-Service	1497425839	1497425839	1	1	ROBINSON, ALLAN CPO	4/15/2024	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2175 WINCHESTER BLVD	None	CAMPBELL	CA	95008	3425	43	06085	37.28380271	-121.9498552	Santa Clara County
17920	Fee-for-Service	1699866640	1699866640	1	1	ROSENBAUM, ARIEH L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66584	41	Internal Medicine	0	In state provider	None	CASTRO & DUBOCE STS	None	SAN FRANCISCO	CA	94114	0000	38	06075	37.769049	-122.43582	San Francisco County
17941	Fee-for-Service	1972631356	1972631356	1	1	ROUBINIAN, NAREG H MD	10/30/2007	207R00000X	NA	Other	026	PHYSICIANS	101503	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17981	Fee-for-Service	1215072079	1215072079	1	1	REEVES, CLARENCE A JR MD	2/18/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32653	None	None	0	In state provider	None	2438 E PONDEROSA DR	None	CAMARILLO	CA	93010	4724	56	06111	34.22423486	-119.0363019	Ventura County
17990	Fee-for-Service	1003443664	1003443664	1	1	ROSEKRANS, SAMANTHA MD	10/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186110	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
17995	Fee-for-Service	1013180926	1013180926	1	1	RANDALL, FRANK MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112905	36	Psychiatry	0	In state provider	None	1686 BARTON RD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
18069	Fee-for-Service	1083071195	1083071195	1	1	RODRIGUEZ, CANDITA A NP	11/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18087	Fee-for-Service	1730109331	1730109331	1	1	RIBAS, ANTONI MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76097	78	Neoplastic Diseases/Oncology	0	In state provider	None	#450,455,490,290,550,525	None	LOS ANGELES	CA	90095	0001	19	06037	0	0	None
18131	Fee-for-Service	1831277318	1831277318	1	1	RENEKE, JOHANNA E MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	83585	22	Pathology (M.D. only)	0	In state provider	None	1725 EASTSHORE HIGHWAY	None	BERKELEY	CA	94710	1703	01	06001	37.87082044	-122.3045752	Alameda County
18138	Fee-for-Service	1740486190	1740486190	1	1	REYNOLDS, MICHELE D MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105224	05	Anesthesiology	0	In state provider	None	430 W NAPA STREET	SUITE F	SONOMA	CA	95476	6545	49	06097	38.29277271	-122.4663379	Sonoma County
18169	Fee-for-Service	1356512875	1356512875	1	1	RAEL, EFREN L MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136159	03	Allergy	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
18171	Fee-for-Service	1770524761	1770524761	1	1	RICHMOND, NANCY M NP	12/15/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	645191	-	NOT APPLICABLE	0	In state provider	None	1920 MARENGO STREET	None	LOS ANGELES	CA	90033	1317	19	06037	34.05751768	-118.2095235	Los Angeles County
18172	Fee-for-Service	1730404344	1730404344	1	2	ROJAS, RENAN A MD	11/13/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	149345	-	NOT APPLICABLE	0	In state provider	None	4141 PACIFIC HWY	None	SAN DIEGO	CA	92110	2030	37	06073	32.7444541	-117.1921543	San Diego County
18173	Fee-for-Service	1417031063	1417031063	1	1	ROBERTO LOPEZ	6/6/2016	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 SOUTH 5TH STREET	None	EL CENTRO	CA	92243	3012	13	06025	32.7915915	-115.5546533	Imperial County
18206	Fee-for-Service	1306082920	1306082920	1	1	ROBATEAU, YOLA A	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1404 VIA PALERMO	None	MONTEBELLO	CA	90640	1834	19	06037	34.03205745	-118.1144881	Los Angeles County
18230	Fee-for-Service	1972631356	1972631356	1	1	ROUBINIAN, NAREG H MD	10/30/2007	207R00000X	NA	Other	026	PHYSICIANS	101503	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18238	Fee-for-Service	1225457211	1225457211	1	1	ROMBAOA, CHRISTOPHER M MD	9/2/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	138657	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
18247	Fee-for-Service	1083259535	1083259535	1	1	ROBERTSON, ANGELICA CSW	6/13/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
18309	Fee-for-Service	1073566717	1073566717	1	1	RANDALL, ROBERT L MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	78312	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
18341	Fee-for-Service	1700879848	1700879848	1	1	RANDALL HENDERSON	11/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1314 N BRAZOS ST	None	WHITNEY	TX	76692	2010	00	None	31.96410998	-97.32428819	Hill County
18365	Fee-for-Service	1679654164	1679654164	1	1	RAPHAEL, LAWRENCE D MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	33789	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
18369	Fee-for-Service	1770661357	1770661357	1	1	RYBIY, SERGIY Y MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88066	25	Physical Medicine and Rehabilitation	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
18370	Fee-for-Service	1730109331	1730109331	1	1	RIBAS, ANTONI MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76097	68	Hematology	0	In state provider	None	#450,455,490,290,550,525	None	LOS ANGELES	CA	90095	0001	19	06037	0	0	None
18383	Fee-for-Service	1407855240	1407855240	1	10	ROCKY MOUNTAIN HOLDINGS, LLC	8/27/2017	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	401 BOYLE STREET	STE 202	SOMERSET	KY	42503	2850	00	None	37.0858237	-84.62245656	Pulaski County
18390	Fee-for-Service	1003295494	1003295494	1	1	ROSEN, HEATHER R PHD	7/31/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
18401	Fee-for-Service	1598516759	1598516759	1	1	ROBBINS, DEIRDRE DOULA	6/3/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
18424	Fee-for-Service	1851440713	1851440713	1	1	RUPRECHT, PHILLIP K	6/30/1992	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1933 CENTRAL AVE	STE A	MCKINLEYVILLE	CA	95519	3668	12	06023	40.940424	-124.1009345	Humboldt County
18439	Fee-for-Service	1861951998	1861951998	1	1	RAGHAVAN, GOVIND MD	6/28/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180655	None	None	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
18455	Fee-for-Service	1356512875	1356512875	1	1	RAEL, EFREN L MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136159	41	Internal Medicine	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
18480	Fee-for-Service	1255751822	1255751822	1	1	RADLER, IRIS A MD	2/27/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156191	15	Obstetrics (D.O. only)	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
18482	Fee-for-Service	1992021273	1992021273	1	1	RYU, JUBIN W MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118428	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18496	Fee-for-Service	1861965352	1861965352	1	1	ROBERTS, SUSAN L CNM	7/1/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
18541	Fee-for-Service	1659435741	1659435741	1	1	ROCKNEY, LYNN ROSANNE MD	2/28/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61926	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
18551	Fee-for-Service	1619052586	1619052586	1	1	RADPARVAR, MICHAEL H MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88567	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
18555	Fee-for-Service	1114122009	1114122009	1	1	ROSHAL, MARA A LCSW	8/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
18578	Fee-for-Service	1538815105	1538815105	1	1	ROMULO L & NOELIA M GARCIA	6/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2800 COTTAGE DR	None	CORONA	CA	92881	3634	33	06065	33.83711762	-117.5409189	Riverside County
18597	Fee-for-Service	1366691842	1366691842	1	1	RETTINGER, SARAH R MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88064	67	Endocrinology	0	In state provider	None	725 W LA VETA AVE	STE 220	ORANGE	CA	92886	4446	30	06059	33.78063949	-117.8603285	Orange County
18598	Fee-for-Service	1073566717	1073566717	1	1	RANDALL, ROBERT L MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	78312	78	Neoplastic Diseases/Oncology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
18645	Fee-for-Service	1497277354	1497277354	1	1	RUMMELHOFF, SARA NP	8/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18654	Fee-for-Service	1679654164	1679654164	1	1	RAPHAEL, LAWRENCE D MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	33789	41	Internal Medicine	0	In state provider	None	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
18687	Fee-for-Service	1790289288	1790289288	1	1	RASHIDI, VANIA MD	9/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
18706	Fee-for-Service	1760593610	1760593610	1	1	REYES, ELIZABETH L	4/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50588	01	General Practice	0	In state provider	REYES MEDICAL ASSOCIATES	408 S BEACH BLVD	STE 111	ANAHEIM	CA	92804	1866	30	06059	33.82709101	-117.9932293	Orange County
18720	Fee-for-Service	1184757494	1184757494	1	1	REGO, JOHN C LMFT	5/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18753	Fee-for-Service	1780075424	1780075424	1	1	RODRIGUES, BENJAMIN MD	7/21/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	174059	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
18761	Fee-for-Service	1578084422	1578084422	1	1	RIDER, RACHEL L MD	8/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173042	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
18766	Fee-for-Service	1255751822	1255751822	1	1	RADLER, IRIS A MD	2/27/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156191	09	Gynecology (D.O. only)	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
18774	Fee-for-Service	1447882279	1447882279	1	1	RABARA, MARY JEAN NP	5/1/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95029539	-	NOT APPLICABLE	0	In state provider	None	6425 UNIVERSITY AVE	None	SAN DIEGO	CA	92115	5808	37	06073	32.75524392	-117.0562593	San Diego County
18794	Fee-for-Service	1477966851	1477966851	1	1	RENNERT, ROBERT C MD	7/5/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	139629	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
18811	Fee-for-Service	1104147172	1104147172	1	1	ROC, GILBERT JR MD	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143571	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
18818	Fee-for-Service	1861629222	1861629222	1	1	RESEDA FAMILY MEDICINE	8/20/2009	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CLINIC AND MULTISPECIALT	6830 RESEDA BLVD	None	RESEDA	CA	91335	4204	19	06037	34.19499052	-118.5360141	Los Angeles County
18862	Fee-for-Service	1811121650	1811121650	1	1	ROBERTS, KISA LPCC	9/16/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
18868	Fee-for-Service	1568128569	1568128569	1	1	ROY, KATHERINE E CNP	3/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8831 VILLA LA JOLLA DR	None	LA JOLLA	CA	92037	1949	37	06073	32.869242	-117.230535	San Diego County
18885	Fee-for-Service	1144924275	1144924275	1	1	RODRIGUEZ, JESSICA V LPCC	2/3/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
18894	Fee-for-Service	1366691842	1366691842	1	1	RETTINGER, SARAH R MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88064	41	Internal Medicine	0	In state provider	None	725 W LA VETA AVE	STE 220	ORANGE	CA	92886	4446	30	06059	33.78063949	-117.8603285	Orange County
18897	Fee-for-Service	1851926190	1851926190	1	1	ROYAL VISTA SAN GABRIEL LLC	9/18/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	901 W SANTA ANITA ST	None	SAN GABRIEL	CA	91776	1018	19	06037	34.09514442	-118.1120396	Los Angeles County
18941	Fee-for-Service	1639307200	1639307200	1	1	RAJAGOPAL, NALINI MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116684	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
18986	Fee-for-Service	1609924505	1609924505	1	1	RAFAELOFF, MOJGAN MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	55553	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
18995	Fee-for-Service	1760593610	1760593610	1	1	REYES, ELIZABETH L	4/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50588	40	Pediatrics	0	In state provider	REYES MEDICAL ASSOCIATES	408 S BEACH BLVD	STE 111	ANAHEIM	CA	92804	1866	30	06059	33.82709101	-117.9932293	Orange County
19001	Fee-for-Service	1013092394	1013092394	1	1	RIVERSIDE RADIOLOGY	10/17/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	4500 BROCKTON AVE	STE 219	RIVERSIDE	CA	92501	4090	33	06065	33.97785263	-117.3836152	Riverside County
19058	Fee-for-Service	1093212334	1093212334	1	1	RICHARDS, AMY M MD	1/26/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167296	None	None	0	In state provider	None	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
19065	Fee-for-Service	1407855240	1407855240	1	14	ROCKY MOUNTAIN HOLDINGS, LLC	4/23/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	1200 MOHAVE RD	None	PARKER	AZ	85344	6349	00	None	34.137999	-114.283098	La Paz County
19098	Fee-for-Service	1689615692	1689615692	1	1	RODERICK BEAVER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN'S MEDICAL CENTER	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
19145	Fee-for-Service	1770856411	1770856411	1	1	RUEGG, CLAUDIA C OD	3/21/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
19175	Fee-for-Service	1144240037	1144240037	1	1	ROSENTHAL, ARTHUR D LMFT	6/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	650 LARKFIELD CENTER	SUITE A	SANTA ROSA	CA	95403	1400	49	06097	38.50131189	-122.7513365	Sonoma County
19192	Fee-for-Service	1588198352	1588198352	1	1	RODRIGUEZ, RICHARD MD	3/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161390	08	Family Practice	0	In state provider	None	3401 W SUNFLOWER AVE	STE 250	SANTA ANA	CA	92704	6948	30	06059	33.69575566	-117.9144503	Orange County
19208	Fee-for-Service	1336589696	1336589696	1	1	RIEDEL, MARY LCSW	10/4/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
19211	Fee-for-Service	1225133341	1225133341	1	1	ROHOVIT, STACIE O NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
19229	Fee-for-Service	1013974351	1013974351	1	1	RESPIRATORY CARE OF	7/1/1995	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AMERICA, INC	1180 S BEVERLY DR	STE 300	LOS ANGELES	CA	90035	1154	19	06037	34.05550055	-118.395555	Los Angeles County
19317	Fee-for-Service	1912922519	1912922519	1	1	RALPHS GROCERY COMPANY	7/31/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #51	1020 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	7325	37	06073	32.74853291	-117.1545191	San Diego County
19356	Fee-for-Service	1366908410	1366908410	1	1	RIO HONDO HEALTHCARE, INC	3/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13007 PARAMOUNT BLVD	None	DOWNEY	CA	90242	4329	19	06037	33.91815349	-118.1565513	Los Angeles County
19379	Fee-for-Service	1477531127	1477531127	1	1	ROBERTS, DONALD L MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	1707 W CHARLESTON BLVD	STE 120	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
19381	Fee-for-Service	1992281372	1992281372	1	1	RIVERSIDE COMMUNITY HEALTH F	2/9/2024	174H00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	OUNDATION	4275 LEMON ST	None	RIVERSIDE	CA	92501	3817	33	06065	33.97624699	-117.3752737	Riverside County
19390	Fee-for-Service	1003348764	1003348764	1	1	RAYA, TERESA MD	10/5/2021	207P00000X	NA	Other	026	PHYSICIANS	174005	None	None	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
19406	Fee-for-Service	1114032208	1114032208	1	3	ROMERO, JESUSA N MD APC	5/10/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34299	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10230 E ARTESIA BLVD	STE 209	BELLFLOWER	CA	90706	6769	19	06037	33.8728276	-118.1160403	Los Angeles County
19408	Fee-for-Service	1619350337	1619350337	1	1	RICHLER, AARON MD	8/29/2024	207R00000X	NA	Other	026	PHYSICIANS	161190	45	Nephrology (Renal-Kidney)	0	In state provider	None	10941 BLOOMFIELD ST	SUITE A	LOS ALAMITOS	CA	90720	6702	30	06059	33.804234	-118.0632055	Orange County
19451	Fee-for-Service	1144479411	1144479411	1	1	ROSENBERG, AARON S MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131746	41	Internal Medicine	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
19454	Fee-for-Service	1023078987	1023078987	1	1	ROSENBERG, JOSHUA A DO	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE#100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
19463	Fee-for-Service	1619055217	1619055217	1	1	REGO, JOHN D JR MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40921	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
19481	Fee-for-Service	1831768571	1831768571	1	1	RANDHAWA, JASDEEP MD	10/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	82935 AVENUE 48	STE 101	INDIO	CA	92201	6757	33	06065	33.7002687	-116.2177115	Riverside County
19488	Fee-for-Service	1629091038	1629091038	1	1	RICO, CARLOS ALBERTO MD	7/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88018	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
19493	Fee-for-Service	1942369558	1942369558	1	1	RAMAMURTI, SURESH MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37089	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
19501	Fee-for-Service	1467895847	1467895847	1	1	RIPLEY-CLOSE, LAUREN E CRNA	4/4/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
19516	Fee-for-Service	1750967253	1750967253	1	1	RODRIGUEZ, ERNESTO MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
19528	Fee-for-Service	1144327032	1144327032	1	1	ROMAN, RICARDO R MD	9/16/2012	207R00000X	NA	Other	026	PHYSICIANS	79013	41	Internal Medicine	0	In state provider	None	4708 EAGLE ROCK BLVD	None	EAGLE ROCK	CA	90041	2712	19	06037	34.13048242	-118.2165574	Los Angeles County
19538	Fee-for-Service	1417964917	1417964917	1	1	REDDY, DWARAKNATH P MD	10/30/1990	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34093	41	Internal Medicine	0	In state provider	None	811 E 11TH ST	STE 208	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
19549	Fee-for-Service	1477916633	1477916633	1	1	RIDOLFI, NICOLE M DO	8/27/2021	390200000X	NA	Other	026	PHYSICIANS	15882	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
19561	Fee-for-Service	1770527434	1770527434	1	1	ROOBILA NAZ, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 W CAMPBELL RD	None	RICHARDSON	TX	75080	3416	00	None	32.97532651	-96.7266135	Dallas County
19606	Fee-for-Service	1164558771	1164558771	1	1	ROSALES, SANTIAGO CO	7/15/2020	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4512 FEATHER RIVER DR	SUITE A	STOCKTON	CA	95219	6563	39	06077	37.98245291	-121.3469128	San Joaquin County
19697	Fee-for-Service	1619350337	1619350337	1	1	RICHLER, AARON MD	8/29/2024	207R00000X	NA	Other	026	PHYSICIANS	161190	41	Internal Medicine	0	In state provider	None	10941 BLOOMFIELD ST	SUITE A	LOS ALAMITOS	CA	90720	6702	30	06059	33.804234	-118.0632055	Orange County
19698	Fee-for-Service	1114032208	1114032208	1	3	ROMERO, JESUSA N MD APC	5/10/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34299	01	General Practice	0	In state provider	None	10230 E ARTESIA BLVD	STE 209	BELLFLOWER	CA	90706	6769	19	06037	33.8728276	-118.1160403	Los Angeles County
19717	Fee-for-Service	1700460151	1700460151	1	1	RICAFORT, JEAN A NP	3/28/2023	390200000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
19734	Fee-for-Service	1376795377	1376795377	1	1	RUIZ, MELISSA J MD	12/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137641	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
19739	Fee-for-Service	1144479411	1144479411	1	1	ROSENBERG, AARON S MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131746	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
19824	Fee-for-Service	1417964917	1417964917	1	1	REDDY, DWARAKNATH P MD	10/30/1990	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34093	10	Gastroenterology (M.D. only)	0	In state provider	None	811 E 11TH ST	STE 208	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
19851	Fee-for-Service	1104291871	1104291871	1	1	RUSKIN, JEANNINE LAC	3/12/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	770 26TH AVENUE	SUITE A & B	SANTA CRUZ	CA	95062	5004	44	06087	36.9632464	-121.9757158	Santa Cruz County
19882	Fee-for-Service	1720166598	1720166598	1	1	RAHIM, ZARGHOONA MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75039	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
19891	Fee-for-Service	1972955755	1972955755	1	1	RANGANATHAN, SUDHA MD	12/2/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168939	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
19913	Fee-for-Service	1841476447	1841476447	1	1	REDBUD COMMUNITY HOSP	11/14/2006	261QR1300X	NA	Rural Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FAMILY HEALTH CENTER	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
19919	Fee-for-Service	1093016610	1093016610	1	1	RUSSELL, SUSANNA	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	312 W J ST	None	LOS BANOS	CA	93635	4069	24	06047	37.06221105	-120.8570564	Merced County
19937	Fee-for-Service	1629413422	1629413422	1	1	RAVANDI, BAHAREH MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142959	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
19952	Fee-for-Service	1235122292	1235122292	1	1	RAJA, NATASHA M MD	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83454	40	Pediatrics	0	In state provider	None	PUEBLO AT BATH ST	None	SANTA BARBARA	CA	93102	0000	42	06083	34.430526	-119.72196	Santa Barbara County
19960	Fee-for-Service	1730190729	1730190729	1	1	RICHES, ELAN J PT	12/7/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15325 FAIRFIELD RANCH RD	STE. 150	CHINO HILLS	CA	91709	8834	36	06071	33.9729714	-117.6918388	San Bernardino County
20017	Fee-for-Service	1730404344	1730404344	1	1	ROJAS, RENAN A MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149345	02	General Surgery	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
20027	Fee-for-Service	1144479411	1144479411	1	1	ROSENBERG, AARON S MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131746	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
20053	Fee-for-Service	1578727996	1578727996	1	2	RUSSELL, DAVID J MD	7/8/2022	208600000X	NA	General Surgery	026	PHYSICIANS	89958	None	None	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
20057	Fee-for-Service	1194790238	1194790238	1	1	REDDY, RAVINDER D MD	10/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55966	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
20065	Fee-for-Service	1255623567	1255623567	1	1	ROSE, JOHN A MD	6/25/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	121818	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20097	Fee-for-Service	1184942484	1184942484	1	1	ROVANE, TAMMY A LMFT	3/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
20131	Fee-for-Service	1295977122	1295977122	1	1	RASCH, DAMIAN R DO	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14015	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
20139	Fee-for-Service	1962122192	1962122192	1	1	RIGHTRX	4/22/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	510 W CENTRAL AVE	STE. A	BREA	CA	92821	3032	30	06059	33.93188767	-117.9048961	Orange County
20165	Fee-for-Service	1972586386	1972586386	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	155 S 5TH STREET	None	COALINGA	CA	93210	1903	10	06019	36.13845412	-120.3582671	Fresno County
20219	Fee-for-Service	1386851160	1386851160	1	1	ROBERTS, JENNIFER L NP	6/19/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20220	Fee-for-Service	1992063416	1992063416	1	1	RAHMAN, KAZI S DO	7/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13102	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
20225	Fee-for-Service	1609150820	1609150820	1	2	RODRIGUEZ, BRITTANY M	5/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
20239	Fee-for-Service	1407855240	1407855240	1	15	ROCKY MOUNTAIN HOLDINGS, LLC	6/4/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	13500 80TH TERRACE	None	LIVE OAK	FL	32060	8868	00	None	30.30393678	-83.02582615	Suwannee County
20241	Fee-for-Service	1669435491	1669435491	1	1	RUERAS, MARIA CECILIA	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56514	08	Family Practice	0	In state provider	None	9508 STOCKDALE HWY	STE 150	BAKERSFIELD	CA	93311	3623	15	06029	35.35453237	-119.1086014	Kern County
20254	Fee-for-Service	1891079885	1891079885	1	1	REDDY, MANORAMA M MD INC	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	39669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4533 COLLEGE AVE	None	SAN DIEGO	CA	92115	4010	37	06073	32.759334	-117.066313	San Diego County
20265	Fee-for-Service	1659748242	1659748242	1	1	ROMERO, AMANDA M RN CPNP	4/28/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
20281	Fee-for-Service	1265605497	1265605497	1	1	RASOOLI, SARA MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115263	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20286	Fee-for-Service	1366626673	1366626673	1	1	ROSE, JANEEN CRNA	8/27/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
20305	Fee-for-Service	1942272976	1942272976	1	1	REIDEL, WARREN MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	37420	10	Gastroenterology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
20307	Fee-for-Service	1891854428	1891854428	1	1	RAMOS, MILAGRO D MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86092	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
20372	Fee-for-Service	1053454835	1053454835	1	1	ROGALA, JAMES J OD	4/19/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	SUITE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
20388	Fee-for-Service	1215995337	1215995337	1	1	RUBINGER, MARTIN D MD	4/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35169	41	Internal Medicine	0	In state provider	None	4720 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.441916	-122.6643435	Sonoma County
20430	Fee-for-Service	1396813374	1396813374	1	1	RAIBLE, LYN H MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74921	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
20453	Fee-for-Service	1972586386	1972586386	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	155 S 5TH STREET	None	COALINGA	CA	93210	1903	10	06019	36.13845412	-120.3582671	Fresno County
20479	Fee-for-Service	1740898139	1740898139	1	1	REYES, MATTHEW R PT	6/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
20489	Fee-for-Service	1588779904	1588779904	1	1	ROSS-DOUGLAS, BRANDI K MD	5/6/2019	207RC0200X	NA	Other	026	PHYSICIANS	146751	41	Internal Medicine	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
20506	Fee-for-Service	1992063416	1992063416	1	1	RAHMAN, KAZI S DO	7/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13102	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
20516	Fee-for-Service	1710052840	1710052840	1	1	RICHARDSON, GREGG A PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
20531	Fee-for-Service	1669435491	1669435491	1	1	RUERAS, MARIA CECILIA	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56514	40	Pediatrics	0	In state provider	None	9508 STOCKDALE HWY	STE 150	BAKERSFIELD	CA	93311	3623	15	06029	35.35453237	-119.1086014	Kern County
20538	Fee-for-Service	1134383581	1134383581	1	1	RUDERMAN, RACHEL A	9/25/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
20543	Fee-for-Service	1891079885	1891079885	1	1	REDDY, MANORAMA M MD INC	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	39669	41	Internal Medicine	0	In state provider	None	4533 COLLEGE AVE	None	SAN DIEGO	CA	92115	4010	37	06073	32.759334	-117.066313	San Diego County
20545	Fee-for-Service	1356975130	1356975130	1	1	RAMIREZ-RODRIGUEZ, LAURA LM	9/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	140794	-	NOT APPLICABLE	0	In state provider	FT	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
20549	Fee-for-Service	1801045513	1801045513	1	1	RUSTAGI, TARUN MD	7/6/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177126	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
20559	Fee-for-Service	1518550755	1518550755	1	1	RICHARDSON, MARZENA A NP	4/19/2022	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
20565	Fee-for-Service	1801838198	1801838198	1	1	RELIANT IMMEDIATE CARE	4/1/2003	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP INC	9601 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	5203	19	06037	33.948297	-118.3963665	Los Angeles County
20567	Fee-for-Service	1528026341	1528026341	1	1	RAM, SUMITA MD	2/19/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158498	40	Pediatrics	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
20571	Fee-for-Service	1265605497	1265605497	1	1	RASOOLI, SARA MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115263	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20585	Fee-for-Service	1811525033	1811525033	1	1	ROCHA, BRENDA T NP	8/16/2022	163WC0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20595	Fee-for-Service	1942272976	1942272976	1	1	REIDEL, WARREN MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	37420	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
20658	Fee-for-Service	1124258637	1124258637	1	1	REDDY, CLAUDIA A LCSW	4/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 WOODRUFF AVE	STE 209	LONG BEACH	CA	90808	2149	19	06037	33.828786	-118.1165535	Los Angeles County
20675	Fee-for-Service	1558576108	1558576108	1	1	REDWOOD SLEEP CENTER INC.	2/4/2022	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1615 HILL RD	SUITE 16	NOVATO	CA	94947	4340	21	06041	38.09764686	-122.5787662	Marin County
20739	Fee-for-Service	1972586386	1972586386	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	155 S 5TH STREET	None	COALINGA	CA	93210	1903	10	06019	36.13845412	-120.3582671	Fresno County
20786	Fee-for-Service	1497039119	1497039119	1	1	RUSSELL, MARLON S MD	6/4/2019	207R00000X	NA	Other	026	PHYSICIANS	118486	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
20800	Fee-for-Service	1184018012	1184018012	1	2	REED, LATESHA T NP	5/31/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95002463	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
20822	Fee-for-Service	1952863888	1952863888	1	1	RABANG, JOSHUA MD	6/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
20860	Fee-for-Service	1043579162	1043579162	1	1	RICHEY, JOHANNA MARIE DPM	10/2/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
20902	Fee-for-Service	1801254230	1801254230	1	1	ROBINSON, JACOB PT	9/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	42150 JACKSON	BLDG E SUITE 103	INDIO	CA	92203	9780	33	06065	33.7423867	-116.2165708	Riverside County
20904	Fee-for-Service	1629802434	1629802434	1	1	RUSSEAU, KATHERINE M PSYD	12/3/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
20926	Fee-for-Service	1538144290	1538144290	1	1	RIGGLE, PAUL C MD	9/30/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45554	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
20943	Fee-for-Service	1144213166	1144213166	1	2	REGENTS/UCDPBG/PED CARDI	5/1/1999	2080P0202X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
20944	Fee-for-Service	1407501877	1407501877	1	2	REGENTS UNIVERSITY OF CA	8/25/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MOBILE	2211 MICHIGAN AVE	None	SANTA MONICA	CA	90404	3905	19	06037	34.02472321	-118.4713821	Los Angeles County
20999	Fee-for-Service	1245291038	1245291038	1	1	ROBERT O. SHAVER	1/31/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 LILE CT	STE 101	LITTLE ROCK	AR	72205	6239	00	None	34.745589	-92.37852	Pulaski County
21008	Fee-for-Service	1730327099	1730327099	1	1	ROBERT MURITHI M.D.	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	595 COPELAND MILL RD	STE 2D	WESTERVILLE	OH	43081	8908	00	None	40.11266949	-82.94622461	Franklin County
21026	Fee-for-Service	1972586386	1972586386	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	155 S 5TH STREET	None	COALINGA	CA	93210	1903	10	06019	36.13845412	-120.3582671	Fresno County
21035	Fee-for-Service	1114105384	1114105384	1	2	RETINA ASSOCIATES OF ORANGE	6/14/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	23521 PASEO DE VALENCIA	SUITE 207	LAGUNA HILLS	CA	92653	3107	30	06059	33.61113028	-117.7126684	Orange County
21052	Fee-for-Service	1780703355	1780703355	1	1	RIBAUDO, JANICE MD	10/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133413	None	None	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
21065	Fee-for-Service	1598287138	1598287138	1	1	ROCCO, RAFFAELE MD	11/1/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
21092	Fee-for-Service	1801483581	1801483581	1	1	RUTLEDGE, ABIGAIL	7/29/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	873 BERTINO PL	None	CHICO	CA	95973	9376	04	06007	39.77438725	-121.8555142	Butte County
21177	Fee-for-Service	1366619645	1366619645	1	1	RANDY WINDREICH M.D.	8/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 PENN AVE	None	PITTSBURGH	PA	15224	1334	00	None	40.46605162	-79.9530831	Allegheny County
21212	Fee-for-Service	1154370302	1154370302	1	1	REDJAL, NASSER MD	8/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41807	03	Allergy	0	In state provider	None	15243 VANOWEN ST	STE 304	VAN NUYS	CA	91405	3652	19	06037	34.19394848	-118.4654115	Los Angeles County
21231	Fee-for-Service	1144213166	1144213166	1	2	REGENTS/UCDPBG/PED CARDI	8/11/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
21235	Fee-for-Service	1144213604	1144213604	1	1	ROTH, TIMOTHY J DO	11/28/1994	204D00000X	NA	Other	026	PHYSICIANS	5200	08	Family Practice	0	In state provider	None	255 W BULLARD AVE	STE 102	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
21238	Fee-for-Service	1700892395	1700892395	1	1	ROSENBERG, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
21255	Fee-for-Service	1760553721	1760553721	1	1	RUTKOWSKI, MARK P MD	8/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83326	45	Nephrology (Renal-Kidney)	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
21266	Fee-for-Service	1407855240	1407855240	1	19	ROCKY MOUNTAIN HOLDINGS, LLC	8/15/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	7798 FULLER ST	None	CASPER	WY	82604	1644	00	None	42.902595	-106.457562	Natrona County
21315	Fee-for-Service	1154381309	1154381309	1	1	ROBERT J TALLAKSEN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 STADIUM DR	None	MORGANTOWN	WV	26506	7900	00	None	39.65330334	-79.95441785	Monongalia County
21400	Fee-for-Service	1114275997	1114275997	1	1	ROBERTS, MADHUR A MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132934	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
21440	Fee-for-Service	1790186831	1790186831	1	1	REYES-TENA, SONIA S PSYD	5/16/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
21465	Fee-for-Service	1932615077	1932615077	1	1	RAINCROSS URGENT CARE, INC.	2/1/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4646 BROCKTON AVE	STE 101	RIVERSIDE	CA	92506	0103	33	06065	33.9760171	-117.3860626	Riverside County
21489	Fee-for-Service	1417973124	1417973124	1	1	REIDY, STEPHEN J MD	6/30/1995	207L00000X	NA	Other	026	PHYSICIANS	81452	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
21495	Fee-for-Service	1659364677	1659364677	1	2	REGENTS/UCDPBG/ANESTHESI	5/1/1999	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
21512	Fee-for-Service	1376643395	1376643395	1	1	ROSENBLUM, DAVID B OD	9/23/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11805 SOUTH ST	None	CERRITOS	CA	90703	5425	19	06037	33.85849845	-118.0814715	Los Angeles County
21573	Fee-for-Service	1649507906	1649507906	1	1	ROWEN, TAMI S MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21660	Fee-for-Service	1649313347	1649313347	1	1	RICHESON, LORI I LMFT	11/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2830 G ST	SUITE C-1	EUREKA	CA	95501	4447	12	06023	40.78218776	-124.1624709	Humboldt County
21678	Fee-for-Service	1679856827	1679856827	1	1	ROSSETTI, GINA C MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118518	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
21680	Fee-for-Service	1184894073	1184894073	1	1	RIBLE, RADHIKA D MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95274	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	6975	19	06037	34.06527974	-118.4462792	Los Angeles County
21687	Fee-for-Service	1114275997	1114275997	1	1	ROBERTS, MADHUR A MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132934	01	General Practice	0	In state provider	None	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
21732	Fee-for-Service	1184725707	1184725707	2	1	RIEGLER, JONATHAN L	1/21/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	68339	41	Internal Medicine	0	In state provider	None	850 FAIR OAKS AVE	None	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
21741	Fee-for-Service	1306183660	1306183660	1	1	REZAI, SHADI MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143477	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
21747	Fee-for-Service	1669813382	1669813382	1	1	RASKOFF, KELLY M NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21777	Fee-for-Service	1780846253	1780846253	1	1	RAMAN S. POOLA M.D. INC	4/15/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	18523 CORWIN RD	STE H	APPLE VALLEY	CA	92307	2338	36	06071	34.54095703	-117.2601143	San Bernardino County
21778	Fee-for-Service	1982627725	1982627725	1	1	RUTGERS, RICHARD P MD	2/1/1995	207L00000X	NA	Other	026	PHYSICIANS	60456	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
21785	Fee-for-Service	1659364677	1659364677	1	2	REGENTS/UCDPBG/ANESTHESI	4/7/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
21796	Fee-for-Service	1316025513	1316025513	1	1	ROBERTO A BEATON MD INC	2/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
21829	Fee-for-Service	1750678231	1750678231	1	1	RENN, CAITLIN MD	11/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169909	None	None	0	In state provider	None	7720 N FRESNO ST	104	FRESNO	CA	93720	2407	10	06019	36.85068226	-119.7836282	Fresno County
21837	Fee-for-Service	1518001551	1518001551	1	1	ROSENSTEIN, DAVID H MD	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	8010 W SAHARA AVE	STE #235	LAS VEGAS	NV	89117	7911	00	None	36.14390533	-115.2659781	Clark County
21873	Fee-for-Service	1821131129	1821131129	1	1	RANDHAWA, RAJDEEP	1/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
21880	Fee-for-Service	1811912348	1811912348	1	1	ROSENFELD, JEFFREY MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88516	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
21891	Fee-for-Service	1063451557	1063451557	1	1	ROBINSON, HARRISON L MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53636	41	Internal Medicine	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
21912	Fee-for-Service	1487283172	1487283172	1	1	REDDY, ABHINAV DO	12/21/2023	208M00000X	NA	Other	026	PHYSICIANS	22259	None	None	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
21953	Fee-for-Service	1275023293	1275023293	1	1	REINA, EVANGELINA E LCSW	8/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
21973	Fee-for-Service	1982477634	1982477634	1	1	REZA RASOULI MD INC	11/23/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
22021	Fee-for-Service	1184725707	1184725707	2	1	RIEGLER, JONATHAN L	1/21/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	68339	10	Gastroenterology (M.D. only)	0	In state provider	None	850 FAIR OAKS AVE	None	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
22023	Fee-for-Service	1205819349	1205819349	1	1	ROBERT HARFORD M.D. A MEDICA	7/23/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	L CORPORATION	750 E LATHAM AVE	SUITE 3	HEMET	CA	92543	4370	33	06065	33.74940646	-116.964504	Riverside County
22045	Fee-for-Service	1295763597	1295763597	1	1	RINEHART, KRISTOPHER R	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80354	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
22048	Fee-for-Service	1508930801	1508930801	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF I LLC	1451 SECRET RAVINE PKWY	SUITE 130	ROSEVILLE	CA	95661	4051	31	06061	38.7647101	-121.2431538	Placer County
22073	Fee-for-Service	1659364677	1659364677	1	2	REGENTS/UCDPBG/ANESTHESI	6/4/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
22084	Fee-for-Service	1972536704	1972536704	1	1	REYNOLDS, LOWELL W MD	1/1/1997	207L00000X	NA	Other	026	PHYSICIANS	75291	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
22115	Fee-for-Service	1043416282	1043416282	1	1	RADER, CATHY E LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
22133	Fee-for-Service	1184828964	1184828964	1	1	REGIS, LOUELLA M MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101548	08	Family Practice	0	In state provider	None	11000 OLSON DRIVE	SUITE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
22153	Fee-for-Service	1295916914	1295916914	2	1	RICHRON, INC	5/16/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15525 FELLOWSHIP ST	None	LA PUENTE	CA	91744	1114	19	06037	34.04635425	-117.9456718	Los Angeles County
22170	Fee-for-Service	1811912348	1811912348	1	1	ROSENFELD, JEFFREY MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88516	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	SUITE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
22189	Fee-for-Service	1548604895	1548604895	2	1	RUSSELL, BIANCA ELIZABETH MD	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	154948	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
22205	Fee-for-Service	1558542845	1558542845	1	1	RICE, KRISTEN N MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98229	None	None	0	In state provider	None	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
22206	Fee-for-Service	1932653235	1932653235	1	1	ROEHRIG, JAMES P PHD	9/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
22254	Fee-for-Service	1215940911	1215940911	1	1	ROSS, MICHAEL G MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47590	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
22292	Fee-for-Service	1225599913	1225599913	1	1	ROGINIEL, ALIYA MD MPH	7/10/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187768	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22302	Fee-for-Service	1396858965	1396858965	1	1	RAVITS, JOHN M MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43695	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
22306	Fee-for-Service	1538644315	1538644315	1	1	RAMIREZ, ANDREW PT	6/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
22328	Fee-for-Service	1104277953	1104277953	1	1	RAVAL, JAYDEEP J DO	12/24/2021	171000000X	NA	Other	026	PHYSICIANS	15867	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
22340	Fee-for-Service	1811411929	1811411929	1	1	RAO, SANJANA MD	9/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176567	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
22353	Fee-for-Service	1659382539	1659382539	1	1	REHAN, VIRENDER K MD	8/14/2000	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	68186	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
22354	Fee-for-Service	1215039607	1215039607	1	1	RALEY'S	8/4/1976	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1040 EMERALD BAY RD	None	SOUTH LAKE TAHOE	CA	96150	6200	09	06017	38.9121799	-120.0039838	El Dorado County
22381	Fee-for-Service	1699870147	1699870147	1	1	ROSENSTEIN, DANIEL I MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77178	34	Urology and Urological Surgery	0	In state provider	None	280 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
22382	Fee-for-Service	1013116433	1013116433	1	1	RASSEL, RUTH A DO	4/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9890	02	General Surgery	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 300B	FAIRFIELD	CA	94533	1184	48	06095	38.261952	-122.0498745	Solano County
22390	Fee-for-Service	1801854310	1801854310	1	1	RODRIGUEZ, BARBARA	3/1/2000	207P00000X	NA	Other	026	PHYSICIANS	58655	40	Pediatrics	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
22452	Fee-for-Service	1912281064	1912281064	1	1	RODRIGUEZ, ALEJANDRA LMFT	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
22455	Fee-for-Service	1356798524	1356798524	1	1	RODENBECK, KATHERINE M MD	11/10/2020	207L00000X	NA	Other	026	PHYSICIANS	168043	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
22463	Fee-for-Service	1578827663	1578827663	1	1	RODRIGUEZ, BRENDA LCSW	10/22/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD STE 1	None	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
22500	Fee-for-Service	1669765251	1669765251	1	1	RAYMOND R RENDON &	6/23/1994	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES	2120 FOREST AVE	STE 2	SAN JOSE	CA	95128	1478	43	06085	37.32673881	-121.9382042	Santa Clara County
22532	Fee-for-Service	1710157474	1710157474	1	1	RAVAL, MEHUL	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105804	None	None	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
22547	Fee-for-Service	1134149503	1134149503	1	1	RENE B MILNER	7/8/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 65TH AVENUE	None	OSCEOLA	WI	54020	4370	00	None	45.30352849	-92.7007245	Polk County
22553	Fee-for-Service	1740320852	1740320852	1	1	RODEVICH, MICHAEL A PHD	12/21/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
22599	Fee-for-Service	1093225898	1093225898	1	1	REPARD, BRENNA LMFT	10/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	141 PARKER ST	None	VACAVILLE	CA	95688	3921	48	06095	38.35806912	-121.9898561	Solano County
22647	Fee-for-Service	1801260179	1801260179	1	1	ROBARTS, EVELYN K LMFT	11/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22654	Fee-for-Service	1033159868	1033159868	1	1	RABEY, KEVIN E MD	3/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87096	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
22723	Fee-for-Service	1164194676	1164194676	1	1	RAMIREZ, JUAN C NP	12/19/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	STE 2021	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
22746	Fee-for-Service	1144811597	1144811597	1	1	ROSE J EAPEN, MD, PC	9/26/2022	261QM2500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	GOLOGY	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
22836	Fee-for-Service	1073971289	1073971289	1	1	RUDRA, ANANYA OT	9/7/2023	390200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
22893	Fee-for-Service	1356573620	1356573620	1	1	RAZ, ORI MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118132	05	Anesthesiology	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	9468	37	06073	33.12542915	-117.0764725	San Diego County
22943	Fee-for-Service	1912342874	1912342874	1	1	RAHMAN, MOBEEN MD	8/11/2022	207ZP0102X	NA	Other	026	PHYSICIANS	139054	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
22944	Fee-for-Service	1841498292	1841498292	1	1	ROSARIO, VICTORIA L LMFT	10/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11417 WEST BERNARDO COU	B	SAN DIEGO	CA	92127	1635	37	06073	33.02158933	-117.0834832	San Diego County
22959	Fee-for-Service	1023629391	1023629391	1	1	RIOS & RIOS COMMUNITY HEALTH	11/18/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	21091 RIDER STREET	SUITE 218	PERRIS	CA	92570	8800	33	06065	33.8298049	-117.2941212	Riverside County
22981	Fee-for-Service	1538815683	1538815683	1	1	ROYAL NON MEDICAL TRANSPORT	6/22/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	6683 DELBERT AVE	None	FRESNO	CA	93722	8305	10	06019	36.83536723	-119.8878832	Fresno County
22998	Fee-for-Service	1194834424	1194834424	1	1	REYES, ARJUN C MD	1/7/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77173	01	General Practice	0	In state provider	None	24978 NORMANS WAY	None	CALABASAS	CA	91302	3089	19	06037	34.1308232	-118.6664276	Los Angeles County
23024	Fee-for-Service	1982782579	1982782579	1	1	REISFELD, ROBERT I JR MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	38787	36	Psychiatry	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
23035	Fee-for-Service	1447553276	1447553276	1	1	RAIOLA, FRANCOISE A MD	9/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114773	None	None	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
23063	Fee-for-Service	1194744680	1194744680	1	1	RACZKA, RICHARD C MD	8/24/2004	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34092	20	Orthopedic Surgery	0	In state provider	None	710 N EUCLID ST	STE 201	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
23096	Fee-for-Service	1386701217	1386701217	1	1	RITTENHOUSE, JANET J LCSW	12/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
23114	Fee-for-Service	1598730616	1598730616	1	1	REGENTS UNIVERSITY OF CA	5/25/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SFGH DEPT NEUROSURGERY	1001 POTRERO AVE	RM 4M39	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
23118	Fee-for-Service	1154782167	1154782167	1	1	REYNOLDS, WILLIAM M PHD	3/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
23201	Fee-for-Service	1942224092	1942224092	1	1	ROSELLINI, GREGORY R MD	10/18/1996	207P00000X	NA	Other	026	PHYSICIANS	61075	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
23240	Fee-for-Service	1679566764	1679566764	1	1	REGENTS/UCDPBG/PM&R	9/30/2024	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
23254	Fee-for-Service	1801250410	1801250410	1	1	REDDY, NEIL MD	9/1/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	140287	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
23280	Fee-for-Service	1235154782	1235154782	1	1	RUSSELL, SARAH	9/17/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85116	08	Family Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
23312	Fee-for-Service	1205816923	1205816923	1	1	RUSSELL, KELLY Y. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE	STE 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
23357	Fee-for-Service	1891847216	1891847216	1	1	RONALD LONG	4/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7651 LK RAYSTOWN SH CTR	None	HUNTINGDON	PA	16652	8403	00	None	40.47900578	-78.01080006	Huntingdon County
23458	Fee-for-Service	1922390384	1922390384	1	1	RATZLAFF, JANNA L CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1183 E FOOTHILL BLVD	None	UPLAND	CA	91786	4079	36	06071	34.10724648	-117.6359175	San Bernardino County
23488	Fee-for-Service	1396198958	1396198958	1	1	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	6560 GREENBACK LN	None	CITRUS HEIGHTS	CA	95621	6237	34	06067	38.677716	-121.310793	Sacramento County
23528	Fee-for-Service	1679566764	1679566764	1	1	REGENTS/UCDPBG/PM&R	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
23633	Fee-for-Service	1932532058	1932532058	1	1	RAJAPAKSE, RUWAN I NP	9/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23687	Fee-for-Service	1962722322	1962722322	1	2	REMEDY MEDICAL SUPPLY INC	6/27/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3717 E THOUSAND OAKS BLV	STE 212	WESTLAKE VILLAGE	CA	91362	3607	56	06111	34.16423881	-118.8289076	Ventura County
23744	Fee-for-Service	1992917108	1992917108	1	1	RIES, JEFFREY D DO, APC	11/26/2008	174400000X	NA	Other	026	PHYSICIANS	5138	01	General Practice	0	In state provider	None	1310 SAN BERNARDINO RD	SUITE 101	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
23750	Fee-for-Service	1164507984	1164507984	1	1	ROHRMANN, CHARLES A JR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HARBORVIEW MEDICAL CTR	325 9TH AVE	C/O UWP MS 359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
23765	Fee-for-Service	1366637415	1366637415	1	1	ROGOWAY, WILLIAM M OD	10/24/2007	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9418 FIRESTONE BLVD	None	DOWNEY	CA	90241	5504	19	06037	33.93147456	-118.1159463	Los Angeles County
23782	Fee-for-Service	1437285251	1437285251	1	1	ROCKCREEK, INC	8/8/1990	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27889 RAINBOW LN	None	HIGHLAND	CA	92346	2666	36	06071	34.13365619	-117.1962045	San Bernardino County
23854	Fee-for-Service	1386107001	1386107001	1	1	RAO, SUMAN S MD	12/7/2023	208M00000X	NA	Other	026	PHYSICIANS	179770	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
23884	Fee-for-Service	1144615105	1144615105	1	1	ROBINSON, MARGARET A MD	5/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147424	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
23903	Fee-for-Service	1225010598	1225010598	2	1	ROWE, DOROTHY H MD	3/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	1919 E THOMAS ROAD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
23921	Fee-for-Service	1740675644	1740675644	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17742 BEACH BLVD	SUITE 350	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
23936	Fee-for-Service	1063401826	1063401826	1	1	REGENTS/UCDPBG/IM ALL/RH	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
23938	Fee-for-Service	1205880598	1205880598	1	1	RODRIGUEZ, KRISTIN M DO	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
23979	Fee-for-Service	1972814507	1972814507	1	1	RIVAS, VANESSA LCSW	11/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
23985	Fee-for-Service	1215967609	1215967609	2	1	REDIX, LOUIS C MD	2/2/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	44785	None	None	0	In state provider	None	525 MELISSA AVE	A	BARSTOW	CA	92311	3002	36	06071	34.89483846	-117.0173202	San Bernardino County
23992	Fee-for-Service	1053759217	1053759217	1	2	REID, CALEB M NP	2/28/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	350 E COMMERCIAL ROAD	STE 112	SAN BERNARDINO	CA	92408	3764	36	06071	34.05584763	-117.2773573	San Bernardino County
24003	Fee-for-Service	1275563751	1275563751	1	1	RASMUSSEN,J GRANT MD	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	48 W 1500 N	None	NEPHI	UT	84648	8900	00	None	39.7306275	-111.83724	Juab County
24020	Fee-for-Service	1487656955	1487656955	1	1	ROZUM, JENNIFER S MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 SR MARY COLUMBA DR	None	RED BLUFF	CA	96080	0000	52	06103	40.14940711	-122.2203251	Tehama County
24031	Fee-for-Service	1992917108	1992917108	1	1	RIES, JEFFREY D DO, APC	11/26/2008	174400000X	NA	Other	026	PHYSICIANS	5138	13	Neurology (M.D. only)	0	In state provider	None	1310 SAN BERNARDINO RD	SUITE 101	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
24122	Fee-for-Service	1982233045	1982233045	1	1	RASHAD, RAMY M MD	5/10/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24184	Fee-for-Service	1417236274	1417236274	1	1	RAINCE, JAGDEEP K MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143397	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE B265	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
24186	Fee-for-Service	1679528053	1679528053	1	1	RAVIKUMAR, JAYANTHI MD	2/8/2015	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	33094	25	Physical Medicine and Rehabilitation	0	In state provider	None	5451 LA PALMA AVE	STE 47	LA PALMA	CA	90623	1732	30	06059	33.84643146	-118.038843	Orange County
24192	Fee-for-Service	1508189952	1508189952	1	1	RANDOLPH, JULIANNE E DO	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	11064	40	Pediatrics	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
24201	Fee-for-Service	1568514289	1568514289	1	1	REDDY, HARI C MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54222	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
24210	Fee-for-Service	1740675644	1740675644	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17742 BEACH BLVD	SUITE 350	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
24223	Fee-for-Service	1033672605	1033672605	1	1	ROBERTS, DUSTIN G MD	3/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182448	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
24241	Fee-for-Service	1669411054	1669411054	1	1	RELIABLE DIANOSTICS SRV INC	4/4/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	30 N RAYMOND	STE 208	PASADENA	CA	91103	4478	19	06037	34.14631307	-118.1488659	Los Angeles County
24243	Fee-for-Service	1972008670	1972008670	1	1	RAJMOHAN, RAVI MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	164229	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
24257	Fee-for-Service	1114058740	1114058740	1	1	REDD, IYASHEMA LMFT	1/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
24282	Fee-for-Service	1881749026	1881749026	1	1	RUELAZ, ROBERT A MD	1/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78097	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1510 S CENTRAL AVE	STE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
24326	Fee-for-Service	1093882953	1093882953	1	1	RODRIGUEZ, JUAN MD	4/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75149	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
24331	Fee-for-Service	1841444874	1841444874	1	1	ROBESON, DEBRA A	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
24350	Fee-for-Service	1639665144	1639665144	1	1	RO, TRACY MD	7/18/2022	207L00000X	NA	Other	026	PHYSICIANS	166749	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
24365	Fee-for-Service	1578610028	1578610028	1	1	RIVERA, ANGEL L MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87828	36	Psychiatry	0	In state provider	None	1465 30TH ST	STE K	SAN DIEGO	CA	92154	3497	37	06073	32.72113554	-117.1302118	San Diego County
24423	Fee-for-Service	1992291439	1992291439	1	1	RAHMAN, TANVIR	9/3/2024	208M00000X	NA	Other	026	PHYSICIANS	174867	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24428	Fee-for-Service	1811706831	1811706831	1	1	RAZO, ALEXANDRA LMFT	2/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1461 FORD ST	202	REDLANDS	CA	92373	3909	36	06071	34.03913285	-117.1563139	San Bernardino County
24437	Fee-for-Service	1134158496	1134158496	1	1	ROSEN, BRADLEY T MD	3/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80006	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
24480	Fee-for-Service	1265451173	1265451173	1	1	RINGMAN, JOHN M MD	5/23/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83793	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA PLAZA DR	STE B200	LOS ANGELES	CA	90024	0000	19	06037	34.06465655	-118.4461	Los Angeles County
24504	Fee-for-Service	1982764916	1982764916	1	1	REED, ANALISA R	10/17/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
24508	Fee-for-Service	1447819131	1447819131	1	1	ROMERO, ISABELLA PSYD	3/14/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
24526	Fee-for-Service	1407855240	1407855240	1	22	ROCKY MOUNTAIN HOLDINGS, LLC	8/21/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	4980 CITY CENTER BLVD	None	NORTH PORT	FL	34286	8037	00	None	27.073782	-82.2082275	Sarasota County
24568	Fee-for-Service	1558360628	1558360628	1	1	RUPP, ROBERT E MD	2/8/2015	2251X0800X	NA	Physical Therapist	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	RUPP MEDICAL CORPORTION	212 ELKS POINT RD	STE 200	ZEPHYR COVE	NV	89448	9800	00	None	38.98585115	-119.9417018	Douglas County
24575	Fee-for-Service	1194834424	1194834424	1	2	REYES, ARJUN C	12/22/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	77173	-	NOT APPLICABLE	0	In state provider	None	4380 APRICOT RD	None	SIMI VALLEY	CA	93063	2317	56	06111	34.28074854	-118.709793	Ventura County
24588	Fee-for-Service	1194920108	1194920108	1	1	ROLLINS, RAQUEL A LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52555	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
24605	Fee-for-Service	1043521487	1043521487	1	1	RIZVI, ASIM A MD	4/14/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	123831	None	None	0	In state provider	None	3535 WEST COMMONWEALTH A	None	FULLERTON	CA	92833	2821	30	06059	33.8700505	-117.9749565	Orange County
24629	Fee-for-Service	1386293751	1386293751	1	1	RMD SERVICES INC	10/29/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	606 GLACIER WAY	None	OAKLEY	CA	94561	5208	07	06013	37.98239089	-121.6851838	Contra Costa County
24693	Fee-for-Service	1225011794	1225011794	1	1	RICHARDS, JOHN C MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55548	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10956 DONNER PASS RD	STE 360	TRUCKEE	CA	96161	4861	29	06057	39.32625521	-120.2012059	Nevada County
24746	Fee-for-Service	1306400361	1306400361	1	1	ROTEFF, PEYTON M MD	2/22/2024	390200000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
24801	Fee-for-Service	1932465010	1932465010	1	1	ROBERT BLAKELY	3/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
24802	Fee-for-Service	1740216654	1740216654	2	1	REID, JANELL D	6/28/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	12791 NEWPORT AVE	SUITE 101	TUSTIN	CA	92780	2785	30	06059	33.75168784	-117.808677	Orange County
24822	Fee-for-Service	1942238852	1942238852	1	1	ROSA, JOSEPH III MD	8/31/1989	207L00000X	NA	Other	026	PHYSICIANS	66856	02	General Surgery	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
24829	Fee-for-Service	1922277078	1922277078	1	1	RHEE, JIN-SAE MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104225	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
24843	Fee-for-Service	1740477074	1740477074	1	1	RUDRAPATNA, VIVEK S MD	2/16/2011	207R00000X	NA	Other	026	PHYSICIANS	113280	41	Internal Medicine	0	In state provider	None	355 ABBOTT ST	STE 100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
24852	Fee-for-Service	1457963910	1457963910	1	1	ROUFAIL, MAREENA OD	7/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24857	Fee-for-Service	1164292744	1164292744	1	1	ROBERTS, JASMINE LCSW	3/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14726 RAMONA AVE	#E10	CHINO	CA	91710	5730	36	06071	33.98583108	-117.7064762	San Bernardino County
24868	Fee-for-Service	1982824405	1982824405	1	1	ROSS, LAURA R NP	5/27/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27350 IRIS AVENUE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
24914	Fee-for-Service	1578516829	1578516829	1	2	RADIOLOGY MEDICAL GROUP	4/1/1999	207U00000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
24919	Fee-for-Service	1740212356	1740212356	1	1	RIVERA, AILENE B PT	6/3/2023	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10515 BALBOA BLVD	285	GRANADA HILLS	CA	91344	6343	19	06037	34.261497	-118.502318	Los Angeles County
24920	Fee-for-Service	1720289374	1720289374	1	1	RAKOSKI, MINA O MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96170	10	Gastroenterology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
24926	Fee-for-Service	1750828331	1750828331	1	1	RAHMAN, SHAHED S MD INC	1/2/2017	207L00000X	NA	Other	026	PHYSICIANS	91768	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
24970	Fee-for-Service	1104057231	1104057231	1	1	RODGER, DAMIEN C MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114719	18	Ophthalmology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
24987	Fee-for-Service	1700314804	1700314804	1	1	ROBERTS, EMILY V CCC-SLP	8/1/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1972 DEL PASO RD	SUITE 156	SACRAMENTO	CA	95834	7724	34	06067	38.654703	-121.505949	Sacramento County
25012	Fee-for-Service	1023192721	1023192721	1	2	REYZELMAN, ALEXANDER DPM	8/12/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2299 POST ST	STE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
25043	Fee-for-Service	1578611513	1578611513	1	1	RAMIREZ, DESIREE R MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96684	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
25062	Fee-for-Service	1407143936	1407143936	1	1	ROBLES, STEVEN DO	8/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1409 E LAKE MEAD BLVD	None	N LAS VEGAS	NV	89030	7120	00	None	36.19579448	-115.1228925	Clark County
25070	Fee-for-Service	1275103202	1275103202	1	1	ROZYCKI, MADISON M CCC-SLP	2/13/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
25072	Fee-for-Service	1063457380	1063457380	1	2	REID HOSPITAL & HEALTHCARE	12/27/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES INC	1100 REID PARKWAY	None	RICHMOND	IN	47274	1157	00	None	39.864753	-84.884274	Wayne County
25105	Fee-for-Service	1104197177	1104197177	1	1	RICHARDSON, RACHEL M PSYD	5/18/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
25123	Fee-for-Service	1710460639	1710460639	1	1	ROJAS, JENNAFER LMFT	9/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
25149	Fee-for-Service	1003975699	1003975699	1	1	REISINGER, DIANE M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83712	07	Dermatology	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
25158	Fee-for-Service	1760669022	1760669022	1	1	RAFII, ROKHSARA MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104223	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
25207	Fee-for-Service	1720289374	1720289374	1	1	RAKOSKI, MINA O MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96170	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
25265	Fee-for-Service	1700220746	1700220746	1	1	REINHACKEL, CHRISTOPHER M MD	3/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
25282	Fee-for-Service	1205648904	1205648904	1	1	RODRIGUEZ, DIANE NP	3/17/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
25299	Fee-for-Service	1215053574	1215053574	1	1	ROWE, JEFFREY K MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54055	36	Psychiatry	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25316	Fee-for-Service	1013952654	1013952654	1	1	RINCON, FRANCISCO I MD	2/28/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45411	40	Pediatrics	0	In state provider	None	414 N BOYLE AVE	None	LOS ANGELES	CA	90033	2410	19	06037	34.05043205	-118.2180396	Los Angeles County
25319	Fee-for-Service	1346741980	1346741980	1	1	ROWLEYTYLER RAY, CPO	12/11/2017	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1844 SOUTH STREET	None	REDDING	CA	96001	1809	45	06089	40.57937643	-122.3951239	Shasta County
25345	Fee-for-Service	1356413157	1356413157	1	1	RAO, NAYANATARA V MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72519	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
25350	Fee-for-Service	1306169388	1306169388	1	1	REDDY, BINDUSAGAR MD INC	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48170	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	579 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06956759	-119.0299875	Tulare County
25355	Fee-for-Service	1063457380	1063457380	1	2	REID HOSPITAL & HEALTHCARE	3/27/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES INC	1100 REID PARKWAY	None	RICHMOND	IN	47274	1157	00	None	39.864753	-84.884274	Wayne County
25358	Fee-for-Service	1184675688	1184675688	1	1	ROVZAR, MICHAEL A MD	10/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53398	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
25359	Fee-for-Service	1023033081	1023033081	1	1	RUSSO, JENNEFER A MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82067	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
25374	Fee-for-Service	1477601375	1477601375	1	1	RUBIO, CYNTHIA F MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86814	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25382	Fee-for-Service	1538295993	1538295993	1	1	RSCR CALIFORNIA, INC	2/9/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1603 W CRIS AVE	None	ANAHEIM	CA	92802	2417	30	06059	33.8090716	-117.9372168	Orange County
25414	Fee-for-Service	1871541953	1871541953	1	1	REGENTS OF THE UNIVERSITY OF	11/17/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
25431	Fee-for-Service	1184708554	1184708554	1	1	ROSS, MELVYN B MD	8/1/2001	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	34100	06	Cardiovascular Disease (M.D. only)	0	In state provider	MELVYN B ROSS MD INC	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
25434	Fee-for-Service	1326824129	1326824129	1	1	RED-WHITE AND BLUE CHARITY	10/29/2024	261QC1500X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	1825 GRANT ST	None	SAN MATEO	CA	94402	2655	41	06081	37.55397048	-122.3021756	San Mateo County
25442	Fee-for-Service	1467895169	1467895169	1	1	RACHAKONDA, VARUN M MD	7/22/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151973	None	None	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
25467	Fee-for-Service	1467582445	1467582445	2	1	ROBERTSON CHIROPRACTIC INC	3/11/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	5649 N PALM AVE	None	FRESNO	CA	93704	3202	10	06019	36.82032099	-119.8084596	Fresno County
25499	Fee-for-Service	1821250481	1821250481	1	1	REED, EBONIE LMFT	7/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5055 CANYON CREST DR	None	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
25500	Fee-for-Service	1699814533	1699814533	1	1	RECHDOUNI, AIDA K MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72786	22	Pathology (M.D. only)	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
25504	Fee-for-Service	1013030402	1013030402	1	1	RICO, OSCAR W MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	44703	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
25579	Fee-for-Service	1598323750	1598323750	1	1	REGALADO SELLERS, SCARLETT	11/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	71687 HIGHWAY 111	SUITE 205	RANCHO MIRAGE	CA	92270	4515	33	06065	33.74279697	-116.4137932	Riverside County
25598	Fee-for-Service	1003062613	1003062613	1	1	RABINOV, ANNA MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122391	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
25624	Fee-for-Service	1184672040	1184672040	1	1	ROTHMAN, MARC D MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103743	41	Internal Medicine	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
25632	Fee-for-Service	1881889301	1881889301	1	1	RIOS, DAVID A MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97514	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
25649	Fee-for-Service	1184675688	1184675688	1	1	ROVZAR, MICHAEL A MD	10/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53398	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
25666	Fee-for-Service	1447367388	1447367388	1	1	REDDY, ALYSSA T MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156378	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
25698	Fee-for-Service	1871541953	1871541953	1	1	REGENTS OF THE UNIVERSITY OF	10/30/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
25719	Fee-for-Service	1184708554	1184708554	1	1	ROSS, MELVYN B MD	8/1/2001	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	34100	41	Internal Medicine	0	In state provider	MELVYN B ROSS MD INC	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
25722	Fee-for-Service	1265476501	1265476501	1	1	RABBANI, GITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
25729	Fee-for-Service	1225354145	1225354145	1	1	RIOJAS, RAMON A MD	12/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	158735	02	General Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
25735	Fee-for-Service	1285615567	1285615567	1	1	ROMAN, SANZIANA A MD	4/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154676	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
25740	Fee-for-Service	1720366024	1720366024	1	1	RYAN, ROBERT W J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116656	14	Neurological Surgery	0	In state provider	None	2335 E KASHIAN LANE	#301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
25780	Fee-for-Service	1184887010	1184887010	1	1	RODRIGUEZ, KATHERINE	9/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
25785	Fee-for-Service	1376553008	1376553008	1	1	RUCKER, BURNETT MD	6/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34349	08	Family Practice	0	In state provider	None	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	19	06037	34.58013142	-118.0898273	Los Angeles County
25786	Fee-for-Service	1629074364	1629074364	1	1	RHEE, JAMES MD	9/4/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	85069	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
25788	Fee-for-Service	1669645594	1669645594	1	1	RANDALL, MELANIE M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109645	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	0000	33	06065	33.912117	-117.195849	Riverside County
25837	Fee-for-Service	1750478160	1750478160	1	1	RESPIRATORY CONSULTANTS	2/28/1988	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF SANTA MONICA, MED GRP	1301 20TH ST	STE 360	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
25852	Fee-for-Service	1871663401	1871663401	1	1	REE, PETER C MD	7/6/2005	2085R0001X	NA	Other	026	PHYSICIANS	29884	30	Radiology	0	In state provider	MEDICAL CLINIC INC	11480 BROOKSHIRE AVE	STE 100	DOWNEY	CA	90241	5022	19	06037	33.93622932	-118.1311752	Los Angeles County
25854	Fee-for-Service	1487756532	1487756532	1	1	RICHARD CHARLES BATZ,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	0000	00	None	32.812245	-96.841584	Dallas County
25869	Fee-for-Service	1164434676	1164434676	1	1	RHEE, EDWARD DPM	7/16/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	966 S WESTERN AVE	205	LOS ANGELES	CA	90006	1015	19	06037	34.053777	-118.3090505	Los Angeles County
25881	Fee-for-Service	1053759217	1053759217	1	1	REID, CALEB M NP	6/3/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5938 MOURNING DOVE DR	None	JURUPA VALLEY	CA	91752	2934	33	06065	33.98002689	-117.5421739	Riverside County
25889	Fee-for-Service	1154687564	1154687564	1	1	ROOS, JONATHAN D MFT	4/3/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8936 S SEPULVEDA BLVD	SUITE 200	LOS ANGELES	CA	90045	3628	19	06037	33.954957	-118.3961925	Los Angeles County
25906	Fee-for-Service	1962513416	1962513416	1	1	RUGMINI WARRIER MD	2/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S 48TH ST	None	LINCOLN	NE	68506	1283	00	None	40.79662742	-96.65363209	Lancaster County
25953	Fee-for-Service	1093756140	1093756140	1	1	RANDOLPH, ROBERT E MD	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53481	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25960	Fee-for-Service	1669556361	1669556361	1	1	ROLAND, AARON M MD	5/9/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65645	08	Family Practice	0	In state provider	FAMILY CARE ASSOCIATES	1720 EL CAMINO REAL	STE 130	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
25981	Fee-for-Service	1043424153	1043424153	1	1	RICHARDS, MOLLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTIVEW BLVD	None	AURORA	CO	80045	1719	00	None	39.748041	-104.834673	Adams County
25987	Fee-for-Service	1871541953	1871541953	1	1	REGENTS OF THE UNIVERSITY OF	2/23/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26014	Fee-for-Service	1255623336	1255623336	1	1	REISH, JOSHUA J LMFT	2/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
26036	Fee-for-Service	1477710358	1477710358	1	1	ROSS, MELISSA M MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108656	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
26038	Fee-for-Service	1972189058	1972189058	1	1	RIVERA, CATHERINE C	4/27/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	20035 HOLLY DR	None	SANTA CLARITA	CA	91350	5702	19	06037	34.44479409	-118.4875511	Los Angeles County
26046	Fee-for-Service	1023024783	1023024783	1	1	RAPP, LYLE R LMFT	8/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17772 IRVINE BLVD	STE 102	TUSTIN	CA	92780	3233	30	06059	33.74824746	-117.8220736	Orange County
26063	Fee-for-Service	1891715041	1891715041	1	1	RAO, RAJEEV K MD	5/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79290	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
26073	Fee-for-Service	1376553008	1376553008	1	1	RUCKER, BURNETT MD	6/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34349	01	General Practice	0	In state provider	None	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	19	06037	34.58013142	-118.0898273	Los Angeles County
26086	Fee-for-Service	1316018054	1316018054	1	1	REYES, JORGE E LCSW	12/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23550 LYONS AVE	SUITE 211	NEWHALL	CA	91321	2520	19	06037	34.37938495	-118.5458635	Los Angeles County
26116	Fee-for-Service	1801979299	1801979299	1	1	RACU, CAMELLIA MD	6/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107797	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
26127	Fee-for-Service	1750478160	1750478160	1	1	RESPIRATORY CONSULTANTS	2/28/1988	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OF SANTA MONICA, MED GRP	1301 20TH ST	STE 360	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
26157	Fee-for-Service	1285622639	1285622639	1	1	RALICK, VERONICA M OD	1/16/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 COFFEE ROAD	None	MODESTO	CA	95355	1161	50	06099	37.69158077	-120.9761536	Stanislaus County
26166	Fee-for-Service	1235471798	1235471798	1	1	ROGUEL, ARNOLD S	7/18/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	SUITE 120	HUNTINGTON BEACH	CA	92648	2030	30	06059	33.69070037	-117.9886896	Orange County
26169	Fee-for-Service	1053759217	1053759217	1	1	REID, CALEB M NP	6/3/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5938 MOURNING DOVE DR	None	JURUPA VALLEY	CA	91752	2934	33	06065	33.98002689	-117.5421739	Riverside County
26193	Fee-for-Service	1396813374	1396813374	1	2	RAIBLE, LYN H MD	10/6/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	74921	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVE	STE A, B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
26196	Fee-for-Service	1689884504	1689884504	1	1	RIALTO UNIFIED SCHOOL	10/11/2011	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	815 SOUTH WILLOW AVENUE	None	RIALTO	CA	92376	6934	36	06071	34.08651162	-117.3745828	San Bernardino County
26216	Fee-for-Service	1811042047	1811042047	1	1	RAMAMURTHI,RADHAMANGALA	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96327	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
26233	Fee-for-Service	1922206705	1922206705	1	1	RAOFI, BAHRAM MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50943	30	Radiology	0	In state provider	None	3320 N LOS COYOTES DIAGO	None	LONG BEACH	CA	90808	3918	19	06037	33.8173793	-118.1104908	Los Angeles County
26246	Fee-for-Service	1497990790	1497990790	1	1	ROBINSON, MELISSA A LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
26285	Fee-for-Service	1699078030	1699078030	1	7	RIDGE EYE CARE INC	10/5/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 S HARDING BLVD	None	ROSEVILLE	CA	95678	3360	31	06061	38.74341053	-121.2730868	Placer County
26325	Fee-for-Service	1972189058	1972189058	1	1	RIVERA, CATHERINE C	4/27/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	20035 HOLLY DR	None	SANTA CLARITA	CA	91350	5702	19	06037	34.44479409	-118.4875511	Los Angeles County
26331	Fee-for-Service	1457740334	1457740334	1	1	RAYMOND, SUSAN MD	5/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169864	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
26334	Fee-for-Service	1295981512	1295981512	1	1	ROBY, JASON L DO	7/15/2019	207P00000X	NA	Other	026	PHYSICIANS	17183	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
26340	Fee-for-Service	1922436336	1922436336	1	1	RASKOFF, JOSHUA PT	6/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
26349	Fee-for-Service	1164067971	1164067971	1	1	RIDGECREST REGIONAL HOSPITAL	5/23/2023	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 220	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
26415	Fee-for-Service	1689940694	1689940694	1	1	REDDY, SWAYTA M MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130077	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
26416	Fee-for-Service	1750478160	1750478160	1	1	RESPIRATORY CONSULTANTS	2/28/1988	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	OF SANTA MONICA, MED GRP	1301 20TH ST	STE 360	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
26434	Fee-for-Service	1083749238	1083749238	1	1	REIMAGINE NETWORK	11/8/1996	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	OF SOUTHERN CALIFORNIA	130 LAGUNA RD	None	FULLERTON	CA	92835	3614	30	06059	33.89323144	-117.9301527	Orange County
26436	Fee-for-Service	1932203536	1932203536	1	1	RUPLEY, KATHRYNE F DPM	8/18/2003	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2451 E SHIELDS AVE	STE 101	FRESNO	CA	93726	6526	10	06019	36.77978448	-119.782035	Fresno County
26544	Fee-for-Service	1770539306	1770539306	1	1	RENARD, THOMAS H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 W PLANO PKWY	STE 200	PLANO	TX	75075	8934	00	None	33.006996	-96.714072	Collin County
26571	Fee-for-Service	1699078030	1699078030	1	7	RIDGE EYE CARE INC	10/5/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	100 S HARDING BLVD	None	ROSEVILLE	CA	95678	3360	31	06061	38.74341053	-121.2730868	Placer County
26595	Fee-for-Service	1821243478	1821243478	1	1	RIVERA, MIDORI MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	96799	01	General Practice	0	In state provider	None	860 W VALLEY PKWY	STE 150	ESCONDIDO	CA	91702	2801	37	06073	33.1175634	-117.0952973	San Diego County
26604	Fee-for-Service	1366976896	1366976896	1	1	ROBERTS, JEFFREY MD	10/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176141	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
26708	Fee-for-Service	1962961276	1962961276	1	1	RUSCONI-RODRIGUES, YASH MD	7/26/2022	207R00000X	NA	Other	026	PHYSICIANS	178511	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
26760	Fee-for-Service	1871218685	1871218685	1	1	RANDHAWA, RAMANDEEP K NP	12/21/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
26779	Fee-for-Service	1427687680	1427687680	1	1	RIVERA, NATALIE MD	8/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	192170	15	Obstetrics (D.O. only)	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
26799	Fee-for-Service	1366465130	1366465130	1	1	RODRIGUES, BERNICE M MD	2/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78705	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
26806	Fee-for-Service	1649727116	1649727116	1	1	RIVAS, YAMILETH D LMFT	3/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
26856	Fee-for-Service	1558843326	1558843326	1	1	REEDAL, JENNIFER A CRNA	11/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1365	10	06019	36.7423511	-119.7834688	Fresno County
26867	Fee-for-Service	1417975491	1417975491	1	1	ROBINSON, WILLIAM H MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63606	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
26912	Fee-for-Service	1235248683	1235248683	1	1	RITE AID #6342	2/11/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1590 BUTTE HOUSE RD	None	YUBA CITY	CA	95993	2237	51	06101	39.14777049	-121.6430867	Sutter County
26931	Fee-for-Service	1124231972	1124231972	1	1	ROSEN, RUTH MD	11/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53110	None	None	0	In state provider	None	869 CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
26996	Fee-for-Service	1134270952	1134270952	1	1	ROMOLAND SCHOOL DISTRICT	1/26/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	25900 LEON RD	None	HOMELAND	CA	92548	9141	33	06065	33.74476996	-117.1191331	Riverside County
27004	Fee-for-Service	1174689590	1174689590	2	1	ROSTON, WARREN L MD	9/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	41613	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 1006	LOS ANGELES	CA	90067	2013	19	06037	34.05887194	-118.4122914	Los Angeles County
27011	Fee-for-Service	1164747853	1164747853	2	1	RAY, JEREMIAH W MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142024	01	General Practice	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
27055	Fee-for-Service	1952408007	1952408007	1	1	RYAN, COLLEEN M MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133544	01	General Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
27070	Fee-for-Service	1396198958	1396198958	1	2	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NTER	3441 MARYSVILLE BLVD	None	SACRAMENTO	CA	95838	4512	34	06067	38.631231	-121.431402	Sacramento County
27084	Fee-for-Service	1982624144	1982624144	1	1	RASHEED, AMJAD A MD	9/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76606	30	Radiology	0	In state provider	None	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
27108	Fee-for-Service	1902497266	1902497266	1	1	RUJJU CONSULTANTS LLC	11/14/2022	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	4650 HOEN AVE	None	SANTA ROSA	CA	95405	9407	49	06097	38.441034	-122.665257	Sonoma County
27140	Fee-for-Service	1295072049	1295072049	1	1	RENAISSANCE ASC, LLC	4/21/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	44139 MONTEREY AVE	SUITE B	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
27143	Fee-for-Service	1821273038	1821273038	1	1	RICHARD S. MONTGOMERY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
27155	Fee-for-Service	1417975491	1417975491	1	1	ROBINSON, WILLIAM H MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63606	83	Rheumatology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
27159	Fee-for-Service	1598120594	1598120594	1	1	RODRIGUEZ, MAGALI LCSW	6/27/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
27161	Fee-for-Service	1063473767	1063473767	1	1	ROBERT M REYNOLDS MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	420 WATER ST	STE 105B	KERRVILLE	TX	78028	5200	00	None	30.04925326	-99.14422258	Kerr County
27179	Fee-for-Service	1083792162	1083792162	1	1	RAHN, CYNTHIA L MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61222	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
27239	Fee-for-Service	1174763924	1174763924	1	1	RODRIGUEZ, DAVIDA E LMFT	4/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
27269	Fee-for-Service	1629647623	1629647623	1	1	ROSELLINI, BENJAMIN D MD	4/11/2025	207L00000X	NA	Other	026	PHYSICIANS	191474	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
27284	Fee-for-Service	1871525675	1871525675	1	1	REDIGER, JEFFREY D MD	4/1/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
27291	Fee-for-Service	1174689590	1174689590	2	1	ROSTON, WARREN L MD	9/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	41613	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1006	LOS ANGELES	CA	90067	2013	19	06037	34.05887194	-118.4122914	Los Angeles County
27300	Fee-for-Service	1164747853	1164747853	2	1	RAY, JEREMIAH W MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142024	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
27317	Fee-for-Service	1710441993	1710441993	1	2	REDWOOD COUNSELING A LICENSE	12/14/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	D CLINICAL SOCIAL WORKER	8580 UTICA AVE	200	RANCHO CUCAMONGA	CA	91730	4870	36	06071	34.097355	-117.5730075	San Bernardino County
27343	Fee-for-Service	1376012278	1376012278	1	1	RIX, LISA R LCSW	3/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2830 G ST	SUITE C-2	EUREKA	CA	95501	4446	12	06023	40.78218776	-124.1624709	Humboldt County
27348	Fee-for-Service	1558328211	1558328211	1	1	ROSBE, KRISTINA W MD	12/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85659	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	STE A730	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
27374	Fee-for-Service	1265504914	1265504914	1	1	RAMAKRISHNAN, NALINI MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37590	40	Pediatrics	0	In state provider	None	1580 VALENCIA ST	None	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
27394	Fee-for-Service	1982946323	1982946323	1	1	RICHARD PARK M.D., A PROFESS	5/17/2024	193200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10515 BALBOA BLVD	STE 325	GRANADA HILLS	CA	91344	6364	19	06037	34.261497	-118.502318	Los Angeles County
27406	Fee-for-Service	1154330389	1154330389	1	1	ROGERO, GRANT W	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63582	30	Radiology	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
27448	Fee-for-Service	1366585986	1366585986	1	1	ROBINSON, TED MD	1/5/2024	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	43357	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
27470	Fee-for-Service	1356529093	1356529093	1	1	ROE, ROCHELLE W	3/26/2014	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	STE 100	IRVINE	CA	92618	3186	30	06059	33.66719598	-117.7642461	Orange County
27594	Fee-for-Service	1548252836	1548252836	1	1	RODRIGUEZ, ROBERTO L MD	11/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	88020	None	None	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
27605	Fee-for-Service	1710441993	1710441993	1	1	REDWOOD COUNSELING A LICENSE	5/27/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	D CLINICAL SOCIAL WORKER	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
27618	Fee-for-Service	1164124400	1164124400	1	1	ROSON PHARMACY INC	4/26/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9323 CHESAPEAKE DR	SUITE C1	SAN DIEGO	CA	92123	1044	37	06073	32.83752409	-117.128055	San Diego County
27620	Fee-for-Service	1427041698	1427041698	1	2	REGENTS/UCDPBG/SUR VASCU	4/13/2021	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
27632	Fee-for-Service	1063523330	1063523330	1	1	RALPH, LEE P MD	9/30/1988	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	66851	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
27656	Fee-for-Service	1962218024	1962218024	1	1	RADWAN P C	1/25/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
27683	Fee-for-Service	1982946323	1982946323	1	1	RICHARD PARK M.D., A PROFESS	5/17/2024	193200000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	10515 BALBOA BLVD	STE 325	GRANADA HILLS	CA	91344	6364	19	06037	34.261497	-118.502318	Los Angeles County
27712	Fee-for-Service	1740351543	1740351543	1	2	RUNYAN, STEPHANIE D DO	7/26/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	12443	30	Radiology	0	In state provider	None	29101 HOSPTIAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
27751	Fee-for-Service	1073777249	1073777249	1	1	RAGHURAM RAO M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1833 N POWER RD	None	MESA	AZ	85205	3799	00	None	33.449229	-111.6835875	Maricopa County
27773	Fee-for-Service	1467943464	1467943464	1	1	RIGELHAUPT, GAIL LMFT	7/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34165	-	NOT APPLICABLE	0	In state provider	None	1916 CHURCH LN	None	SAN PABLO	CA	94806	3708	07	06013	37.95741415	-122.3414778	Contra Costa County
27776	Fee-for-Service	1972681047	1972681047	1	1	ROYAI, RAMIN A MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84507	34	Urology and Urological Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
27805	Fee-for-Service	1417255761	1417255761	1	1	RECOVERY DME INC	1/29/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9449 BALBOA AVE	STE 110	SAN DIEGO	CA	92123	4336	37	06073	32.8221995	-117.1264275	San Diego County
27807	Fee-for-Service	1578889176	1578889176	1	1	READ, KRISTEL R	7/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
27839	Fee-for-Service	1770764243	1770764243	1	1	RAGOSTA, LORRAINE T LMFT	8/2/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48893	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
27899	Fee-for-Service	1710441993	1710441993	1	1	REDWOOD COUNSELING A LICENSE	1/2/2022	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	D CLINICAL SOCIAL WORKER	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
27912	Fee-for-Service	1427041698	1427041698	1	2	REGENTS/UCDPBG/SUR VASCU	5/1/1999	2086S0129X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
27945	Fee-for-Service	1023696440	1023696440	1	1	RAO, ADAM MD	6/28/2024	207R00000X	NA	Other	026	PHYSICIANS	184749	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
27946	Fee-for-Service	1992867899	1992867899	1	1	REYES, MYRA J CRNA	10/19/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
27966	Fee-for-Service	1871537035	1871537035	1	1	ROSS, KATHRYN A MD	10/1/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	42979	66	Emergency Medicine (Urgent Care)	0	In state provider	None	361 HOSPITAL RD	STE 331	NEWPORT BEACH	CA	92663	3524	30	06059	33.62579141	-117.9299554	Orange County
27972	Fee-for-Service	1942631460	1942631460	1	1	RIOS, JAVIER DR AMC	3/7/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	21091 RIDER ST	SUITE 218	PERRIS	CA	92570	8878	33	06065	33.8298049	-117.2941212	Riverside County
27977	Fee-for-Service	1508262742	1508262742	1	1	RODRIGUEZ, JOSHUA J	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24671 MONROE AVE	#101C	MURRIETA	CA	92562	2527	33	06065	33.56694181	-117.2021151	Riverside County
27986	Fee-for-Service	1053323923	1053323923	1	1	RAJ, VIKRAM DO	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	15793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
27999	Fee-for-Service	1366433682	1366433682	1	1	ROKEACH, MICHAEL H MD	12/31/1987	207P00000X	NA	Other	026	PHYSICIANS	28302	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
28017	Fee-for-Service	1700828019	1700828019	1	1	ROMERO, HOWARD R MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	6432	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
28064	Fee-for-Service	1477564136	1477564136	1	1	ROCKICH, FABRICE PT	9/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 S MERCEY SPRINGS RD	STE I	LOS BANOS	CA	93635	4928	24	06047	37.054854	-120.835392	Merced County
28090	Fee-for-Service	1669748158	1669748158	1	1	RITZENBERG, MAXIM L MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128625	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
28095	Fee-for-Service	1720101645	1720101645	1	2	RAGLAND, HOWARD K MD	11/23/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51837	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1511 S VERMONT AVE	2	LOS ANGELES	CA	90006	4505	19	06037	34.044921	-118.2916365	Los Angeles County
28151	Fee-for-Service	1588785919	1588785919	1	1	RABIDEAUX, LEIGH D CNP	8/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
28165	Fee-for-Service	1356503478	1356503478	1	1	ROBERT HANNA	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	37000 N GANTZEL RD	None	QUEEN CREEK	AZ	85140	7303	00	None	33.21531	-111.565503	Pinal County
28183	Fee-for-Service	1710441993	1710441993	1	1	REDWOOD COUNSELING A LICENSE	12/17/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	D CLINICAL SOCIAL WORKER	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
28189	Fee-for-Service	1134476005	1134476005	1	1	ROJAS, JANEEN A NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
28194	Fee-for-Service	1972568400	1972568400	1	1	RHOADES, PATRICK N MD	4/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51949	25	Physical Medicine and Rehabilitation	0	In state provider	CNTRL VLLY PAIN MNGMT &	1300 MABLE AVE	STE 2	MODESTO	CA	95355	1120	50	06099	37.69607582	-120.9757068	Stanislaus County
28278	Fee-for-Service	1407855240	1407855240	1	21	ROCKY MOUNTAIN HOLDINGS, LLC	6/5/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	515 RODEO ROAD	None	WILLIAMS	AZ	86046	0000	00	None	35.25789313	-112.1887407	Coconino County
28295	Fee-for-Service	1528146214	1528146214	1	1	RETODO, ANTHONY G MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
28301	Fee-for-Service	1134124431	1134124431	1	1	RICHMOND AMBULANCE AUTHORITY	6/6/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2400 HERMITAGE RD	None	RICHMOND	VA	23260	0000	00	None	37.56518795	-77.4605043	Richmond city
28382	Fee-for-Service	1508801499	1508801499	1	1	ROMERO-URQUHART GLENDA L	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72018	None	None	0	In state provider	MD	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
28385	Fee-for-Service	1285163949	1285163949	1	1	REJUVENEXT, INC	1/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2211 MOORPARK AVE	SUITE 250	SAN JOSE	CA	95128	2656	43	06085	37.31613943	-121.9326665	Santa Clara County
28428	Fee-for-Service	1467781401	1467781401	1	1	RYDEN, JENIFER	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
28467	Fee-for-Service	1710441993	1710441993	1	2	REDWOOD COUNSELING A LICENSE	7/10/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	D CLINICAL SOCIAL WORKER	8580 UTICA AVE	200	RANCHO CUCAMONGA	CA	91730	4870	36	06071	34.097355	-117.5730075	San Bernardino County
28521	Fee-for-Service	1245773860	1245773860	1	1	ROBERTS, KANIKA A LCSW	1/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
28565	Fee-for-Service	1558407460	1558407460	1	1	RYAN, ROMNEY B PHD	3/15/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
28569	Fee-for-Service	1194897645	1194897645	1	1	RASTOGI, SACHIN MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94294	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
28588	Fee-for-Service	1528146214	1528146214	1	1	RETODO, ANTHONY G MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79352	41	Internal Medicine	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
28594	Fee-for-Service	1184603417	1184603417	1	1	ROSBRUGH, JAMES MD	1/10/1996	207P00000X	NA	Other	026	PHYSICIANS	81127	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PLAZA DR	None	SANTA MARIA	CA	93454	6907	42	06083	34.93736276	-120.4298781	Santa Barbara County
28611	Fee-for-Service	1871819284	1871819284	1	1	RAMANI, HAMI DO	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13128	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
28616	Fee-for-Service	1750363404	1750363404	1	1	RENEAU, JOHN D MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	25	Physical Medicine and Rehabilitation	1	Border provider	None	501 S RANCHO DR	STE I-67	LAS VEGAS	NV	89106	4862	00	None	36.16564978	-115.1725191	Clark County
28623	Fee-for-Service	1699977934	1699977934	1	1	ROBINSON, PICOLYA K PSYD	4/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
28656	Fee-for-Service	1114032208	1114032208	1	1	ROMERO, JESUSA N MD APC	10/4/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34299	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3100 E FLORENCE AVE	STE 5	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
28697	Fee-for-Service	1376580597	1376580597	1	1	RAYMOND M VILLALOBOS M.D.	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 WASHINGTON ST	None	BOSTON	MA	02111	1552	00	None	42.349662	-71.063514	Suffolk County
28707	Fee-for-Service	1437205051	1437205051	1	1	RAVITZ, RISA M MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99684	08	Family Practice	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
28710	Fee-for-Service	1366166464	1366166464	1	1	RAYBON, JESSICA C LMFT	11/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1115 TORO ST	SUITE F	SAN LUIS OBISPO	CA	93401	3321	40	06079	35.28254633	-120.6576679	San Luis Obispo County
28714	Fee-for-Service	1174514491	1174514491	1	1	ROOKE, CHRISTOPHER T MD	8/31/1992	207P00000X	NA	Other	026	PHYSICIANS	75204	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
28720	Fee-for-Service	1871912808	1871912808	1	1	RICE, BRITTANY DPM	12/31/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
28730	Fee-for-Service	1396969341	1396969341	1	1	ROBERTS, THOMAS E LMFT	11/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	549 ISLA PLACE	None	DAVIS	CA	95616	0136	57	06113	38.56962259	-121.7564486	Yolo County
28780	Fee-for-Service	1174040661	1174040661	1	1	RODRIGUEZ, ANTONIA	11/1/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1345 OLIVE STREET	None	SANGER	CA	93657	3432	10	06019	36.69612878	-119.5553478	Fresno County
28792	Fee-for-Service	1578696217	1578696217	1	1	ROGERS, RICHARD R PHD	9/19/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 FIRST ST.	STE 242	CLAREMONT	CA	91711	4736	19	06037	34.09450024	-117.7183344	Los Angeles County
28805	Fee-for-Service	1225262975	1225262975	1	1	RITTER, MICHELE L MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112536	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
28807	Fee-for-Service	1568511913	1568511913	1	1	RYAN, MICHELLE A MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	57030	41	Internal Medicine	0	In state provider	None	10861 CHERRY ST	STE 302	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
28809	Fee-for-Service	1063693885	1063693885	1	1	REHABILITATION MANAGEMENT SY	4/22/2024	174400000X	NA	Other	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	STEMS	648 NORTHFIELD DR	None	SACRAMENTO	CA	95833	2442	34	06067	38.607786	-121.47723	Sacramento County
28823	Fee-for-Service	1356736672	1356736672	1	1	RAJAN, JAY S MD	6/24/2020	207L00000X	NA	Other	026	PHYSICIANS	146140	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
28829	Fee-for-Service	1659301935	1659301935	1	1	RECOVERCARE THERAPY GROUP, I	6/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NESS PROGRAM	13330 BLOOMFIELD AVE	STE 101	NORWALK	CA	90650	3259	19	06037	33.90988905	-118.0644875	Los Angeles County
28840	Fee-for-Service	1669734653	1669734653	1	2	RIDGECREST REGIONAL HOSPITAL	12/13/2016	273Y00000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1131 N CHINA BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640981	-117.672714	Kern County
28873	Fee-for-Service	1588846380	1588846380	1	2	RANADIVE, SAYALI A MD	8/16/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	85619	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
28908	Fee-for-Service	1952368029	1952368029	1	1	RANDALL L SCOTT MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
28927	Fee-for-Service	1649613456	1649613456	1	1	RETINA MACULA CONSULTANTS OF	6/9/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	90589	18	Ophthalmology	0	In state provider	CALIFORNIA INC	10 CONGRESS STREET	SUITE 502	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
28950	Fee-for-Service	1215171681	1215171681	1	1	RAHEJA, AMIT A MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118538	30	Radiology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
28951	Fee-for-Service	1649490129	1649490129	1	1	REDOUTEY, MARY LMFT	4/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	SUITE 102	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
28996	Fee-for-Service	1457380784	1457380784	1	1	RATTER, MICHAEL L MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	56347	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
29067	Fee-for-Service	1174040661	1174040661	1	1	RODRIGUEZ, ANTONIA	11/1/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1345 OLIVE STREET	None	SANGER	CA	93657	3432	10	06019	36.69612878	-119.5553478	Fresno County
29126	Fee-for-Service	1902231533	1902231533	1	1	RODRIGUEZ, KELLY R LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99917	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
29130	Fee-for-Service	1225328800	1225328800	1	1	ROBINSON, NATALIE L MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125014	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
29160	Fee-for-Service	1588846380	1588846380	1	2	RANADIVE, SAYALI A MD	8/16/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	85619	67	Endocrinology	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
29224	Fee-for-Service	1427039916	1427039916	1	1	RODGERS, VANCE D	1/20/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44433	41	Internal Medicine	0	In state provider	None	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
29239	Fee-for-Service	1568742450	1568742450	1	1	ROBELLO, MICHELLE M MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118079	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
29257	Fee-for-Service	1366630303	1366630303	1	1	RIVAS, FRANK E	6/8/2000	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	463 BREWSTER AVE	SUITE 6	REDWOOD CITY	CA	94063	1783	41	06081	37.4919571	-122.2297604	San Mateo County
29290	Fee-for-Service	1619275203	1619275203	1	1	ROSENBERG, GARY J DO	12/22/2017	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	15694	None	None	0	In state provider	None	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.714	-117.9333585	Orange County
29317	Fee-for-Service	1780116962	1780116962	1	1	ROESSLER, NADIA MD	7/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169259	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
29347	Fee-for-Service	1285793729	1285793729	1	1	RICHEY, MICHAEL D DC	11/7/2005	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	LIVING WELL FAMILY CHIRO	99 LONG CT	STE 103	THOUSAND OAKS	CA	91360	7404	56	06111	34.17738252	-118.8666576	Ventura County
29352	Fee-for-Service	1063504348	1063504348	1	1	RANDHAWA, PRITPAL MD	8/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83324	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
29355	Fee-for-Service	1396198958	1396198958	1	3	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2727 W CAPITOL AVE	None	WEST SACRAMENTO	CA	95691	2220	57	06113	38.57922315	-121.5475869	Yolo County
29443	Fee-for-Service	1386181592	1386181592	1	1	RHODES, ALEXANDRA L LMSW	2/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
29481	Fee-for-Service	1518493097	1518493097	1	1	RADHAKRISHNAN, ARUNA CCC-SL	12/26/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	1261 TRAVIS BLVD	120	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
29492	Fee-for-Service	1588893853	1588893853	1	1	RUFIN-LEW, CLAIRE MD	11/3/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	178410	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
29500	Fee-for-Service	1184018012	1184018012	1	1	REED, LATESHA T NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5970 S CENTRAL AVENUE	None	LOS ANGELES	CA	90001	0000	19	06037	33.985584	-118.256433	Los Angeles County
29502	Fee-for-Service	1467401240	1467401240	1	1	ROBACK, DONALD L MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	22819	None	None	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
29504	Fee-for-Service	1245499656	1245499656	1	1	ROY, SION K MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111005	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
29512	Fee-for-Service	1427039916	1427039916	1	1	RODGERS, VANCE D	1/20/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44433	10	Gastroenterology (M.D. only)	0	In state provider	None	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
29527	Fee-for-Service	1568742450	1568742450	1	1	ROBELLO, MICHELLE M MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118079	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
29531	Fee-for-Service	1437685237	1437685237	1	1	REHMAN, FAISAL MD	12/20/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
29533	Fee-for-Service	1003245358	1003245358	1	1	ROBINSON WOODS, KRISTEN LMF	4/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1543 E PALMDALE BLVD	SUITE K-2	PALMDALE	CA	93550	2000	19	06037	34.57966352	-118.101582	Los Angeles County
29635	Fee-for-Service	1942396940	1942396940	1	1	ROMIG, CHRISTOPHER B MD	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96968	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
29661	Fee-for-Service	1467047753	1467047753	1	1	ROYALKIDS CLINIC	6/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	18 ENDEAVOR	203	IRVINE	CA	92618	3181	30	06059	33.6675519	-117.7622659	Orange County
29663	Fee-for-Service	1275714495	1275714495	1	1	RAO, SEEMA S MD	11/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132855	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
29678	Fee-for-Service	1750394938	1750394938	1	1	RACADIO, JOHN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
29685	Fee-for-Service	1043661143	1043661143	1	1	RESTORATION FAMILY COUNSELIN	9/17/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	G CENTER	141 PARKER ST	None	VACAVILLE	CA	95688	3921	48	06095	38.35806912	-121.9898561	Solano County
29711	Fee-for-Service	1851565006	1851565006	1	1	ROACH, CHRISTOPHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 HILAND AVE	None	BURLEY	ID	83318	0000	00	None	42.53489313	-113.7833899	Cassia County
29733	Fee-for-Service	1245413632	1245413632	1	1	RIOS, FERNANDO LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
29749	Fee-for-Service	1265972806	1265972806	1	1	ROSS, MONICA A LPCC	12/22/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
29771	Fee-for-Service	1184935991	1184935991	1	1	RICE, GABRIEL M MD	9/23/2020	207L00000X	NA	Other	026	PHYSICIANS	169981	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
29780	Fee-for-Service	1235590852	1235590852	1	1	ROWELL, CHARLES A LMFT	4/7/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	56020 SANTA FE TRAIL	None	YUCCA VALLEY	CA	92284	6269	36	06071	34.1193523	-116.4419562	San Bernardino County
29801	Fee-for-Service	1639266141	1639266141	1	1	RODRIGUEZ, EVA B MD INC	6/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33241	40	Pediatrics	0	In state provider	None	1403 LOMITA BLVD	STE 305	HARBOR CITY	CA	90710	2085	19	06037	33.79783692	-118.30188	Los Angeles County
29811	Fee-for-Service	1841486172	1841486172	1	1	RANDHAWA, SANDEEP MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111757	18	Ophthalmology	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
29825	Fee-for-Service	1265878508	1265878508	1	1	RHODES, RACHEL DO	4/7/2025	2084P0804X	NA	Psychiatry	026	PHYSICIANS	23990	36	Psychiatry	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
29826	Fee-for-Service	1225493356	1225493356	1	1	REEKESHRPATELMD INC	5/13/2016	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	126035	25	Physical Medicine and Rehabilitation	0	In state provider	None	1401 S GRAND AVENUE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
29831	Fee-for-Service	1497064463	1497064463	1	1	ROSS, MATTHEW S MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132624	None	None	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
29898	Fee-for-Service	1790798908	1790798908	1	1	ROCKLIN FAMILY PRACTICE AND	3/3/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SPORTS MEDICINE	3104 SUNSET BLVD	STE 2B	ROCKLIN	CA	95677	3093	31	06061	38.78632648	-121.2517479	Placer County
29934	Fee-for-Service	1982849923	1982849923	1	1	RAGHEB, JOSETTE W MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128920	22	Pathology (M.D. only)	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
29938	Fee-for-Service	1356308803	1356308803	1	1	RABBAN, JOSEPH T III MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70912	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
29952	Fee-for-Service	1275714495	1275714495	1	1	RAO, SEEMA S MD	11/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132855	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
29986	Fee-for-Service	1477739605	1477739605	1	1	RICHBURG, DELENE A MD	7/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108842	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
29992	Fee-for-Service	1881758688	1881758688	1	1	RUANE, PETER J MD INC	9/16/2009	193400000X	NA	Other	026	PHYSICIANS	42947	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 401	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
30054	Fee-for-Service	1316436645	1316436645	1	1	RANCHO SANTA FE PHYSICIAN	5/30/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CONSULTANTS INC	1580 BROADWAY	None	EL CAJON	CA	92021	5124	37	06073	32.80773958	-116.923909	San Diego County
30060	Fee-for-Service	1144546326	1144546326	1	1	RIVERSIDE NEPHROLOGY	7/12/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	PHYSICIANS INC	3595 VAN BUREN BLVD	SUITE 203	RIVERSIDE	CA	92503	0311	33	06065	33.91698281	-117.4435757	Riverside County
30070	Fee-for-Service	1659455202	1659455202	1	1	RASTOGI, ANIL K MD	11/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36945	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1275 E LATHAM AVE	None	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
30072	Fee-for-Service	1821290180	1821290180	1	1	RAKHLIN, ELENA Y MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121748	33	Thoracic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
30090	Fee-for-Service	1306834270	1306834270	1	1	RICHARD ROSENBLUM DO	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1833 N POWER RD	None	MESA	AZ	85205	3799	00	None	33.449229	-111.6835875	Maricopa County
30100	Fee-for-Service	1821077280	1821077280	1	1	ROMAN, NORA L MD	6/1/2009	207L00000X	NA	Other	026	PHYSICIANS	44341	05	Anesthesiology	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
30125	Fee-for-Service	1215052832	1215052832	1	1	RAMOS, BERTHA A LCSW	5/12/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST	103	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
30134	Fee-for-Service	1609249408	1609249408	1	1	REGENTS OF THE UIVERSITY	12/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	1260 15TH ST	STE 1200	SANTA MONICA	CA	90404	1147	19	06037	34.02648965	-118.4867439	Los Angeles County
30188	Fee-for-Service	1790798908	1790798908	1	1	ROCKLIN FAMILY PRACTICE AND	3/3/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SPORTS MEDICINE	3104 SUNSET BLVD	STE 2B	ROCKLIN	CA	95677	3093	31	06061	38.78632648	-121.2517479	Placer County
30225	Fee-for-Service	1356308803	1356308803	1	1	RABBAN, JOSEPH T III MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70912	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
30240	Fee-for-Service	1275714495	1275714495	1	1	RAO, SEEMA S MD	11/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132855	38	Geriatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
30249	Fee-for-Service	1518282920	1518282920	1	1	REYNOLDS, KERISIMASI L MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13974	20	Orthopedic Surgery	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
30273	Fee-for-Service	1477739605	1477739605	1	1	RICHBURG, DELENE A MD	7/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108842	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
30281	Fee-for-Service	1881758688	1881758688	1	1	RUANE, PETER J MD INC	9/16/2009	193400000X	NA	Other	026	PHYSICIANS	42947	77	Infectious Disease	0	In state provider	None	5901 W OLYMPIC BLVD	STE 401	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
30316	Fee-for-Service	1780875658	1780875658	1	1	RAZZAQI, FAISAL S MD	11/24/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	109943	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
30329	Fee-for-Service	1356418297	1356418297	1	1	REIGEL, DEBRA L MD	9/2/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77523	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
30333	Fee-for-Service	1255365813	1255365813	1	1	RAZI, BIJAN MD	2/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37882	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5555 RESERVOIR DR	STE 100	SAN DIEGO	CA	92120	5199	37	06073	32.77628471	-117.0563688	San Diego County
30343	Fee-for-Service	1316436645	1316436645	1	1	RANCHO SANTA FE PHYSICIAN	5/30/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CONSULTANTS INC	1580 BROADWAY	None	EL CAJON	CA	92021	5124	37	06073	32.80773958	-116.923909	San Diego County
30347	Fee-for-Service	1144546326	1144546326	1	1	RIVERSIDE NEPHROLOGY	7/12/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PHYSICIANS INC	3595 VAN BUREN BLVD	SUITE 203	RIVERSIDE	CA	92503	0311	33	06065	33.91698281	-117.4435757	Riverside County
30396	Fee-for-Service	1447673009	1447673009	1	1	RELIANT HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8880 BENSON AVENUE	SUITE 104	MONTCLAIR	CA	91763	1651	36	06071	34.09317481	-117.6809466	San Bernardino County
30441	Fee-for-Service	1568898575	1568898575	1	1	ROHRA CARDIOVASCULAR INC.	6/20/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2485 HIGH SCHOOL AVE	103	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
30469	Fee-for-Service	1699943845	1699943845	1	1	RUSHTON, MICHELE C MD	12/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2200 BRYANT WILLIAMS DR	None	KLAMATH FALLS	OR	97601	1120	00	None	42.25198664	-121.7841082	Klamath County
30474	Fee-for-Service	1790798908	1790798908	1	1	ROCKLIN FAMILY PRACTICE AND	3/3/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	SPORTS MEDICINE	3104 SUNSET BLVD	STE 2B	ROCKLIN	CA	95677	3093	31	06061	38.78632648	-121.2517479	Placer County
30478	Fee-for-Service	1275540460	1275540460	1	1	RAZZECA, KRISTEN J MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60451	01	General Practice	0	In state provider	None	820 23RD ST	None	RICHMOND	CA	94804	1338	07	06013	37.943973	-122.3474635	Contra Costa County
30499	Fee-for-Service	1285628081	1285628081	1	1	RASOUMOFF, THEODORE MD	10/31/2023	207L00000X	NA	Other	026	PHYSICIANS	83538	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
30500	Fee-for-Service	1780616128	1780616128	1	1	RARICK, THOMAS L MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86555	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
30591	Fee-for-Service	1508971185	1508971185	1	1	ROJAS-FLETES, CHRISTINA NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27201 TOURNEY RD	None	SANTA CLARITA	CA	91355	1854	19	06037	34.41741018	-118.5770409	Los Angeles County
30593	Fee-for-Service	1518908805	1518908805	1	1	ROBERT J MUNSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CITY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
30594	Fee-for-Service	1225069248	1225069248	1	1	RADHAKRISHNA, SUMAN M MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	51467	01	General Practice	0	In state provider	None	820 34TH ST	STE 202	BAKERSFIELD	CA	93301	2268	15	06029	35.39053308	-119.0117133	Kern County
30603	Fee-for-Service	1780875658	1780875658	1	1	RAZZAQI, FAISAL S MD	11/24/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	109943	68	Hematology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
30618	Fee-for-Service	1356418297	1356418297	1	1	REIGEL, DEBRA L MD	9/2/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77523	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
30620	Fee-for-Service	1255365813	1255365813	1	1	RAZI, BIJAN MD	2/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37882	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 100	SAN DIEGO	CA	92120	5199	37	06073	32.77628471	-117.0563688	San Diego County
30641	Fee-for-Service	1598061624	1598061624	1	1	ROSENFELD, DAVID S MD	10/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	37044	13	Neurology (M.D. only)	0	In state provider	None	11121 SUN CENTER DRIVE	SUITE G	RANCHO CORDOVA	CA	95670	6199	34	06067	38.595627	-121.270149	Sacramento County
30651	Fee-for-Service	1144241779	1144241779	1	1	RASHTI, MANOUCHER MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	40167	01	General Practice	0	In state provider	None	11819 WILSHIRE BLVD	STE 210	LOS ANGELES	CA	90025	6631	19	06037	34.04797767	-118.4628495	Los Angeles County
30660	Fee-for-Service	1538173059	1538173059	1	1	REESE, JAMES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31768	02	General Surgery	0	In state provider	None	940 SYLVA LN	STE B	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
30682	Fee-for-Service	1972670990	1972670990	1	1	RINGHAM, JOAN D MD	12/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	76150	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
30684	Fee-for-Service	1447673009	1447673009	1	1	RELIANT HOSPICE INC	11/18/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8880 BENSON AVENUE	SUITE 104	MONTCLAIR	CA	91763	1651	36	06071	34.09317481	-117.6809466	San Bernardino County
30706	Fee-for-Service	1790198612	1790198612	1	1	ROY, TARA D MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133478	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
30734	Fee-for-Service	1164817714	1164817714	1	1	ROTHSCHILD, JAMES M MD	7/26/2021	207L00000X	NA	Other	026	PHYSICIANS	147800	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
30782	Fee-for-Service	1932260106	1932260106	1	2	RAHNEMUN, MARYAM MD INC	2/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53377	08	Family Practice	0	In state provider	None	31654 RANCHO VIEJO RD	STE E	SAN JUAN CAPISTRA	CA	92675	6720	30	06059	33.50258708	-117.6542978	Orange County
30817	Fee-for-Service	1003074345	1003074345	1	1	RABIL, CYRUS M MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62625	08	Family Practice	0	In state provider	None	866 PLUMAS ST	None	YUBA CITY	CA	95991	4022	51	06101	39.14154171	-121.6177237	Sutter County
30879	Fee-for-Service	1821118126	1821118126	1	1	REMEDIOS, LISA G MD	5/19/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168739	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
30885	Fee-for-Service	1578025482	1578025482	1	1	ROSEBAY LLC	3/20/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	310 OAK RIDGE DRIVE	None	ROSEVILLE	CA	95661	3420	31	06061	38.74206708	-121.2699441	Placer County
30892	Fee-for-Service	1780875658	1780875658	1	1	RAZZAQI, FAISAL S MD	11/24/2009	2080P0207X	NA	Hematology	026	PHYSICIANS	109943	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
30893	Fee-for-Service	1356375489	1356375489	1	1	RODRIGUEZ, FRANCISCO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	VALLEY SURGICAL CLINIC	16601 N. 40TH STREET	STE 216	PHOENIX	AZ	85032	0000	00	None	33.637356	-111.995514	Maricopa County
30901	Fee-for-Service	1215514534	1215514534	1	1	RANDHAWA, POONAMDEEP	10/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187505	08	Family Practice	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
30908	Fee-for-Service	1255365813	1255365813	1	1	RAZI, BIJAN MD	2/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37882	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 100	SAN DIEGO	CA	92120	5199	37	06073	32.77628471	-117.0563688	San Diego County
30909	Fee-for-Service	1952626830	1952626830	1	2	RAMBO, CHELSEA LCSW	12/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
30916	Fee-for-Service	1760562912	1760562912	1	1	REDDY, VARALASKHMI MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51707	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 27	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
30926	Fee-for-Service	1598252785	1598252785	1	1	RAMOS, YOLANDA LCSW	12/1/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
30947	Fee-for-Service	1467734269	1467734269	1	1	RODRIGUEZ, ALHAM F LMFT	9/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	3053	44	06087	36.92586689	-121.7796602	Santa Cruz County
30948	Fee-for-Service	1538173059	1538173059	1	1	REESE, JAMES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31768	66	Emergency Medicine (Urgent Care)	0	In state provider	None	940 SYLVA LN	STE B	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
30952	Fee-for-Service	1013545953	1013545953	1	1	RAMDAS, ANKHITA MD	1/19/2024	207R00000X	NA	Other	026	PHYSICIANS	191297	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
30965	Fee-for-Service	1316392780	1316392780	1	1	RAMESH, RADHA MD	2/25/2020	207R00000X	NA	Other	026	PHYSICIANS	158393	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
30968	Fee-for-Service	1568510352	1568510352	1	1	RIEWERTS, ROBERTS J MD	6/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63701	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
30970	Fee-for-Service	1972670990	1972670990	1	1	RINGHAM, JOAN D MD	12/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	76150	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
30973	Fee-for-Service	1649903154	1649903154	1	2	ROYAL CARE TRANSPORTS LLC	8/22/2022	343800000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14747 ARTESIA BLVD	5J	LA MIRADA	CA	90638	6008	19	06037	33.87342709	-118.016463	Los Angeles County
31029	Fee-for-Service	1417213422	1417213422	1	1	RIVERA, ALVIN H MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124000	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
31050	Fee-for-Service	1275202558	1275202558	1	1	ROWEN, KEVIN D PSYD	2/7/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
31129	Fee-for-Service	1194784678	1194784678	1	1	RAMCHANDRAN, ASHA MD	4/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63418	40	Pediatrics	0	In state provider	None	5720 STONERIDGE MALL RD	STE 240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
31157	Fee-for-Service	1689960700	1689960700	1	1	ROSS, JAVAY M MD	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114353	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
31174	Fee-for-Service	1912945072	1912945072	1	1	RAO,JAYASHREE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDRENS HOSPITAL	3901 BEAUBIEN STREET	None	DETROIT	MI	48201	2119	00	None	42.35164453	-83.05377946	Wayne County
31177	Fee-for-Service	1750571766	1750571766	1	1	ROMERO, ELIZABETH R MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51989	01	General Practice	0	In state provider	None	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1619	36	06071	34.24602097	-116.8885243	San Bernardino County
31199	Fee-for-Service	1457778912	1457778912	1	1	RASSAMDANA, FAYDIM OD	2/16/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
31252	Fee-for-Service	1447309398	1447309398	1	1	REEF-SUNSET UNIFIED SD	1/25/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	205 N PARK AVE	None	AVENAL	CA	93204	1425	16	06031	36.00828573	-120.1255809	Kings County
31266	Fee-for-Service	1831572544	1831572544	1	1	RENWICK, MICHELLE PSYD	4/25/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
31270	Fee-for-Service	1942451919	1942451919	1	1	ROMANO, OLIVIA B MD	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
31283	Fee-for-Service	1164065835	1164065835	1	1	ROBLES, REGINA LCSW	10/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
31288	Fee-for-Service	1033134754	1033134754	1	1	RILEY, MARY ANN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80103	08	Family Practice	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
31291	Fee-for-Service	1326044876	1326044876	1	1	RAHHAL, SUHAIL MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52380	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
31300	Fee-for-Service	1912439928	1912439928	1	1	REYES, ADARA D LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
31311	Fee-for-Service	1417585423	1417585423	1	1	RUSSELL, ALEX MD	7/29/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
31321	Fee-for-Service	1588608301	1588608301	1	1	RITT, DONALD J MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	41	Internal Medicine	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
31324	Fee-for-Service	1043474067	1043474067	1	1	RUIZ, MARIBEL MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97705	40	Pediatrics	0	In state provider	None	175 N JACKSON AVE	STE 212	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
31402	Fee-for-Service	1881958825	1881958825	1	1	REDDY, SATYARUPA MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132926	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
31474	Fee-for-Service	1417187378	1417187378	1	1	ROBY, CATHERINE M DO	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12804	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
31508	Fee-for-Service	1568612042	1568612042	1	1	RODRIGUEZ, GENARO A LMFT	7/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
31539	Fee-for-Service	1669667820	1669667820	1	1	ROSAS, RIGOBERTO LMFT	8/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
31552	Fee-for-Service	1053474528	1053474528	1	1	RAMIREZ, MARK A MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44346	None	None	0	In state provider	None	1000 E LATHAM AVE	None	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
31570	Fee-for-Service	1487729307	1487729307	1	1	RGGS, INC	9/7/2010	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	9499 I AVE	None	HESPERIA	CA	92345	6282	36	06071	34.42368424	-117.2820123	San Bernardino County
31579	Fee-for-Service	1053304113	1053304113	1	2	REGENTS/UCDPBG/IM CARDIO	4/1/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
31610	Fee-for-Service	1588608301	1588608301	1	1	RITT, DONALD J MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	10	Gastroenterology (M.D. only)	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
31673	Fee-for-Service	1659310100	1659310100	1	1	RIMMER, STEVEN O MD	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	69154	18	Ophthalmology	0	In state provider	None	2232 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2312	19	06037	34.0306404	-118.4775425	Los Angeles County
31674	Fee-for-Service	1184339913	1184339913	1	1	REDWOOD CENTER STREET TWO	7/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OPCO LLC	2451 CENTER STREET	None	BAKERSFIELD	CA	93306	5105	15	06029	35.37217405	-118.9632446	Kern County
31687	Fee-for-Service	1255486866	1255486866	1	1	RAVAN, SHAHRAM F MD INC	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40168	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9001 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
31706	Fee-for-Service	1760126445	1760126445	1	1	ROMULO L & NOELIA M GARCIA	6/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2685 COTTAGE DR	None	CORONA	CA	92881	3634	33	06065	33.83795798	-117.5402939	Riverside County
31746	Fee-for-Service	1134161524	1134161524	1	1	RASHEED, SABIHA MD	1/30/2012	207RR0500X	NA	Other	026	PHYSICIANS	53697	83	Rheumatology	0	In state provider	None	734 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
31777	Fee-for-Service	1194986794	1194986794	1	1	RAJABI, BABAK MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127081	78	Neoplastic Diseases/Oncology	0	In state provider	None	6555 COYLE AVE	STE 301	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
31800	Fee-for-Service	1336333475	1336333475	1	1	RIEGER, KERRI E MD	1/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10107	07	Dermatology	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
31866	Fee-for-Service	1053304113	1053304113	1	2	REGENTS/UCDPBG/IM CARDIO	5/1/1999	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
31882	Fee-for-Service	1164698726	1164698726	1	1	RHEE, JEANNIE S MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125055	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31889	Fee-for-Service	1962453555	1962453555	1	1	RODRIGUES, BRYAN K RPT	2/28/1982	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	969 PLUMAS ST	STE 213	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
31897	Fee-for-Service	1588608301	1588608301	1	1	RITT, DONALD J MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
31916	Fee-for-Service	1114084209	1114084209	1	1	RYAN, CAROLINE A MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111475	05	Anesthesiology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
31928	Fee-for-Service	1447390737	1447390737	1	1	RENKEN, WOLFGANG H OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 7TH ST	None	WASCO	CA	93280	1732	15	06029	35.59421519	-119.3406002	Kern County
31966	Fee-for-Service	1053549196	1053549196	1	1	RODRIGUEZ, LORENE N MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132793	70	Clinic (mixed specialty)	0	In state provider	None	4871 WHITE LN	None	BAKERSFIELD	CA	93309	6375	15	06029	35.31793896	-119.0561249	Kern County
31968	Fee-for-Service	1104859354	1104859354	1	1	REDDING RANCHERIA	11/20/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICE	1441 LIBERTY ST	None	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
31976	Fee-for-Service	1255486866	1255486866	1	1	RAVAN, SHAHRAM F MD INC	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40168	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
31977	Fee-for-Service	1437513165	1437513165	1	1	ROMINSKI, ROBERT T MD	11/17/2019	207P00000X	NA	Other	026	PHYSICIANS	154660	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
31991	Fee-for-Service	1225363468	1225363468	1	1	RIDGECREST REGIONAL HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1653 TRIANGLE DRIVE	None	RIDGECREST	CA	93555	3130	15	06029	35.65097477	-117.6711843	Kern County
31996	Fee-for-Service	1114000551	1114000551	1	1	RUHS, WILLIAM F LMFT	9/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1125 MISSOURI ST	STE 101	FAIRFIELD	CA	94533	6088	48	06095	38.24811048	-122.047884	Solano County
32034	Fee-for-Service	1134161524	1134161524	1	1	RASHEED, SABIHA MD	1/30/2012	207RR0500X	NA	Other	026	PHYSICIANS	53697	41	Internal Medicine	0	In state provider	None	734 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
32079	Fee-for-Service	1023331865	1023331865	1	1	REGACHO, KATHLEEN A MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110697	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6253	07	06013	37.98252	-121.8030615	Contra Costa County
32097	Fee-for-Service	1275582892	1275582892	1	1	ROSALES, NELSON R DO	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8484	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
32118	Fee-for-Service	1528758745	1528758745	1	1	ROPES, EMILY A LCSW	9/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
32126	Fee-for-Service	1003100728	1003100728	1	1	ROBERTS, TIFFANY J LMFT	9/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
32139	Fee-for-Service	1174538649	1174538649	1	1	RENDALL,CHRISTOBEL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD AVE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
32151	Fee-for-Service	1447315064	1447315064	1	1	RUSSO, PAULA R NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27201 TOURNEY RD	None	SANTA CLARITA	CA	91355	1854	19	06037	34.41741018	-118.5770409	Los Angeles County
32169	Fee-for-Service	1598067688	1598067688	1	1	ROBINSON, ANGEL C MD MPH	1/5/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	174567	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	STE 200 225	LOS ANGELES	CA	90033	6720	19	06037	34.05112725	-118.2173921	Los Angeles County
32182	Fee-for-Service	1356862163	1356862163	1	1	RUIZ, NATASHA M	6/9/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
32244	Fee-for-Service	1871660894	1871660894	1	1	RICHTER, PAULA M MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73637	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
32252	Fee-for-Service	1467444380	1467444380	1	1	ROOS, EUGENE H DO	6/22/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6326	30	Radiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
32257	Fee-for-Service	1104859354	1104859354	1	1	REDDING RANCHERIA	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICE	1441 LIBERTY ST	None	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
32262	Fee-for-Service	1962805283	1962805283	1	2	REEDLEY COMMUNITY HOSPITAL	9/14/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	10	06019	36.60787518	-119.4523704	Fresno County
32279	Fee-for-Service	1225363468	1225363468	1	1	RIDGECREST REGIONAL HOSPITAL	2/17/2011	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1653 TRIANGLE DRIVE	None	RIDGECREST	CA	93555	3130	15	06029	35.65097477	-117.6711843	Kern County
32301	Fee-for-Service	1902497266	1902497266	1	2	RUJJU CONSULTANTS LLC	11/14/2022	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	101 MONROE ST	None	PETALUMA	CA	94954	2328	49	06097	38.25630881	-122.62758	Sonoma County
32325	Fee-for-Service	1225126600	1225126600	1	1	RAJAMANICKAM, ANITHA MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137462	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	220 SOUTH FIRST STREET	None	ALHAMBRA	CA	91801	3893	19	06037	34.09192598	-118.1259775	Los Angeles County
32358	Fee-for-Service	1912993635	1912993635	1	1	ROSENFELD, HOWARD M MD	2/16/1994	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78396	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
32406	Fee-for-Service	1255971164	1255971164	1	1	REED, ASHLEY LMFT	8/24/2022	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
32430	Fee-for-Service	1588405740	1588405740	1	1	RUBIO, DALIA OT	6/27/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
32432	Fee-for-Service	1215026711	1215026711	2	1	ROSE PHARMACY SA LLC	7/31/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1220 W HEMLOCK WAY	110	SANTA ANA	CA	92707	3600	30	06059	33.70975375	-117.8842792	Orange County
32439	Fee-for-Service	1558506865	1558506865	1	1	ROUGEAU, SEAN E NP	6/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
32443	Fee-for-Service	1114105384	1114105384	1	4	RETINA ASSOCIATES OF ORANGE	6/14/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COUNTY	2010 E FIRST STREET	SUITE 140	SANTA ANA	CA	92705	4086	30	06059	33.74554507	-117.8387522	Orange County
32462	Fee-for-Service	1326005380	1326005380	1	1	ROBERT P LAM MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2602	00	None	39.08455286	-94.57578107	Jackson County
32511	Fee-for-Service	1861458390	1861458390	1	1	RAHMAN, SHAHED MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91768	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
32541	Fee-for-Service	1144291337	1144291337	1	1	ROBLES-GOCHE, RUTH MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36159	40	Pediatrics	0	In state provider	None	353 H ST	STE F	CHULA VISTA	CA	91910	5501	37	06073	32.63388349	-117.0791723	San Diego County
32544	Fee-for-Service	1104859354	1104859354	1	1	REDDING RANCHERIA	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICE	1441 LIBERTY ST	None	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
32546	Fee-for-Service	1356758619	1356758619	1	1	RAMOS, JOSHUA V OT	10/18/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
32548	Fee-for-Service	1962805283	1962805283	1	2	REEDLEY COMMUNITY HOSPITAL	3/18/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	10	06019	36.60787518	-119.4523704	Fresno County
32580	Fee-for-Service	1114308053	1114308053	1	1	RONEY, ALICIA M NP	8/4/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
32590	Fee-for-Service	1982672283	1982672283	1	1	ROSEVILLE SURGERY CENTER	10/30/2002	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1420 E ROSEVILLE PKWY	STE 100	ROSEVILLE	CA	95661	3080	31	06061	38.76199451	-121.249161	Placer County
32592	Fee-for-Service	1841312071	1841312071	1	1	ROBBINS, TIFFANY L LMFT	1/22/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50768	-	NOT APPLICABLE	0	In state provider	None	2595 DEPOT ROAD	None	HAYWARD	CA	94545	2341	01	06001	37.63872323	-122.1145864	Alameda County
32598	Fee-for-Service	1174552731	1174552731	1	1	ROSENBERG, JOSHUA M DO	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
32633	Fee-for-Service	1477512069	1477512069	1	1	ROSENBERG, BRADLEY J MD	7/1/1996	2084N0400X	NA	Neurology	026	PHYSICIANS	45198	13	Neurology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
32637	Fee-for-Service	1710955570	1710955570	1	1	RICCI, RICHARD R MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	48803	08	Family Practice	0	In state provider	None	488 E VALLEY PKWY	SUITE 201	ESCONDIDO	CA	92025	3398	37	06073	33.12523814	-117.0769715	San Diego County
32647	Fee-for-Service	1912993635	1912993635	1	1	ROSENFELD, HOWARD M MD	2/16/1994	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78396	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
32650	Fee-for-Service	1407811003	1407811003	1	1	RING, WILLIAM L MD	9/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69579	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
32655	Fee-for-Service	1598912859	1598912859	1	1	ROSE-NUSSBAUMER, JENNIFER R	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121301	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
32665	Fee-for-Service	1902111834	1902111834	1	1	REDDY, MALLU MD INC	1/30/2012	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1196 N PARK AVE	None	POMONA	CA	91768	3027	19	06037	34.06976919	-117.7549069	Los Angeles County
32729	Fee-for-Service	1376674259	1376674259	1	1	RODRIGUEZ, REINA M MD	2/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91076	08	Family Practice	0	In state provider	None	350 30TH ST	STE 411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
32742	Fee-for-Service	1992110605	1992110605	1	1	REDDY, KIRAN A MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
32748	Fee-for-Service	1225574429	1225574429	1	1	RODGERS, MICHELLE LYNN	2/24/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5492 CARLSON DR APT 4	None	SACRAMENTO	CA	95819	2444	34	06067	38.572416	-121.432203	Sacramento County
32769	Fee-for-Service	1649439258	1649439258	1	1	REMINICK, ALISON M MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112984	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
32831	Fee-for-Service	1487663837	1487663837	1	1	RAMBHATLA, SAVITRI K MD	6/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	36245	40	Pediatrics	0	In state provider	None	111 W BEVERLY BLVD	STE 220	MONTEBELLO	CA	90640	4312	19	06037	34.01572372	-118.0991599	Los Angeles County
32835	Fee-for-Service	1104859354	1104859354	1	1	REDDING RANCHERIA	9/1/2002	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICE	1441 LIBERTY ST	None	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
32837	Fee-for-Service	1962805283	1962805283	1	2	REEDLEY COMMUNITY HOSPITAL	3/18/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	10	06019	36.60787518	-119.4523704	Fresno County
32849	Fee-for-Service	1154895183	1154895183	1	1	ROMANYSHYN, TALIA L CNP	7/13/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
32860	Fee-for-Service	1053648980	1053648980	1	1	RODRIGUEZ, EDWIN LMFT	12/18/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
32863	Fee-for-Service	1871962027	1871962027	1	1	ROJAS, SARAH A LMFT	8/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	220 SANSOME	400	SAN FRANCISCO	CA	94104	2321	38	06075	37.79250132	-122.4009823	San Francisco County
32914	Fee-for-Service	1659948214	1659948214	1	1	ROBIN, ARIANNA MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	184452	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
32920	Fee-for-Service	1477512069	1477512069	1	1	ROSENBERG, BRADLEY J MD	7/1/1996	2084N0400X	NA	Neurology	026	PHYSICIANS	45198	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
32934	Fee-for-Service	1043699374	1043699374	1	1	RIVAS, DORIS M MD	4/12/2021	207R00000X	NA	Other	026	PHYSICIANS	168846	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
32949	Fee-for-Service	1154532828	1154532828	1	1	ROSSO, RONALD F MD A MEDICAL	12/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	79401	24	Plastic Surgery	0	In state provider	CORPORATION	3400 LOMITA BLVD	#306	TORRANCE	CA	90505	4909	19	06037	33.81309744	-118.3448635	Los Angeles County
32971	Fee-for-Service	1497877096	1497877096	1	1	ROJAS, ELVIA G LMFT	8/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
32972	Fee-for-Service	1922029453	1922029453	1	1	RAMIREZ, ALEJANDRO E MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	59398	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
32978	Fee-for-Service	1821351230	1821351230	1	1	RAGHAVAN, SONYA MD	12/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157142	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2575 E BIDWELL STREET	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
32983	Fee-for-Service	1366552028	1366552028	1	1	RALEYS	5/12/1986	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1315 NORTH STATE ST	None	UKIAH	CA	95482	3419	23	06045	39.1685754	-123.2113307	Mendocino County
33009	Fee-for-Service	1831124577	1831124577	1	1	REYNOLDS, MARK M MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78047	None	None	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
33034	Fee-for-Service	1245250133	1245250133	1	1	ROMERO, ANTHONY C MD	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65716	20	Orthopedic Surgery	0	In state provider	None	2324 BATH ST	None	SANTA BARBARA	CA	93105	4330	42	06083	34.43130628	-119.7229224	Santa Barbara County
33037	Fee-for-Service	1225574429	1225574429	1	1	RODGERS, MICHELLE LYNN	2/24/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5492 CARLSON DR APT 4	None	SACRAMENTO	CA	95819	2444	34	06067	38.572416	-121.432203	Sacramento County
33055	Fee-for-Service	1447498779	1447498779	1	2	ROMERO, IRMA Y CSW	2/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
33125	Fee-for-Service	1962805283	1962805283	1	2	REEDLEY COMMUNITY HOSPITAL	11/30/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	10	06019	36.60787518	-119.4523704	Fresno County
33140	Fee-for-Service	1891213245	1891213245	1	1	RISHI JINDAL MD INC	12/12/2017	208200000X	NA	General Surgery	026	PHYSICIANS	149221	24	Plastic Surgery	0	In state provider	None	12264 EL CAMINO REAL	SUITE 101	SAN DIEGO	CA	92130	3060	37	06073	32.93959909	-117.2401598	San Diego County
33147	Fee-for-Service	1558708578	1558708578	1	1	RATHORE, AWTAR K DO	7/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14836	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
33192	Fee-for-Service	1255882346	1255882346	1	1	ROBINSON, BRITTNEY A MD	1/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145471	15	Obstetrics (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
33263	Fee-for-Service	1710612338	1710612338	1	1	RAYGOZA, TANIA	4/8/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
33271	Fee-for-Service	1063920296	1063920296	1	1	ROAM HEALTHCARE INC A	10/30/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	PROFESSIONAL NURSING	8345 RESEDA BLVD	SUITE 209	NORTHRIDGE	CA	91324	5941	19	06037	34.222005	-118.5360975	Los Angeles County
33279	Fee-for-Service	1962571174	1962571174	1	1	REYES, SONIA NP	2/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
33280	Fee-for-Service	1134239890	1134239890	1	1	RALEY'S #231	9/10/1996	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6119 HORSESHOE BAR RD	None	LOOMIS	CA	95650	8528	31	06061	38.81743022	-121.1897544	Placer County
33292	Fee-for-Service	1821156217	1821156217	1	1	ROSENFELD, ELON LAC	12/29/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
33300	Fee-for-Service	1164543625	1164543625	1	1	RX NOW INC	3/3/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17170 COLIMA RD	SUITE F	HACIENDA HEIGHTS	CA	91745	6771	19	06037	33.9907128	-117.9325812	Los Angeles County
33304	Fee-for-Service	1760568265	1760568265	1	1	ROSAS, EFREN E MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	65999	02	General Surgery	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
33327	Fee-for-Service	1588856322	1588856322	1	1	RUSSELL, KELLIE S DO	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14139	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
33364	Fee-for-Service	1063417624	1063417624	1	1	REDDY, KRISHNA G MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33724	41	Internal Medicine	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
33379	Fee-for-Service	1295120244	1295120244	1	1	RAMPERSAUD, RYAN MD	7/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145362	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33415	Fee-for-Service	1891213245	1891213245	1	1	RISHI JINDAL MD INC	12/12/2017	208200000X	NA	General Surgery	026	PHYSICIANS	149221	46	Hand Surgery	0	In state provider	None	12264 EL CAMINO REAL	SUITE 101	SAN DIEGO	CA	92130	3060	37	06073	32.93959909	-117.2401598	San Diego County
33416	Fee-for-Service	1245918614	1245918614	1	1	RAPID TRANS INC	7/24/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13915 SATICOY STREET	None	PANORAMA CITY	CA	91402	6521	19	06037	34.21036264	-118.4360357	Los Angeles County
33478	Fee-for-Service	1063888683	1063888683	1	1	REIGHTER, BRADLIANNE LCSW	7/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
33482	Fee-for-Service	1255882346	1255882346	1	1	ROBINSON, BRITTNEY A MD	1/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145471	09	Gynecology (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
33560	Fee-for-Service	1568480093	1568480093	1	1	RHEE, EDWARD K MD	4/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	1919 E THOMAS ROAD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
33574	Fee-for-Service	1376168153	1376168153	1	1	ROSS, JULIE L LMFT	1/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	650 HAMPSHIRE RD	SUITE 200	WESTLAKE VILLAGE	CA	91361	2540	56	06111	34.15918414	-118.8359242	Ventura County
33617	Fee-for-Service	1821495953	1821495953	1	1	ROBB, EMILY E CNP	11/12/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1800 WESTWIND DR	STE 301	BAKERSFIELD	CA	93301	3055	15	06029	35.37531587	-119.0424856	Kern County
33644	Fee-for-Service	1619106325	1619106325	1	1	REGESTER, SHANTI LMFT	11/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16152 BEACH BLVD	170	HUNTINGTON BEACH	CA	92647	3806	30	06059	33.72889962	-117.9891397	Orange County
33649	Fee-for-Service	1063417624	1063417624	1	1	REDDY, KRISHNA G MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33724	68	Hematology	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
33658	Fee-for-Service	1407044530	1407044530	1	1	RADCHUK, OLENA MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107089	01	General Practice	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
33754	Fee-for-Service	1427318682	1427318682	1	1	REDDY, KAVYA M MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127553	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
33788	Fee-for-Service	1083622294	1083622294	1	1	ROY, SUBIR MD	2/1/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	24383	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	637 LUCAS AVE	None	LOS ANGELES	CA	90017	1912	19	06037	34.05351827	-118.2646017	Los Angeles County
33790	Fee-for-Service	1427033836	1427033836	1	1	ROBINSON, RICHARD H MD	7/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	50892	02	General Surgery	0	In state provider	None	411 W 20TH ST	None	MERCED	CA	95340	3713	24	06047	37.30404265	-120.4804769	Merced County
33808	Fee-for-Service	1922157320	1922157320	1	1	REITMAN, JONATHAN E MD	11/19/2018	207RA0401X	NA	Other	026	PHYSICIANS	66975	41	Internal Medicine	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
33862	Fee-for-Service	1841408812	1841408812	1	1	RADER, FLORIAN MD	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120370	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
33868	Fee-for-Service	1598086688	1598086688	1	1	RAMAGE, CHRISTOPHER M DO	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
33871	Fee-for-Service	1053891754	1053891754	1	1	RANDHAWA, TEJINDER M D A	4/23/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	311 N ABBY ST	None	FRESNO	CA	93701	1906	10	06019	36.74716555	-119.7894243	Fresno County
33878	Fee-for-Service	1265426936	1265426936	1	1	RIECHMANN, ROBERT JR MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	19099	22	Pathology (M.D. only)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
33906	Fee-for-Service	1932763281	1932763281	1	1	ROBERTS, RICHARD S DO	7/21/2023	207L00000X	NA	Other	026	PHYSICIANS	20954	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
33915	Fee-for-Service	1639201502	1639201502	1	1	ROSHAN, BAKHT	9/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120800	None	None	0	In state provider	None	1180 E SHAW	SUITE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
33929	Fee-for-Service	1285712778	1285712778	1	1	RAO, ANJALI K MD	8/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84523	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
33939	Fee-for-Service	1063417624	1063417624	1	1	REDDY, KRISHNA G MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33724	78	Neoplastic Diseases/Oncology	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
33940	Fee-for-Service	1669967386	1669967386	1	1	RIOS, SALVADOR L MD	7/5/2022	207P00000X	NA	Other	026	PHYSICIANS	178477	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
33941	Fee-for-Service	1295862563	1295862563	1	1	ROCKCREEK, INC	6/10/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6083 NEWCOMB ST	None	SAN BERNARDINO	CA	92404	3537	36	06071	34.143579	-117.238833	San Bernardino County
33947	Fee-for-Service	1407044530	1407044530	1	1	RADCHUK, OLENA MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107089	41	Internal Medicine	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
34071	Fee-for-Service	1750487336	1750487336	1	1	RANJAN, CAIN	3/1/2024	207R00000X	NA	Other	026	PHYSICIANS	54338	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
34119	Fee-for-Service	1255368205	1255368205	1	1	RANSOM,CHARLOTTE A MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
34124	Fee-for-Service	1790436269	1790436269	1	1	REDWOOD COMMUNITY PHARMACY,	4/19/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1567 CITY CENTER RD	None	MCKINLEYVILLE	CA	95519	3600	12	06023	40.94311258	-124.1035874	Humboldt County
34136	Fee-for-Service	1821113713	1821113713	1	1	ROBERTS, CAROLE EDGAR LCSW	4/19/2011	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1452 OREGON STREET	None	REDDING	CA	96001	1620	45	06089	40.58366131	-122.3945244	Shasta County
34139	Fee-for-Service	1598023756	1598023756	1	1	RAZAQ, MOMINA MD	3/29/2024	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
34153	Fee-for-Service	1053421537	1053421537	1	1	ROGE, CLAUDE L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32404	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
34191	Fee-for-Service	1164849212	1164849212	1	1	RUSSELL, DARREN J MD	6/7/2023	208600000X	NA	General Surgery	026	PHYSICIANS	140308	None	None	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
34218	Fee-for-Service	1730640400	1730640400	1	1	RASHAD, MARLEY MD	6/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181020	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
34263	Fee-for-Service	1912536806	1912536806	1	1	RIVERA, CRISTINA MD	10/12/2023	207R00000X	NA	Other	026	PHYSICIANS	190668	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
34264	Fee-for-Service	1447498779	1447498779	1	1	ROMERO, IRMA Y CSW	8/25/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	405 14TH ST	STE 211	OAKLAND	CA	94612	2713	01	06001	37.80391132	-122.27024	Alameda County
34280	Fee-for-Service	1689903114	1689903114	1	1	RAHBARI, REZA MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104138	02	General Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
34293	Fee-for-Service	1851566004	1851566004	1	1	REN, DAAN MD	11/30/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105313	08	Family Practice	0	In state provider	None	2151 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75424753	-121.455621	San Joaquin County
34324	Fee-for-Service	1225230642	1225230642	1	1	RONALD F PANGILINAN M.D	1/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N KUAKINI ST	None	HONOLULU	HI	96817	2336	00	None	21.32247447	-157.8564644	Honolulu County
34334	Fee-for-Service	1306355326	1306355326	1	1	RAHNEMA, GUDARS	3/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18261	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
34353	Fee-for-Service	1093032252	1093032252	1	1	RIVERA, EDOUARD E MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147090	05	Anesthesiology	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
34388	Fee-for-Service	1316237548	1316237548	1	1	ROSS, ELSIE G MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122005	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34395	Fee-for-Service	1053491910	1053491910	1	1	RENGARAJAN, USHA MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	185229	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
34416	Fee-for-Service	1588778773	1588778773	1	1	RIAZATI, NASIM MD	4/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80835	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
34420	Fee-for-Service	1750942249	1750942249	1	1	RANTISI, CATHERINE K LCSW	10/28/2022	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5815 STODDARD RD.	600	MODESTO	CA	95356	9041	50	06099	37.72324601	-121.0686809	Stanislaus County
34503	Fee-for-Service	1710725403	1710725403	1	1	RATTO, ELYSABETH CD	7/31/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
34507	Fee-for-Service	1669634184	1669634184	1	1	RYAN HEGGE	4/26/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
34517	Fee-for-Service	1770088254	1770088254	1	1	REBHUN, CARL B MD	7/1/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	176115	None	None	0	In state provider	None	1513 S GRAND AVE	STE 200	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
34593	Fee-for-Service	1992448864	1992448864	1	1	ROSCOE, SYDNEY NP	12/27/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34605	Fee-for-Service	1891131611	1891131611	1	1	RUIZ, RACHEL M MD	4/18/2019	390200000X	NA	Other	026	PHYSICIANS	140532	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34623	Fee-for-Service	1023076916	1023076916	1	1	REYNOLDS, MICHELE S CRNA	1/3/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34629	Fee-for-Service	1053646216	1053646216	1	1	RAYUDU, RANGA N MD	8/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125613	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
34651	Fee-for-Service	1699796326	1699796326	1	1	RIES, DANIEL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 E 27TH ST	None	MINNEAPOLIS	MN	55407	0000	00	None	44.95374448	-93.26145339	Hennepin County
34678	Fee-for-Service	1306834270	1306834270	1	3	RICHARD ROSENBLUM DO	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7171 S 51ST AVE	None	LAVEEN	AZ	85339	2923	00	None	33.380613	-112.16745	Maricopa County
34731	Fee-for-Service	1568605269	1568605269	1	1	RUIZ, FELIPE D DPM	7/22/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1247 E ALLUVIAL AVE	SUITE 101	FRESNO	CA	93720	2686	10	06019	36.84470048	-119.7606195	Fresno County
34744	Fee-for-Service	1255610416	1255610416	1	1	RUBIN, JOSHUA E MD	3/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120297	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLZ	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
34774	Fee-for-Service	1891877387	1891877387	1	1	RADAKOVIC, DIANA M NP	12/27/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
34784	Fee-for-Service	1285666313	1285666313	1	1	RADIOLOGY MEDICAL GROUP	1/1/1984	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF NAPA INC	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
34876	Fee-for-Service	1750486015	1750486015	1	1	RECINTO, CYNTHIA K MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53204	41	Internal Medicine	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
34902	Fee-for-Service	1427091586	1427091586	1	1	RAKER, CHARLES K MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94703	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
34906	Fee-for-Service	1699078030	1699078030	1	9	RIDGE EYE CARE INC	1/29/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5889 CLARK ROAD	None	PARADISE	CA	95969	4861	04	06007	39.75669117	-121.607276	Butte County
34954	Fee-for-Service	1184173056	1184173056	1	1	REDWOOD HEALTHCARE CENTER	11/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	3145 HIGH STREET	None	OAKLAND	CA	94619	1839	01	06001	37.78521629	-122.1989937	Alameda County
35011	Fee-for-Service	1912169319	1912169319	1	1	ROHENA, LUIS MD	4/23/2019	207SG0201X	NA	Other	026	PHYSICIANS	161757	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
35040	Fee-for-Service	1457525891	1457525891	1	1	ROBERT, STEPHEN M MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140712	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
35047	Fee-for-Service	1326280371	1326280371	1	1	ROVELO, MILLICENT O MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130080	24	Plastic Surgery	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
35049	Fee-for-Service	1922069384	1922069384	1	1	RENAL TREATMENT CENTERS	11/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2057 COMPTON AVENUE	SUITE 101	CORONA	CA	92881	7287	33	06065	33.84971564	-117.536168	Riverside County
35103	Fee-for-Service	1770168999	1770168999	1	1	ROSALES, VERONICA L NP	11/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
35105	Fee-for-Service	1669892055	1669892055	1	1	REDDY, CHARITHA D MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
35107	Fee-for-Service	1912261611	1912261611	1	1	RUSCH, SARAH M MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137588	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
35128	Fee-for-Service	1184814758	1184814758	1	1	RANDHAWA, KIRANJOT K DO	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9915	None	None	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
35135	Fee-for-Service	1710038203	1710038203	1	1	RYAN, LESLEY I MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72919	08	Family Practice	0	In state provider	None	7200 BANCROFT AVE	STE 210	OAKLAND	CA	94605	2414	01	06001	37.768221	-122.17608	Alameda County
35168	Fee-for-Service	1144428459	1144428459	1	1	REED,RALPH C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	75724	0000	00	None	32.240493	-110.9460825	Pima County
35197	Fee-for-Service	1801001854	1801001854	1	1	ROYAL OPTOMETRY INC	6/17/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5426 BEACH BLVD	None	BUENA PARK	CA	90621	1234	30	06059	33.88287316	-117.9965551	Orange County
35198	Fee-for-Service	1699078030	1699078030	1	9	RIDGE EYE CARE INC	1/29/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	5889 CLARK ROAD	None	PARADISE	CA	95969	4861	04	06007	39.75669117	-121.607276	Butte County
35221	Fee-for-Service	1225477219	1225477219	1	1	ROBERTS, LINDA T MD	3/15/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	126084	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
35271	Fee-for-Service	1710262522	1710262522	1	1	REGAL HOSPICE HEALTH INC	10/31/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 116A	BURBANK	CA	91502	1849	19	06037	34.18064474	-118.3089507	Los Angeles County
35283	Fee-for-Service	1518235340	1518235340	1	1	RASHIDI MEDICAL CORPORATION	5/7/2012	207T00000X	NA	General Surgery	026	PHYSICIANS	87654	14	Neurological Surgery	0	In state provider	None	95 MONTGOMERY DRIVE	STE 118	SANTA ROSA	CA	95404	6617	49	06097	38.442357	-122.704641	Sonoma County
35303	Fee-for-Service	1740698943	1740698943	1	1	ROBY, KEITH D MD	8/29/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	139462	07	Dermatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
35309	Fee-for-Service	1447537345	1447537345	1	1	RELIABLE HOSPICE INC	4/4/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4175 E LA PALMA AVE	SUITE 100	ANAHEIM	CA	92807	1809	30	06059	33.85947346	-117.8265479	Orange County
35333	Fee-for-Service	1396198958	1396198958	1	6	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NTER	4241 FLORIN RD STE 40	STE 40	SACRAMENTO	CA	95823	2535	34	06067	38.496816	-121.4582625	Sacramento County
35338	Fee-for-Service	1609858729	1609858729	1	1	RGH ENTERPRISES INC	10/24/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1810 SUMMIT COMMERCE PRK	None	TWINSBURG	OH	44087	2300	00	None	41.28605324	-81.44936514	Summit County
35347	Fee-for-Service	1396198958	1396198958	1	8	RIVER CITY MEDICAL GROUP INC	8/17/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NTER	10390 COLOMA AVENUE	B	RANCHO CORDOVA	CA	95670	2152	34	06067	38.596176	-121.3042725	Sacramento County
35383	Fee-for-Service	1376746354	1376746354	1	1	RACHAEL M NICHOLSON M.D.	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
35395	Fee-for-Service	1669892055	1669892055	1	1	REDDY, CHARITHA D MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
35397	Fee-for-Service	1922582667	1922582667	1	1	RAMASAR, GHISLAINE	12/28/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4460 CREST VIEW DR	None	NORCO	CA	92860	1617	33	06065	33.94706454	-117.5258345	Riverside County
35403	Fee-for-Service	1619433497	1619433497	1	1	RUSCA, LISA R LMFT	8/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5588 N. PALM AVE.	Q5	FRESNO	CA	93704	1913	10	06019	36.818874	-119.8082415	Fresno County
35407	Fee-for-Service	1053426957	1053426957	1	1	RUDRICH, HORST R DO	8/10/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	245 TERRACINA BLVD	STE 211B	REDLANDS	CA	92373	4878	36	06071	34.03858912	-117.2066515	San Bernardino County
35413	Fee-for-Service	1811992530	1811992530	1	2	ROCHANAYON, PIRA MD	4/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42420	08	Family Practice	0	In state provider	None	7311 GREENHAVEN DR	STE 125	SACRAMENTO	CA	95831	3595	34	06067	38.492622	-121.5219195	Sacramento County
35420	Fee-for-Service	1770937138	1770937138	1	2	REPPY, LAUREN	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 MISSION ST	None	SANTA CRUZ	CA	95060	3611	44	06087	36.97505419	-122.0337876	Santa Cruz County
35445	Fee-for-Service	1427082569	1427082569	1	1	REICHERT, THERESE PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3821 FRONT ST	None	SAN DIEGO	CA	92103	3019	37	06073	32.74741411	-117.1649991	San Diego County
35453	Fee-for-Service	1942328679	1942328679	1	1	RHIM, BORA DPM	1/25/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	309 E 2ND ST	None	POMONA	CA	91766	1854	19	06037	34.05789396	-117.7476284	Los Angeles County
35534	Fee-for-Service	1942775424	1942775424	1	1	RUSZEL, CLARISSE E PT	6/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
35557	Fee-for-Service	1710262522	1710262522	1	1	REGAL HOSPICE HEALTH INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 116A	BURBANK	CA	91502	1849	19	06037	34.18064474	-118.3089507	Los Angeles County
35596	Fee-for-Service	1447537345	1447537345	1	1	RELIABLE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4175 E LA PALMA AVE	SUITE 100	ANAHEIM	CA	92807	1809	30	06059	33.85947346	-117.8265479	Orange County
35604	Fee-for-Service	1013076629	1013076629	1	1	RAMOS, NANCY MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78463	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
35616	Fee-for-Service	1174886113	1174886113	1	1	RICHARDSON, ZRRIA L MD	9/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148909	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
35619	Fee-for-Service	1346270402	1346270402	1	1	ROSENBERG, MATTHEW E MD	10/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80726	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
35684	Fee-for-Service	1558374363	1558374363	1	1	RANSOHOFF, KURT N MD	1/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	58109	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
35686	Fee-for-Service	1205060837	1205060837	1	1	RICHARDSON, KIMBERLY M MD	7/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101727	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
35694	Fee-for-Service	1053426957	1053426957	1	1	RUDRICH, HORST R DO	8/10/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5970	08	Family Practice	0	In state provider	None	245 TERRACINA BLVD	STE 211B	REDLANDS	CA	92373	4878	36	06071	34.03858912	-117.2066515	San Bernardino County
35708	Fee-for-Service	1225371073	1225371073	1	1	ROSS, MICHAEL H MD	7/31/2018	207L00000X	NA	Other	026	PHYSICIANS	134684	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
35734	Fee-for-Service	1568558492	1568558492	1	1	ROSEN, BARRY A MD	4/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36092	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2601 W ALAMEDA AVE	STE 304	BURBANK	CA	91505	4812	19	06037	34.15783817	-118.3293969	Los Angeles County
35749	Fee-for-Service	1083773667	1083773667	1	1	RAO, BHAVANI S MD	4/26/1988	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	39025	77	Infectious Disease	0	In state provider	None	231 E PALAIS RD	None	ANAHEIM	CA	92805	6239	30	06059	33.81359553	-117.9054855	Orange County
35758	Fee-for-Service	1174241392	1174241392	1	1	ROSEMONT GARDENS INC	6/17/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1345 CLARKE STREET	None	SAN LEANDRO	CA	94577	3632	01	06001	37.72341325	-122.1582316	Alameda County
35768	Fee-for-Service	1699078030	1699078030	1	8	RIDGE EYE CARE INC	9/4/2019	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2890 VENTURA STREET	None	ANDERSON	CA	96007	3533	45	06089	40.45284128	-122.2938885	Shasta County
35811	Fee-for-Service	1558803247	1558803247	1	1	REED, JENNIFER MD	12/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
35816	Fee-for-Service	1740359264	1740359264	1	1	RIED, CHRISTOPHER J MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67131	-	NOT APPLICABLE	0	In state provider	None	812 W TOWN AND COUNTRY	None	ORANGE	CA	92868	4712	30	06059	33.77650924	-117.8609936	Orange County
35835	Fee-for-Service	1962482513	1962482513	1	10	REGENTS OF THE UNIVERSITY OF	6/15/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
35865	Fee-for-Service	1376890640	1376890640	1	1	ROTHMAN, JEAN T LMFT	3/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 GARDEN VIEW COURT	SUITE 19	ENCINITAS	CA	92024	2464	37	06073	33.05846143	-117.2599332	San Diego County
35896	Fee-for-Service	1225637994	1225637994	1	1	RG LEGACY II, LLC	10/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1570 N FAIR OAKS AVE	None	PASADENA	CA	91103	8122	19	06037	34.1730054	-118.1506961	Los Angeles County
35904	Fee-for-Service	1366214827	1366214827	1	1	ROOT AND SOUL ACUPUNCTURE IN	2/14/2025	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9131 FLETCHER PKWY	108	LA MESA	CA	91942	3426	37	06073	32.7928502	-117.0019526	San Diego County
35905	Fee-for-Service	1720601495	1720601495	1	1	ROBERTSON, HANNAH MD	5/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188358	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
35932	Fee-for-Service	1285054635	1285054635	1	1	RAMANI, BHAVESH N MD	12/9/2020	207R00000X	NA	Other	026	PHYSICIANS	163526	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
35951	Fee-for-Service	1477685295	1477685295	1	1	RESENDEZ, YVONNE LMFT	5/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3610 CENTRAL AVE	#400	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
35952	Fee-for-Service	1295472207	1295472207	1	1	RUCH, BRITTANY J	5/19/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	316 E WOODROW ST	None	TAFT	CA	93268	3014	15	06029	35.14370714	-119.4447737	Kern County
35999	Fee-for-Service	1841559580	1841559580	1	1	REZAPOUR, MONA MD	6/17/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	126577	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
36016	Fee-for-Service	1124407838	1124407838	1	1	RAJEEV, SINDHYA MD	7/18/2019	207P00000X	NA	Other	026	PHYSICIANS	162393	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
36036	Fee-for-Service	1083773667	1083773667	1	1	RAO, BHAVANI S MD	4/26/1988	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	39025	41	Internal Medicine	0	In state provider	None	231 E PALAIS RD	None	ANAHEIM	CA	92805	6239	30	06059	33.81359553	-117.9054855	Orange County
36042	Fee-for-Service	1235530999	1235530999	1	1	ROBINOW, SARA	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1042 PACIFIC ST	E	SAN LUIS OBISPO	CA	93401	3621	40	06079	35.28015234	-120.6586689	San Luis Obispo County
36056	Fee-for-Service	1699078030	1699078030	1	8	RIDGE EYE CARE INC	9/4/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2890 VENTURA STREET	None	ANDERSON	CA	96007	3533	45	06089	40.45284128	-122.2938885	Shasta County
36086	Fee-for-Service	1992794176	1992794176	1	1	REICH, DANIEL S MD INC	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	801 N TUSTIN AVE	STE 306	SANTA ANA	CA	92705	3601	30	06059	33.752286	-117.8341735	Orange County
36096	Fee-for-Service	1669734653	1669734653	1	1	RIDGECREST REGIONAL HOSPITAL	1/14/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
36125	Fee-for-Service	1962482513	1962482513	1	10	REGENTS OF THE UNIVERSITY OF	6/15/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
36172	Fee-for-Service	1184019911	1184019911	1	1	RAO, USHA MD	2/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148750	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
36176	Fee-for-Service	1639243249	1639243249	1	1	RAPKO, DAVID A MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95876	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
36208	Fee-for-Service	1477553261	1477553261	1	1	RODA, ALISA A MD	4/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79164	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
36264	Fee-for-Service	1821387192	1821387192	1	1	RIDDELL, JEFFREY C MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122721	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
36322	Fee-for-Service	1659806917	1659806917	1	1	RICHMAN, MICHAEL A MD	11/8/2023	207L00000X	NA	Other	026	PHYSICIANS	191752	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
36332	Fee-for-Service	1871696898	1871696898	1	1	REBECCA C PHILLIPS	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	412 N 200 E	None	LOGAN	UT	84321	4038	00	None	41.73943385	-111.8295138	Cache County
36378	Fee-for-Service	1720013485	1720013485	1	1	RAPKIN, ANDREA MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42583	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
36411	Fee-for-Service	1962482513	1962482513	1	10	REGENTS OF THE UNIVERSITY OF	12/8/2023	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
36425	Fee-for-Service	1619491222	1619491222	1	1	RICE, BRIAN	1/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
36436	Fee-for-Service	1861989790	1861989790	1	1	RADI, MICHAEL S NP	5/18/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
36452	Fee-for-Service	1851361539	1851361539	1	1	ROBERT TREFT M.D.	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1580 W ANTELOPE DR	STE 175	LAYTON	UT	84041	1175	00	None	41.08922695	-111.9943717	Davis County
36466	Fee-for-Service	1427003003	1427003003	1	1	ROUBEN, LAWRENCE R MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	73813	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	341 EAST MAIN ST	STE 100	SAN JACINTO	CA	92583	4206	33	06065	33.78391437	-116.9562698	Riverside County
36498	Fee-for-Service	1366114464	1366114464	1	1	RADIANT BEGINNINGS MARRIAGE	1/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CHILD & FAMILY THERAPY C	711 JEFFERSON STREET	SUITE 203	FAIRFIELD	CA	94533	5166	48	06095	38.249514	-122.0419165	Solano County
36545	Fee-for-Service	1861011108	1861011108	1	1	R & B HOSPICE CARE, INC	11/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 118	VAN NUYS	CA	91411	4712	19	06037	34.18570347	-118.450386	Los Angeles County
36570	Fee-for-Service	1710915137	1710915137	1	1	RIVERA, JORGE MD	8/31/1982	208600000X	NA	General Surgery	026	PHYSICIANS	43588	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
36575	Fee-for-Service	1912229642	1912229642	1	1	RICHARDSON, ELIZABETH J	2/19/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
36581	Fee-for-Service	1346517398	1346517398	1	1	RAMOS-ACOSTA, MONICA L LCSW	12/2/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
36594	Fee-for-Service	1184608002	1184608002	1	1	RAISSI, SHARO S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	44836	09	Gynecology (D.O. only)	0	In state provider	None	8700 BEVERLY BLVD	# 6215	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
36599	Fee-for-Service	1437790367	1437790367	1	1	RIVIERA ENT, P.C.	1/8/2020	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	1819 STATE STREET	A	SANTA BARBARA	CA	93101	2481	42	06083	34.42947749	-119.7128685	Santa Barbara County
36652	Fee-for-Service	1417364696	1417364696	1	1	ROSEN, ALANA K	5/14/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
36677	Fee-for-Service	1245289388	1245289388	1	1	REYES, PAULO J MD INC	10/27/1994	207P00000X	NA	Other	026	PHYSICIANS	38272	41	Internal Medicine	0	In state provider	None	880 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
36700	Fee-for-Service	1962482513	1962482513	1	10	REGENTS OF THE UNIVERSITY OF	6/6/2023	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
36705	Fee-for-Service	1336227164	1336227164	1	1	RAMIREZ, CARLOS MD	12/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	56227	02	General Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
36714	Fee-for-Service	1396010609	1396010609	1	1	REGENTS OF THE UNIV OF CALIF	6/29/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1223 16TH STREET	ROOM 1202	SANTA MONICA	CA	90404	1217	19	06037	34.02773198	-118.4862675	Los Angeles County
36782	Fee-for-Service	1578512471	1578512471	1	1	RX CARE PHARMACY INC	7/27/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 S 5TH ST	STE A	COALINGA	CA	93210	1903	10	06019	36.13845412	-120.3582671	Fresno County
36796	Fee-for-Service	1275044885	1275044885	1	1	ROSARIO, JOSHUA E LMFT	5/18/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	131005	-	NOT APPLICABLE	0	In state provider	None	2414 HOOVER AVE	SUITES A,B,C	NATIONAL CITY	CA	91950	8581	37	06073	32.66033086	-117.1043552	San Diego County
36830	Fee-for-Service	1487217550	1487217550	1	1	RENALS, MADELINE A MD	5/9/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
36831	Fee-for-Service	1861011108	1861011108	1	1	R & B HOSPICE CARE, INC	11/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 118	VAN NUYS	CA	91411	4712	19	06037	34.18570347	-118.450386	Los Angeles County
36876	Fee-for-Service	1659397537	1659397537	1	1	REODICA, RONALD A MD	1/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52763	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1145 WHISKEYTOWN COURT	SUITE A	REDDING	CA	96001	0227	45	06089	40.58504488	-122.4126269	Shasta County
36880	Fee-for-Service	1184608002	1184608002	1	1	RAISSI, SHARO S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	44836	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	# 6215	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
36881	Fee-for-Service	1588600068	1588600068	1	1	RAJU, MINA DO	9/5/2016	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	9970	77	Infectious Disease	0	In state provider	None	5400 W HILLSDALE AVENUE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
36943	Fee-for-Service	1497392807	1497392807	1	1	RAMOS, ADRIANA D CNM	12/6/2022	163WP0807X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3101 TELEGRAPH AVE	None	BERKELEY	CA	94705	1984	01	06001	37.85361291	-122.2600247	Alameda County
36956	Fee-for-Service	1376521906	1376521906	1	1	RAZZAQ, IRFANA MD	3/29/2024	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
36962	Fee-for-Service	1245289388	1245289388	1	1	REYES, PAULO J MD INC	10/27/1994	207P00000X	NA	Other	026	PHYSICIANS	38272	66	Emergency Medicine (Urgent Care)	0	In state provider	None	880 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
36981	Fee-for-Service	1679778252	1679778252	1	1	ROTH, KEVIN M MD	12/13/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	121082	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
37011	Fee-for-Service	1679102800	1679102800	1	1	RAVINE, MADISON DPM	1/31/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
37012	Fee-for-Service	1881161339	1881161339	1	1	ROMERO, JUAN MIGUEL R RCP	2/13/2025	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
37065	Fee-for-Service	1760971063	1760971063	1	1	REIDINGER, RACHEL A CRNA	6/12/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
37076	Fee-for-Service	1720657042	1720657042	1	1	RIFKIN, AUSTIN MD	4/14/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
37083	Fee-for-Service	1821466723	1821466723	1	1	ROMERO ALVAREZ, MARISELA LC	10/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
37122	Fee-for-Service	1427108851	1427108851	1	1	ROSEN, MARK A MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43522	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
37145	Fee-for-Service	1366730186	1366730186	1	1	RAGGIO, JOSEPHINE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
37159	Fee-for-Service	1801406269	1801406269	1	1	RESTORE MEDICAL INC	6/29/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 SOQUEL DR.	STE 4	SANTA CRUZ	CA	95065	1008	44	06087	36.98803429	-121.9848045	Santa Cruz County
37166	Fee-for-Service	1902440100	1902440100	1	1	RX HOME HEALTH INC	6/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	23300 CINEMA DR	STE 275	VALENCIA	CA	91355	1792	19	06037	34.41921148	-118.542807	Los Angeles County
37167	Fee-for-Service	1184608002	1184608002	1	1	RAISSI, SHARO S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	44836	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	# 6215	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
37176	Fee-for-Service	1588688154	1588688154	1	1	RICHMOND UROLOGICAL	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	MEDICAL GROUP CORP	1430 TARA HILLS DR	STE A	PINOLE	CA	94564	2512	07	06013	37.99573181	-122.3044538	Contra Costa County
37205	Fee-for-Service	1396777215	1396777215	1	1	ROWE, VINCENT L MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76069	02	General Surgery	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
37219	Fee-for-Service	1811123565	1811123565	1	1	REDER, LINDSAY S MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108138	04	Otology, Laryngology, Rhinology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
37250	Fee-for-Service	1528375755	1528375755	1	1	RODRIGUEZ, KRISTINA L LCSW	8/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
37297	Fee-for-Service	1659753382	1659753382	1	1	RAJPUT, TOSHIE K MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155086	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
37315	Fee-for-Service	1306821368	1306821368	2	1	RIPPERDA, MARK V MD	12/10/2019	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
37331	Fee-for-Service	1417268137	1417268137	1	1	RAHMAN, ASIF MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
37344	Fee-for-Service	1124411616	1124411616	1	1	RODRIGUEZ, GREGORIO E NP	11/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37363	Fee-for-Service	1891322194	1891322194	1	1	ROSENWOHL-MACK, SARAH MD MP	8/15/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187147	None	None	0	In state provider	H	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
37392	Fee-for-Service	1790099968	1790099968	1	1	RONQUILLO, JONATHAN R MD	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119586	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
37409	Fee-for-Service	1710760210	1710760210	1	1	ROY-POGUTTER, JENNIFER PSYD	11/8/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
37411	Fee-for-Service	1427108851	1427108851	1	1	ROSEN, MARK A MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43522	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
37486	Fee-for-Service	1053451633	1053451633	1	1	ROBERTSON RX INC	3/18/1996	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 N ROBERTSON BLVD	STE 107	BEVERLY HILLS	CA	90211	1767	19	06037	34.0696407	-118.3836988	Los Angeles County
37553	Fee-for-Service	1992455166	1992455166	1	1	ROSENMOSS, SOPHIA J MD	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	190939	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
37567	Fee-for-Service	1982081808	1982081808	1	1	RABIE, JASON MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145006	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
37585	Fee-for-Service	1639453137	1639453137	1	1	REID, PETER C MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	33930	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
37642	Fee-for-Service	1083762033	1083762033	1	1	RAJ, SHEILA MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37176	01	General Practice	0	In state provider	None	2675 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.9892055	-118.2228885	Los Angeles County
37654	Fee-for-Service	1295769453	1295769453	1	1	RAYMOND, PATRICK A MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	52818	05	Anesthesiology	0	In state provider	INC	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
37662	Fee-for-Service	1982993374	1982993374	1	1	ROGERS, MEGAN O MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122784	67	Endocrinology	0	In state provider	None	480 4TH AVE	STE 202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
37687	Fee-for-Service	1417227141	1417227141	1	1	ROBISON, EMILY J DO	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12817	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
37723	Fee-for-Service	1528037124	1528037124	1	1	ROTHMAN, JEFFREY MD INC	5/31/1980	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	32093	10	Gastroenterology (M.D. only)	0	In state provider	None	2095 W VISTA WAY	STE 208	VISTA	CA	92083	6027	37	06073	33.18438885	-117.2876725	San Diego County
37727	Fee-for-Service	1508964941	1508964941	1	1	REDDY, SWATHI MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75901	08	Family Practice	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
37768	Fee-for-Service	1124678610	1124678610	1	1	RICHARD L RABIN MD INC	2/28/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1844 SAN MIGUEL DR	STE 303	WALNUT CREEK	CA	94596	4963	07	06013	37.89504879	-122.0529911	Contra Costa County
37778	Fee-for-Service	1760773733	1760773733	1	1	RAMIREZ, MARCO A LMFT	2/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
37799	Fee-for-Service	1679013114	1679013114	1	1	ROOK-DEL ROSARIO, ANNA M LMF	5/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
37815	Fee-for-Service	1275635831	1275635831	1	1	RUNDELL, MICHAEL J DO	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
37831	Fee-for-Service	1720152374	1720152374	1	1	ROYLANCE, LEAH J LMFT	10/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
37843	Fee-for-Service	1801215876	1801215876	1	1	REILLY, LINDSAY F MD	12/17/2020	208600000X	NA	General Surgery	026	PHYSICIANS	162915	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
37848	Fee-for-Service	1831685676	1831685676	1	1	RUTHERFORD, COLLIN J MD	2/10/2025	208M00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
37854	Fee-for-Service	1346747524	1346747524	1	1	REGENCY HOME HEALTH CARE INC	3/27/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4000 WEST MAGNOLIA BLVD	C	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
37891	Fee-for-Service	1447704598	1447704598	1	1	ROSE, ANDREA P LCSW	4/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3233 3RD AVE	None	SAN DIEGO	CA	92103	5615	37	06073	32.73916528	-117.1621706	San Diego County
37919	Fee-for-Service	1497759898	1497759898	1	1	RICKMAN, CHRISTOPHER E MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88788	None	None	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
37935	Fee-for-Service	1043235195	1043235195	1	1	RANDHAWA, GURINDER K MD	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67417	08	Family Practice	0	In state provider	None	2450 EAST ST	None	CONCORD	CA	94520	0000	07	06013	37.9830627	-122.0342408	Contra Costa County
37943	Fee-for-Service	1235324336	1235324336	1	1	ROXAS, ADRIANE MARIE V DO	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9764	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
37965	Fee-for-Service	1174624217	1174624217	1	1	RUSSIANO, MELISSA	3/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
37988	Fee-for-Service	1447277124	1447277124	1	1	RUH, KATJA MD	9/22/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77263	40	Pediatrics	0	In state provider	None	2 WEST FERN AVENUE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
37994	Fee-for-Service	1346637170	1346637170	1	1	RODRIGUEZ SOLARES, ADIB F MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1524 PINTO LANE	3RD FLOOR	LAS VEGAS	NV	89102	4195	00	None	36.1643883	-115.162182	Clark County
38052	Fee-for-Service	1548285349	1548285349	1	1	RAJAN, GOVIND R MD	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55301	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
38065	Fee-for-Service	1861703670	1861703670	1	1	RACHEL THOMAS M.D.	11/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
38088	Fee-for-Service	1851588438	1851588438	1	1	RODRIGUEZ, RUBICELA LCSW	9/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
38109	Fee-for-Service	1407891880	1407891880	1	1	RONALD F CHRISTIANSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2845 GREENBRIER RD	None	GREEN BAY	WI	54311	6519	00	None	44.47337651	-87.940791	Brown County
38220	Fee-for-Service	1043235195	1043235195	1	1	RANDHAWA, GURINDER K MD	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67417	01	General Practice	0	In state provider	None	2450 EAST ST	None	CONCORD	CA	94520	0000	07	06013	37.9830627	-122.0342408	Contra Costa County
38227	Fee-for-Service	1508209651	1508209651	1	2	RODRIGUEZ, ALDO E MD	6/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134995	40	Pediatrics	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
38275	Fee-for-Service	1467179911	1467179911	1	1	RIKIN TANK MD PC	2/24/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	None	1510 E MAIN ST	SUITE 101	SANTA MARIA	CA	93454	4826	42	06083	34.95282793	-120.4100798	Santa Barbara County
38276	Fee-for-Service	1447277124	1447277124	1	1	RUH, KATJA MD	9/22/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77263	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVENUE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
38281	Fee-for-Service	1932271129	1932271129	1	2	RASKEY, JERRY T DC	7/13/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	21535 PALOMAR STREET	UNIT I	WILDOMAR	CA	92595	7763	33	06065	33.60423194	-117.2736726	Riverside County
38309	Fee-for-Service	1346243375	1346243375	1	2	ROBERT WOOD JOHNSON UNIVERSI	2/26/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL, INC	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
38336	Fee-for-Service	1548285349	1548285349	1	1	RAJAN, GOVIND R MD	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55301	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
38451	Fee-for-Service	1932122207	1932122207	1	1	RANU, GURDEEP S	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32266	None	None	0	In state provider	None	5557 E KINGS CANYON RD	None	FRESNO	CA	93727	4528	10	06019	36.73596559	-119.7021794	Fresno County
38459	Fee-for-Service	1588169817	1588169817	1	1	RAVENBORG, NOAH J MD	3/8/2021	207R00000X	NA	Other	026	PHYSICIANS	165187	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
38491	Fee-for-Service	1437122009	1437122009	1	1	RAPID CITY REGIONAL HOSP	2/1/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	7393	00	None	44.05854729	-103.2246985	Pennington County
38523	Fee-for-Service	1144310939	1144310939	1	1	RITESH DHAR	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
38556	Fee-for-Service	1366407645	1366407645	1	1	ROTH, PATRICIA A MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85454	05	Anesthesiology	0	In state provider	None	1600 DIVISADERO ST	# 1605	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
38560	Fee-for-Service	1609896745	1609896745	1	1	RAO, SRIKANTH S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8793	25	Physical Medicine and Rehabilitation	0	In state provider	None	2080 CENTURY PARK EAST	STE 300	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
38595	Fee-for-Service	1346243375	1346243375	1	2	ROBERT WOOD JOHNSON UNIVERSI	2/26/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL, INC	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
38600	Fee-for-Service	1982126231	1982126231	1	1	REEVES, MONA RIKELE	8/17/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	20725 LEMARSH ST UNIT G	None	CHATSWORTH	CA	91311	7351	19	06037	34.25546851	-118.5846705	Los Angeles County
38605	Fee-for-Service	1134138183	1134138183	1	1	RIGGS, KATHRYN D LCSW	5/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
38649	Fee-for-Service	1942662242	1942662242	1	1	ROSA, WESLYNNE A PT	4/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2200 E. MAPLE AVE	None	EL SEGUNDO	CA	90245	6507	19	06037	33.92690475	-118.3857342	Los Angeles County
38673	Fee-for-Service	1962645044	1962645044	1	1	REYNOLDS, PAMELA J LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
38679	Fee-for-Service	1972040608	1972040608	1	1	ROWELL, NICOLE	6/25/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1555 RIVER PARK DR	STE 206	SACRAMENTO	CA	95815	4604	34	06067	38.600019	-121.434687	Sacramento County
38708	Fee-for-Service	1669698163	1669698163	1	1	RAY, SOURAV MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52780	22	Pathology (M.D. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
38712	Fee-for-Service	1780640631	1780640631	1	1	ROBERTSON, CECIL O MD	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86347	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
38733	Fee-for-Service	1316006984	1316006984	1	1	RAMANATHAN, SWAMINATHAN	5/31/1986	207RH0000X	NA	Hematology	026	PHYSICIANS	42946	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
38748	Fee-for-Service	1558317826	1558317826	1	1	ROHR, SUSAN M. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1201 S EUCLID AVE	None	SIOUX FALLS	SD	57105	7700	00	None	43.536301	-96.74241503	Minnehaha County
38765	Fee-for-Service	1861817892	1861817892	1	1	ROHLWING, MAUREEN C	7/7/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
38779	Fee-for-Service	1437122009	1437122009	1	1	RAPID CITY REGIONAL HOSP	2/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	7393	00	None	44.05854729	-103.2246985	Pennington County
38802	Fee-for-Service	1205813664	1205813664	1	1	REDDY, NEENA M MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78095	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
38873	Fee-for-Service	1134651110	1134651110	2	1	RAO, RAVI M MD	6/9/2023	207R00000X	NA	Other	026	PHYSICIANS	159062	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
38877	Fee-for-Service	1275624231	1275624231	1	1	RAKEEV GARG MD	4/29/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9520 W PALM LN	STE 150-A	PHOENIX	AZ	85037	4403	00	None	33.468894	-112.267413	Maricopa County
38888	Fee-for-Service	1982126231	1982126231	1	1	REEVES, MONA RIKELE	8/17/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	20725 LEMARSH ST UNIT G	None	CHATSWORTH	CA	91311	7351	19	06037	34.25546851	-118.5846705	Los Angeles County
38996	Fee-for-Service	1336911338	1336911338	1	1	RC LIMOUSINES, LLC	1/10/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2845 80TH ST W	None	ROSAMOND	CA	93560	7180	15	06029	34.86078536	-118.2733983	Kern County
39033	Fee-for-Service	1396831392	1396831392	1	1	ROMO, ANTHONY J MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75316	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
39039	Fee-for-Service	1316190457	1316190457	1	1	RAM, RAMIN MD	1/15/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	102239	07	Dermatology	0	In state provider	None	11525 BROOKSHIRE AVE	STE 300	DOWNEY	CA	90241	4892	19	06037	33.93544635	-118.1318321	Los Angeles County
39062	Fee-for-Service	1437504503	1437504503	1	1	RANU, JASKIRAN K MD	10/12/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	154420	None	None	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
39102	Fee-for-Service	1205102217	1205102217	1	1	RING, ADAM C MD	10/16/2020	2086S0129X	NA	General Surgery	026	PHYSICIANS	169387	47	Miscellaneous	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
39162	Fee-for-Service	1043391386	1043391386	1	1	ROSEBERRY, DEBRA LCSW	3/10/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
39174	Fee-for-Service	1386670438	1386670438	1	1	RONAGHY, HOSSAIN A MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	39525	41	Internal Medicine	0	In state provider	None	3023 BUNKER HILL ST	STE 106	SAN DIEGO	CA	92109	5701	37	06073	32.80338605	-117.2152206	San Diego County
39201	Fee-for-Service	1639289390	1639289390	1	1	RALEY'S	3/15/1985	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2485 NOTRE DAME BLVD	None	CHICO	CA	95928	7161	04	06007	39.71648277	-121.7952804	Butte County
39221	Fee-for-Service	1336259738	1336259738	1	1	REDDY, SUMANA MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74149	01	General Practice	0	In state provider	None	250 LOCUST ST	None	SANTA CRUZ	CA	95060	3813	44	06087	36.97493323	-122.028799	Santa Cruz County
39222	Fee-for-Service	1275617243	1275617243	1	1	RUDOW, MARK P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31788	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
39225	Fee-for-Service	1619070661	1619070661	1	1	RINOIE, CHUGO DPM INC	11/23/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	301 W HUNTINGTON DR	STE 300	ARCADIA	CA	91007	1527	19	06037	34.13481053	-118.0425638	Los Angeles County
39228	Fee-for-Service	1750412581	1750412581	1	1	RALPH BELTRAN	1/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
39264	Fee-for-Service	1760913263	1760913263	1	1	RILEY, ELIZABETH NP	10/7/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
39294	Fee-for-Service	1598028524	1598028524	1	1	RICKEY, ANGELA S MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138852	01	General Practice	0	In state provider	None	3133 PROFESSIONAL DRIVE	SUITE 20	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
39305	Fee-for-Service	1447253158	1447253158	1	1	REDDINGTON, LURA J MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76987	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6730 N WEST AVE	STE 115	FRESNO	CA	93711	4301	10	06019	36.83543245	-119.8261062	Fresno County
39317	Fee-for-Service	1699708651	1699708651	1	1	READY, PAMELA A	3/13/2007	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
39361	Fee-for-Service	1831299668	1831299668	2	1	RENO EMERGENCY PHYSICIANS AS	2/19/2025	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	SOCIATION PLLC	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
39391	Fee-for-Service	1689889131	1689889131	1	1	RSCR CALIFORNIA, INC	12/30/1996	310500000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CASA DE VIDA	879 MEINECKE AVE	None	SAN LUIS OBISPO	CA	93405	1732	40	06079	35.29238647	-120.6686565	San Luis Obispo County
39420	Fee-for-Service	1356334320	1356334320	1	1	RODRIGUEZ, JOYCE	10/20/2009	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 29TH ST	STE 304	OAKLAND	CA	94609	3548	01	06001	37.81784861	-122.2652263	Alameda County
39450	Fee-for-Service	1033374681	1033374681	1	1	RETAILLEAU, ELIZABETH L MD	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103728	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
39474	Fee-for-Service	1265702658	1265702658	1	1	REED, DONNA D LMFT	10/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 W FOOTHILL BLVD	STE 140	UPLAND	CA	91786	3686	36	06071	34.10715453	-117.6734115	San Bernardino County
39478	Fee-for-Service	1588322275	1588322275	1	1	RAJESHWARY SWAMIDURAI MD INC	1/4/2022	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
39487	Fee-for-Service	1235300831	1235300831	1	1	RAPHAEL, GAIL R MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103160	36	Psychiatry	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
39561	Fee-for-Service	1386046985	1386046985	1	1	RUIZ, MARY JOYCE D PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
39566	Fee-for-Service	1750364493	1750364493	1	1	RONSON, BRIAN B MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77586	None	None	0	In state provider	None	36450 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9583	33	06065	33.591168	-117.2367715	Riverside County
39581	Fee-for-Service	1992889299	1992889299	1	1	RICHARD M POWELL MD	12/28/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5901 W OLYMPIC BLVD	STE 504	LOS ANGELES	CA	90036	4633	19	06037	34.05764121	-118.3603115	Los Angeles County
39592	Fee-for-Service	1649372582	1649372582	1	1	ROSS, CHARLES R MD	7/13/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85809	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
39595	Fee-for-Service	1508442682	1508442682	1	1	RADIANT HOSPICE CARE INC	7/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 187B	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
39611	Fee-for-Service	1831100841	1831100841	1	1	REINECK, SCOTT E MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68240	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
39707	Fee-for-Service	1366428658	1366428658	1	1	ROGERS, SALLY J PHD	5/6/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
39710	Fee-for-Service	1093202038	1093202038	1	1	RODRIGUEZ, ILIANA G LMFT	10/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
39737	Fee-for-Service	1770655821	1770655821	1	1	ROSARIO, MARSHAL D	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37569	14	Neurological Surgery	0	In state provider	A MEDICAL CORPORATION	50 E HAMILTON AVE	STE 120	CAMPBELL	CA	95008	0251	43	06085	37.29415254	-121.948758	Santa Clara County
39770	Fee-for-Service	1528600129	1528600129	1	1	REACTIVATE PHYSICAL THERAPY	4/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	2451 ROCKWOOD AVE	101	CALEXICO	CA	92231	4401	13	06025	32.69552366	-115.4975945	Imperial County
39798	Fee-for-Service	1003496894	1003496894	1	1	ROAN, RACHEL	1/8/2025	207R00000X	NA	Other	026	PHYSICIANS	192091	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
39803	Fee-for-Service	1295840924	1295840924	1	1	RAMAN, SIVA P MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111824	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39822	Fee-for-Service	1508944307	1508944307	1	1	RYBCZYNSKI, CARYN L MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64558	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39831	Fee-for-Service	1073722112	1073722112	1	1	RAHHAL, RIAD M MD	2/8/2015	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	UNIVERSITY OF IOWA HOSPI	200 HAWKINS DR	None	IOWA CITY	IA	52242	5500	00	None	41.659929	-91.548099	Johnson County
39841	Fee-for-Service	1780730150	1780730150	1	1	ROBINSON, JEHNI S MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	67653	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
39848	Fee-for-Service	1811389745	1811389745	1	1	RAMIREZ, YENISEL CCC-SLP	1/16/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
39871	Fee-for-Service	1992889299	1992889299	1	1	RICHARD M POWELL MD	12/28/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	5901 W OLYMPIC BLVD	STE 504	LOS ANGELES	CA	90036	4633	19	06037	34.05764121	-118.3603115	Los Angeles County
39876	Fee-for-Service	1245462860	1245462860	1	1	ROMERO BABISTA, MARIA E NP	7/17/2023	225400000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
39883	Fee-for-Service	1508442682	1508442682	1	1	RADIANT HOSPICE CARE INC	7/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 187B	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
39902	Fee-for-Service	1356321699	1356321699	1	1	RANGE REGIONAL HEALTH	1/30/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	750 E 34TH ST	None	HIBBING	MN	55746	2341	00	None	47.41000349	-92.92875548	St. Louis County
39914	Fee-for-Service	1699078030	1699078030	1	15	RIDGE EYE CARE INC	2/1/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1720 BRUCE RD	None	CHICO	CA	95928	7942	04	06007	39.73479993	-121.7876245	Butte County
39933	Fee-for-Service	1124201629	1124201629	1	1	RANDY SMITH	7/24/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	2908 SE LOOP 820	None	FORT WORTH	TX	76140	1019	00	None	32.6614669	-97.28488166	Tarrant County
39934	Fee-for-Service	1902823461	1902823461	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
39973	Fee-for-Service	1417970088	1417970088	1	1	REDA, THOMAS J II MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137887	01	General Practice	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
40002	Fee-for-Service	1780213603	1780213603	1	1	RADOC, JEANNIE GAIL MD	6/14/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	186057	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
40010	Fee-for-Service	1083614382	1083614382	1	1	ROBERT PACKER HOSPITAL	1/29/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 GUTHRIE SQ	STE B	SAYRE	PA	18840	1698	00	None	41.98065762	-76.52118375	Bradford County
40024	Fee-for-Service	1639230345	1639230345	1	1	RAPAPORT, EUGENE A MD	5/29/1998	207L00000X	NA	Other	026	PHYSICIANS	65370	None	None	0	In state provider	None	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
40041	Fee-for-Service	1710184767	1710184767	1	1	RAMIREZ, ANA A LCSW	9/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
40112	Fee-for-Service	1174059893	1174059893	1	1	RAMINENI, TINA MD	4/10/2020	207R00000X	NA	Other	026	PHYSICIANS	162414	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
40170	Fee-for-Service	1538845615	1538845615	2	1	RASMUSEN, SAMANTHA LMFT	9/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	825 ZION STREET	None	NEVADA CITY	CA	95959	2922	29	06057	39.2501371	-121.0275348	Nevada County
40174	Fee-for-Service	1073033007	1073033007	1	1	RAZDAN, SHEILA MD	4/15/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	173543	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
40193	Fee-for-Service	1356321699	1356321699	1	1	RANGE REGIONAL HEALTH	1/30/2003	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	750 E 34TH ST	None	HIBBING	MN	55746	2341	00	None	47.41000349	-92.92875548	St. Louis County
40204	Fee-for-Service	1699078030	1699078030	1	15	RIDGE EYE CARE INC	4/11/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1720 BRUCE RD	None	CHICO	CA	95928	7942	04	06007	39.73479993	-121.7876245	Butte County
40224	Fee-for-Service	1902823461	1902823461	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
40244	Fee-for-Service	1780638569	1780638569	1	1	RIMKUNOS, LINDA M MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
40250	Fee-for-Service	1962602367	1962602367	1	1	ROWINSKY, PETER A MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125095	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC:5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
40257	Fee-for-Service	1164686580	1164686580	1	1	ROSETE, CHERYL M	2/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	623 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74934351	-116.9656065	Riverside County
40268	Fee-for-Service	1770274334	1770274334	1	1	REST YOUR HEART HERE & CO LL	1/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
40335	Fee-for-Service	1407987464	1407987464	1	1	RETI, VICTORIA L MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44520	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
40338	Fee-for-Service	1336535699	1336535699	1	1	RAO, RAMYA K MD	4/1/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	13400 JAMBOREE RD	None	IRVINE	CA	92602	2308	30	06059	33.724863	-117.788022	Orange County
40374	Fee-for-Service	1396078697	1396078697	1	1	RUGAMA, SUSI I NP	6/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40415	Fee-for-Service	1972320521	1972320521	1	1	RELLOSA, JESSIE CRNA	11/15/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
40420	Fee-for-Service	1407945777	1407945777	1	1	RIKHY, SEEMA MD	8/1/2006	207R00000X	NA	Other	026	PHYSICIANS	50230	01	General Practice	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
40436	Fee-for-Service	1962482513	1962482513	1	6	REGENTS OF THE UNIVERSITY OF	6/6/2023	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
40451	Fee-for-Service	1568493922	1568493922	2	1	REGENTS OF THE UNIVERSITY OF	3/27/2024	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
40466	Fee-for-Service	1851457055	1851457055	1	1	ROSENTHAL, MACEY H MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	32899	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
40471	Fee-for-Service	1588632673	1588632673	1	1	RUIZ, MICHAEL A MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64848	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
40479	Fee-for-Service	1306672506	1306672506	1	1	RIVAS, NANSI LCSW	1/22/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
40482	Fee-for-Service	1306933585	1306933585	1	1	RICKARDS, MARIANNE LCSW	6/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1821 4TH ST.	None	SANTA ROSA	CA	95404	3202	49	06097	38.450619	-122.69781	Sonoma County
40507	Fee-for-Service	1902823461	1902823461	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
40569	Fee-for-Service	1356420335	1356420335	1	1	RAMIREZ. RHONDA RN	6/30/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	01	06001	37.70519163	-122.1536391	Alameda County
40597	Fee-for-Service	1396743308	1396743308	1	1	RHODES, MELISSA B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	960 JOE FRANK HARRIS PKW	None	CARTERSVILLE	GA	30120	2129	00	None	34.19984075	-84.79568996	Bartow County
40720	Fee-for-Service	1437610136	1437610136	1	1	RAUCH, DANIEL MD	7/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	191205	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
40724	Fee-for-Service	1962482513	1962482513	1	6	REGENTS OF THE UNIVERSITY OF	12/22/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
40738	Fee-for-Service	1568493922	1568493922	2	1	REGENTS OF THE UNIVERSITY OF	3/27/2024	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
40742	Fee-for-Service	1285097709	1285097709	1	1	RABIZADEH, IMAN MD	10/27/2020	207L00000X	NA	Other	026	PHYSICIANS	152653	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
40764	Fee-for-Service	1063476752	1063476752	1	1	RICKS, JEFFREY C MD	8/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	85778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
40767	Fee-for-Service	1760220842	1760220842	1	1	RENEWED LIFE MEDICAL GROUP,	2/22/2025	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	376 HARTNELL AVE	STE A	REDDING	CA	96002	1881	45	06089	40.56518339	-122.3683085	Shasta County
40782	Fee-for-Service	1386721959	1386721959	1	1	ROSANNA W .ISKANDER MD INC.	10/4/2018	193400000X	NA	Other	026	PHYSICIANS	40133	01	General Practice	0	In state provider	None	1330 W COVINA BLVD	SUITE 102	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
40785	Fee-for-Service	1750589826	1750589826	1	1	RAHNAMAYI, ROSHANAK MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112904	42	Nuclear Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
40798	Fee-for-Service	1902823461	1902823461	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
40828	Fee-for-Service	1720559495	1720559495	1	1	RODRIQUEZ, GABRIEL M RCP	10/20/2023	2279G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
40899	Fee-for-Service	1851590624	1851590624	1	1	RASHIDI, BANAFSHEH MD	9/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92478	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
40920	Fee-for-Service	1104988591	1104988591	1	1	RANDALL, RUSSELL J DC	10/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	RANDALL CHIROPRACTIC OFF	227 COLFAX AVE	None	GRASS VALLEY	CA	95945	6843	29	06057	39.21591215	-121.058356	Nevada County
40945	Fee-for-Service	1083031033	1083031033	1	1	RODRIGUEZ, JUAN C MD	9/17/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	140767	45	Nephrology (Renal-Kidney)	0	In state provider	None	3393 G ST	SUITE D	MERCED	CA	95340	0964	24	06047	37.32623794	-120.4692707	Merced County
40948	Fee-for-Service	1891883583	1891883583	1	1	ROWEN, ERIC M MD	4/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	45934	10	Gastroenterology (M.D. only)	0	In state provider	STE 320	5575 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	5801	01	06001	37.69214859	-121.8796532	Alameda County
40989	Fee-for-Service	1356669766	1356669766	1	1	RAJAPAKSE, RIDHMI P MD	9/15/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	1	Border provider	None	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	None	39.4735137	-119.7995156	Washoe County
40991	Fee-for-Service	1255753810	1255753810	1	1	RATCLIFF, TERRI CNP	4/11/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
41001	Fee-for-Service	1366691453	1366691453	1	1	REYES OCAMPO, ARTURO LCSW	1/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	55 SHAW AVE	STE 115	CLOVIS	CA	93612	3819	10	06019	36.80859553	-119.708505	Fresno County
41011	Fee-for-Service	1962482513	1962482513	1	6	REGENTS OF THE UNIVERSITY OF	6/1/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
41046	Fee-for-Service	1255750410	1255750410	1	1	RAJPOOT, RAVI MD	6/27/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141752	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
41054	Fee-for-Service	1699078030	1699078030	1	13	RIDGE EYE CARE INC	1/3/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1070 W. WOOD STREET	SUITE B	WILLOWS	CA	95988	2349	11	06021	39.52419354	-122.2070895	Glenn County
41055	Fee-for-Service	1922503408	1922503408	1	1	ROSSI, MARIE K MD	7/1/2021	390200000X	NA	Other	026	PHYSICIANS	165621	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
41062	Fee-for-Service	1457933152	1457933152	1	1	RHODES, CARL DO	6/28/2024	207P00000X	NA	Other	026	PHYSICIANS	21013	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
41132	Fee-for-Service	1801422894	1801422894	1	1	REYES, ASHLEY D CNP	6/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
41177	Fee-for-Service	1053427294	1053427294	1	1	RAMADAN, NAGLAA A MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43529	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
41300	Fee-for-Service	1962482513	1962482513	1	6	REGENTS OF THE UNIVERSITY OF	3/21/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
41340	Fee-for-Service	1699078030	1699078030	1	13	RIDGE EYE CARE INC	1/3/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1070 W. WOOD STREET	SUITE B	WILLOWS	CA	95988	2349	11	06021	39.52419354	-122.2070895	Glenn County
41341	Fee-for-Service	1124106794	1124106794	1	1	ROCKMAEL, MATTHEW T DPM	12/26/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
41350	Fee-for-Service	1881736650	1881736650	1	1	R & B MEDICAL GRP INC	10/22/1998	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	6700 VALJEAN AVE	None	VAN NUYS	CA	91406	5818	19	06037	34.192098	-118.485843	Los Angeles County
41354	Fee-for-Service	1891310975	1891310975	1	1	RANCHO BERNARDO HEALTHCARE	10/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	5411 AVENDIA ENCINAS	SUITE 270	CARLSBAD	CA	92008	4380	37	06073	33.12902685	-117.3268037	San Diego County
41376	Fee-for-Service	1962733402	1962733402	1	1	RESCUE ONE AMBULANCE	9/3/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	15335 ILLINOIS AVENUE	None	PARAMOUNT	CA	90723	4108	19	06037	33.89413376	-118.1654938	Los Angeles County
41402	Fee-for-Service	1104191154	1104191154	1	1	ROBERTSON, EDWARD E JR MD	3/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
41408	Fee-for-Service	1578516829	1578516829	1	1	RADIOLOGY MEDICAL GROUP	12/1/1997	207U00000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	555 WASHINGTON ST	None	SAN DIEGO	CA	92103	2289	37	06073	32.74986289	-117.1599343	San Diego County
41413	Fee-for-Service	1164614012	1164614012	1	1	RODGERS, ROSS B MD	12/9/2020	207P00000X	NA	Other	026	PHYSICIANS	168489	None	None	0	In state provider	None	9888 GENESEE AVENUE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
41419	Fee-for-Service	1013219393	1013219393	1	1	ROBERTSON, ROBERT FORBES AMC	11/26/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
41465	Fee-for-Service	1053427294	1053427294	1	1	RAMADAN, NAGLAA A MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43529	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
41503	Fee-for-Service	1659459469	1659459469	1	1	RAU, WILLIAM A MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85958	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
41518	Fee-for-Service	1699078030	1699078030	1	14	RIDGE EYE CARE INC	1/20/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 SOLANO STREET	None	CORNING	CA	96021	3433	52	06103	39.92788727	-122.1705565	Tehama County
41575	Fee-for-Service	1609557024	1609557024	1	1	RAY, ASHLEY B CCC-SLP	2/29/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
41580	Fee-for-Service	1295961480	1295961480	1	1	RIVERA, GABRIEL A MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121128	68	Hematology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
41587	Fee-for-Service	1962482513	1962482513	1	6	REGENTS OF THE UNIVERSITY OF	2/6/2023	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
41608	Fee-for-Service	1356965552	1356965552	1	1	REDDY, PRIYA MD	4/30/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	176796	83	Rheumatology	0	In state provider	None	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	19	06037	33.87557796	-118.0725386	Los Angeles County
41619	Fee-for-Service	1225224389	1225224389	1	1	RIVIERA MEDICAL CORPORATION	4/5/2023	261QU0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	360 SAN MIGUEL DR	SUITE 107	NEWPORT BEACH	CA	92660	7853	30	06059	33.61321911	-117.8722084	Orange County
41636	Fee-for-Service	1437269206	1437269206	1	1	REDD, BURTON L MD	4/1/1988	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	21774	20	Orthopedic Surgery	0	In state provider	None	938 N CHERRY ST	None	TULARE	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
41659	Fee-for-Service	1295813863	1295813863	1	1	RELOS, RENE P MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92999	89	Surgery-Traumatic	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
41674	Fee-for-Service	1922179159	1922179159	1	1	ROGERS, ANGELA J MD	7/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55968	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41683	Fee-for-Service	1205141041	1205141041	1	1	REZAEI, BABAK A MD	7/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142760	13	Neurology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
41685	Fee-for-Service	1114901493	1114901493	1	1	RAJU, TANUJA R MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72158	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
41705	Fee-for-Service	1013219393	1013219393	1	1	ROBERTSON, ROBERT FORBES AMC	11/26/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
41712	Fee-for-Service	1114217015	1114217015	1	1	RAPP, GEORGE A MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123361	30	Radiology	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
41727	Fee-for-Service	1154672244	1154672244	1	1	RAZAVI, ASMA MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117148	40	Pediatrics	0	In state provider	None	25845 BARTON ROAD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
41804	Fee-for-Service	1255368809	1255368809	1	1	RAMOS, PERCY D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61324	08	Family Practice	0	In state provider	None	2677 ZOE AVE	STE 108	HUNTINGTON PARK	CA	90255	7209	19	06037	33.9793143	-118.2230319	Los Angeles County
41805	Fee-for-Service	1699078030	1699078030	1	14	RIDGE EYE CARE INC	1/20/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 SOLANO STREET	None	CORNING	CA	96021	3433	52	06103	39.92788727	-122.1705565	Tehama County
41824	Fee-for-Service	1659477685	1659477685	1	1	RUCKER, RICHARD M MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	01	General Practice	0	In state provider	LOS ALAMITOS PULMONARY M	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
41825	Fee-for-Service	1003560624	1003560624	1	1	RAPID HEALTHCARE LABORATORY	5/19/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LLC	881 E CHICAGO ST FL 2	None	ELGIN	IL	60120	6818	00	None	42.03474095	-88.25748724	Cook County
41870	Fee-for-Service	1295961480	1295961480	1	1	RIVERA, GABRIEL A MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121128	78	Neoplastic Diseases/Oncology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
41895	Fee-for-Service	1902839152	1902839152	1	1	RAD, MOLLY F MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53648	40	Pediatrics	0	In state provider	None	2660B SOLACE PL	None	MOUNTAIN VIEW	CA	94040	4316	43	06085	37.36673536	-122.0791859	Santa Clara County
41932	Fee-for-Service	1902959216	1902959216	1	1	REISMAN, RICHARD A MD	8/24/2004	207PE0004X	NA	Other	026	PHYSICIANS	27250	01	General Practice	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
41936	Fee-for-Service	1952479180	1952479180	1	1	REBEL, CYRIL W MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62819	20	Orthopedic Surgery	0	In state provider	None	550 E ALMOND AVE	STE A	MADERA	CA	93637	5641	20	06039	36.94545174	-120.0501641	Madera County
41959	Fee-for-Service	1477696292	1477696292	1	1	ROBINSON, TRACY D MD	10/1/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79355	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500-30 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
41991	Fee-for-Service	1013219393	1013219393	1	1	ROBERTSON, ROBERT FORBES AMC	11/26/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	41	Internal Medicine	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
42016	Fee-for-Service	1821444985	1821444985	1	1	ROONEY, ALAN M PHD	6/7/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1111 TAHQUITZ CANYON WAY	STE 120 , #6	PALM SPRINGS	CA	92262	6784	33	06065	33.8230345	-116.5331835	Riverside County
42035	Fee-for-Service	1316952799	1316952799	1	1	RIJHWANI, MEENA MOHAN	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52651	None	None	0	In state provider	None	4361 RAILROAD AVE	None	PLEASANTON	CA	94566	6611	01	06001	37.66138479	-121.8737265	Alameda County
42037	Fee-for-Service	1730176389	1730176389	1	1	RANDALL W PORTER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	0000	00	None	33.4805218	-112.0782792	Maricopa County
42092	Fee-for-Service	1255368809	1255368809	1	1	RAMOS, PERCY D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61324	01	General Practice	0	In state provider	None	2677 ZOE AVE	STE 108	HUNTINGTON PARK	CA	90255	7209	19	06037	33.9793143	-118.2230319	Los Angeles County
42111	Fee-for-Service	1659477685	1659477685	1	1	RUCKER, RICHARD M MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	41	Internal Medicine	0	In state provider	LOS ALAMITOS PULMONARY M	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
42123	Fee-for-Service	1497189146	1497189146	1	1	RIGBY, KEITH B MSW LCSW	8/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	VICES	920 C ST	None	CRESCENT CITY	CA	95531	0001	08	06015	41.75401679	-124.2063947	Del Norte County
42143	Fee-for-Service	1205913134	1205913134	1	1	REZVANI, FIROZEH MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64557	08	Family Practice	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
42148	Fee-for-Service	1205022084	1205022084	1	1	RAJA, WASIM H MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110055	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0540	34	06067	38.66859	-121.3118055	Sacramento County
42181	Fee-for-Service	1467605972	1467605972	1	1	ROSENSON, JONATHAN MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102680	None	None	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
42199	Fee-for-Service	1982962783	1982962783	1	1	RYAN B. DICK-PEREZ	11/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
42219	Fee-for-Service	1902959216	1902959216	1	1	REISMAN, RICHARD A MD	8/24/2004	207PE0004X	NA	Other	026	PHYSICIANS	27250	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
42222	Fee-for-Service	1407855240	1407855240	1	1	ROCKY MOUNTAIN HOLDINGS, LLC	3/12/2006	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	5301 E. GRANT ROAD	None	TUCSON	AZ	85718	3180	00	None	32.252391	-110.8790055	Pima County
42279	Fee-for-Service	1134199748	1134199748	1	1	RICHARD ELIOT ALTMAN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	31 VILLAGE SQ	None	CHELMSFORD	MA	01824	2712	00	None	42.599205	-71.3511495	Middlesex County
42301	Fee-for-Service	1124135074	1124135074	1	1	ROBERT DANFORTH MD	1/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22101 MOROSS RD	None	DETROIT	MI	48236	2148	00	None	42.41918818	-82.91538222	Wayne County
42315	Fee-for-Service	1336384890	1336384890	1	1	RUTH, JEANNE A LCSW	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28044	-	NOT APPLICABLE	0	In state provider	None	2344 OLD SONOMA ROAD	BLDG A B C F J	NAPA	CA	94559	1344	28	06055	38.2878005	-122.298057	Napa County
42337	Fee-for-Service	1093078313	1093078313	1	1	RAMAKRISHNA, SNEHA MD	9/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157946	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
42348	Fee-for-Service	1568557437	1568557437	1	1	REIDER, DANER R MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	21884	01	General Practice	0	In state provider	None	1619 E EDINGER AVE	None	SANTA ANA	CA	92075	5001	30	06059	33.72684629	-117.846511	Orange County
42370	Fee-for-Service	1407855240	1407855240	1	12	ROCKY MOUNTAIN HOLDINGS, LLC	12/1/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	913 OCOTILLO	None	PARKER	AZ	85344	4924	00	None	34.1478	-114.296499	La Paz County
42392	Fee-for-Service	1730440686	1730440686	1	1	REICH, HEIDI MD	2/1/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	120651	None	None	0	In state provider	None	729 N MEDICAL CTR DR W	STE 223	CLOVIS	CA	93611	6879	10	06019	36.84152435	-119.6624818	Fresno County
42398	Fee-for-Service	1659477685	1659477685	1	1	RUCKER, RICHARD M MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	29	Pulmonary Diseases (M.D. only)	0	In state provider	LOS ALAMITOS PULMONARY M	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
42408	Fee-for-Service	1265850770	1265850770	1	1	RUSSINO, HANZI MD	6/15/2020	207L00000X	NA	Other	026	PHYSICIANS	141078	05	Anesthesiology	0	In state provider	None	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
42416	Fee-for-Service	1255673299	1255673299	1	1	REN, ELIZABETH NP	9/13/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
42423	Fee-for-Service	1184744336	1184744336	1	1	ROY, DEBORSHI MD	9/16/2019	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	54320	84	Surgery-Head and Neck	0	In state provider	None	8241 ROCHESTER AVE	SUITE 130	RANCHO CUCAMONGA	CA	91730	0713	36	06071	34.103979	-117.542898	San Bernardino County
42461	Fee-for-Service	1497291819	1497291819	1	2	RIVERSIDE COUNTY LATINO COMM	10/5/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	50173 CALLE MARBELLA	None	COACHELLA	CA	92236	5542	33	06065	33.683337	-116.1979185	Riverside County
42464	Fee-for-Service	1124683628	1124683628	1	1	REAL, DANIEL MD	8/12/2024	207ZP0102X	NA	Other	026	PHYSICIANS	179651	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	2395	19	06037	34.05358988	-118.2661119	Los Angeles County
42474	Fee-for-Service	1821602822	1821602822	1	1	REAL MIND HOSPICE &	12/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	15130 VENTURA BLVD	SUITE 318	SHERMAN OAKS	CA	91403	3378	19	06037	34.15320952	-118.4627115	Los Angeles County
42485	Fee-for-Service	1457059404	1457059404	1	1	RUTZEN, KRISTA M LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4100 W ALAMEDA AVE FL 3	STE 365	BURBANK	CA	91505	4191	19	06037	34.1526111	-118.3447742	Los Angeles County
42537	Fee-for-Service	1639581713	1639581713	1	1	RED BOW MEDICAL ASSOCIATES	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	INC	36915 COOK ST	SUITE 103	PALM DESERT	CA	92211	6067	33	06065	33.77987071	-116.3558569	Riverside County
42543	Fee-for-Service	1972203248	1972203248	1	1	RICHARDSON-GRANT, CHANTELLE	3/28/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
42561	Fee-for-Service	1639346851	1639346851	1	1	RAO, POORNIMA MD	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113359	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
42685	Fee-for-Service	1891047882	1891047882	1	1	ROSS, ANGELA K CCC-SLP	12/12/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 N CENTRAL AVENUE	SUITE 440	GLENDALE	CA	91203	3951	19	06037	34.15321627	-118.2578985	Los Angeles County
42691	Fee-for-Service	1356600944	1356600944	1	1	RAMANI, SWATHI	6/19/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
42715	Fee-for-Service	1508890161	1508890161	1	1	ROETTGER, JAMES W	1/1/1979	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1940 FEATHER RIVER BLVD	None	OROVILLE	CA	95965	5723	04	06007	39.50290973	-121.5708287	Butte County
42716	Fee-for-Service	1891928008	1891928008	1	1	RAY, VINCENT L MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98487	18	Ophthalmology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
42764	Fee-for-Service	1821602822	1821602822	1	1	REAL MIND HOSPICE &	12/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	15130 VENTURA BLVD	SUITE 318	SHERMAN OAKS	CA	91403	3378	19	06037	34.15320952	-118.4627115	Los Angeles County
42765	Fee-for-Service	1952408775	1952408775	1	1	RAPPAPORT, LARA D MD	1/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
42793	Fee-for-Service	1639216559	1639216559	1	1	RAMIREDDY, OBULAREDDY MD	8/26/1994	207L00000X	NA	Other	026	PHYSICIANS	33722	05	Anesthesiology	0	In state provider	None	5565 W LAS POSITAS BLVD	STE 220	PLEASANTON	CA	94588	5806	01	06001	37.69215143	-121.8800337	Alameda County
42824	Fee-for-Service	1598547770	1598547770	1	1	RAMBEL MEDICAL GROUP PC	2/11/2025	1835P1300X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1671 W MAIN ST	D	EL CENTRO	CA	92243	5420	13	06025	32.79277051	-115.5732165	Imperial County
42859	Fee-for-Service	1386093417	1386093417	1	1	REESE, JULIAN DO	10/23/2024	207R00000X	NA	Other	026	PHYSICIANS	23041	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
42866	Fee-for-Service	1851711204	1851711204	1	1	RANGEL, HEATHER N LCSW	1/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
42879	Fee-for-Service	1215211891	1215211891	1	1	REYES, MARIA LMFT	8/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 N 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
42883	Fee-for-Service	1295813780	1295813780	1	1	RANASINGHE, LEONARD E MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	63199	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
42914	Fee-for-Service	1083958748	1083958748	1	1	ROSS, DANIELLE C OT	5/12/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 MAIN ST	None	CAMBRIA	CA	93428	2820	40	06079	35.56580276	-121.0979727	San Luis Obispo County
42950	Fee-for-Service	1518980325	1518980325	1	1	RAUSCH, HELEN R PHD	12/31/1996	2084N0400X	NA	Neurology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA PLAZA DR	STE B200	LOS ANGELES	CA	90024	0000	19	06037	34.06465655	-118.4461	Los Angeles County
42971	Fee-for-Service	1457469041	1457469041	1	1	REINKE, KARA A MD	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79861	07	Dermatology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
42984	Fee-for-Service	1679640726	1679640726	1	1	REDDY, SUNILKUMAR MD	11/16/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61825	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
42987	Fee-for-Service	1881722999	1881722999	1	1	RANCHO PHYSICAL THERAPY, INC	1/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	12402 INDUSTRIAL BLVD	SUITE B2-B5	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
42990	Fee-for-Service	1942877501	1942877501	1	1	RATCLIFF, STEPHANNIE MD	2/23/2024	390200000X	NA	Other	026	PHYSICIANS	183140	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
42993	Fee-for-Service	1487649943	1487649943	1	1	RASMUSSEN, HENNING MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51673	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93715	0000	10	06019	36.741663	-119.7841005	Fresno County
43037	Fee-for-Service	1902248990	1902248990	1	1	RODRIGUEZ SANTIAGO, STEPHANI	4/11/2023	207U00000X	NA	Other	026	PHYSICIANS	183224	None	None	0	In state provider	E MD	1955 CITRACADO PKWY	STE 100	ESCONDIDO	CA	92029	4158	37	06073	33.11301099	-117.1202081	San Diego County
43039	Fee-for-Service	1619174307	1619174307	1	1	RUCH, SHARON E MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3186 S MARYLAND PRKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
43041	Fee-for-Service	1295883163	1295883163	1	1	RYAN, MICHAEL G MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72821	20	Orthopedic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
43065	Fee-for-Service	1073593133	1073593133	1	1	RACHFORD, JAMES M OD	9/17/1980	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	57463 29 PALMS HWY	STE 201	YUCCA VALLEY	CA	92284	2925	36	06071	34.12447835	-116.4106891	San Bernardino County
43068	Fee-for-Service	1487716064	1487716064	3	1	REMEDY DRUGS BROADWAY INC	12/11/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	459 W BROADWAY STREET	SUITE 4	GLENDALE	CA	91204	1228	19	06037	34.14684351	-118.2638205	Los Angeles County
43117	Fee-for-Service	1598547770	1598547770	1	1	RAMBEL MEDICAL GROUP PC	2/11/2025	1835P1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1671 W MAIN ST	D	EL CENTRO	CA	92243	5420	13	06025	32.79277051	-115.5732165	Imperial County
43148	Fee-for-Service	1598977894	1598977894	1	1	RICO, RAMONA M MD	1/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81075	40	Pediatrics	0	In state provider	None	5220 CLAREMONT AVENUE	None	OAKLAND	CA	94618	1033	01	06001	37.83868281	-122.2612035	Alameda County
43183	Fee-for-Service	1881009108	1881009108	1	1	R AJAKWE MD AND R	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	TATEVOSSIAN MD PRO MED	201 S BUENA VISTA ST	SUITE 238	BURBANK	CA	91505	4569	19	06037	34.15978726	-118.3289164	Los Angeles County
43246	Fee-for-Service	1891112082	1891112082	1	1	RASHID, SAMRA DO	12/15/2021	207R00000X	NA	Other	026	PHYSICIANS	14548	None	None	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
43248	Fee-for-Service	1225198492	1225198492	1	1	REDDY, ASHOK P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33695	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
43253	Fee-for-Service	1831267228	1831267228	1	1	RAUEN, KATHERINE A MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60658	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
43270	Fee-for-Service	1295813921	1295813921	1	1	RUBINSTEIN, BRIAN K MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64457	84	Surgery-Head and Neck	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
43278	Fee-for-Service	1558645374	1558645374	1	1	RAM, RANA A M DO	1/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13388	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 PROSPECT PLACE	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
43281	Fee-for-Service	1861566416	1861566416	1	1	RAI CARE CTRS SO CA II	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1850 N RIVERSIDE AVE	STE 150	RIALTO	CA	92376	8056	36	06071	34.132905	-117.3704675	San Bernardino County
43333	Fee-for-Service	1649349556	1649349556	1	1	RUE, DAVID S MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	26454	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
43338	Fee-for-Service	1275523664	1275523664	1	1	RANDOLPH, MARITNA D MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92403	08	Family Practice	0	In state provider	None	251 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.654946	-121.170537	Sacramento County
43367	Fee-for-Service	1053304071	1053304071	1	1	REGENTS/UCDPBG/MICROBIO	5/1/1983	207ZM0300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UCD DEPT MED MICROBIOLOG	RM 3144 MSIA UNIV OF CA	None	DAVIS	CA	95616	0000	57	06113	0	0	None
43371	Fee-for-Service	1245266972	1245266972	1	1	RADHAKRISHNAN, JAY MD DO	6/3/2021	2085R0204X	NA	Other	026	PHYSICIANS	53448	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
43453	Fee-for-Service	1437669702	1437669702	1	1	RODRIGUEZ, OLIVIA LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
43504	Fee-for-Service	1588153134	1588153134	1	1	RUBENSTEIN, WESLEY L DO	7/21/2021	207ZB0001X	NA	Other	026	PHYSICIANS	16462	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
43514	Fee-for-Service	1144239831	1144239831	1	1	RAJVINDER SINGH BINDRA MD	3/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11101 N SHERMAN RD	None	EDGERTON	WI	53534	9002	00	None	42.83463076	-89.04308317	Rock County
43537	Fee-for-Service	1598184855	1598184855	1	1	RACHEL PAHLS	5/6/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
43552	Fee-for-Service	1942526389	1942526389	1	1	RIOS, EON J MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117533	07	Dermatology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2614	43	06085	37.313433	-121.9318385	Santa Clara County
43600	Fee-for-Service	1417404450	1417404450	1	1	ROSS, MARIEL A LCSW	3/21/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
43624	Fee-for-Service	1306075692	1306075692	1	1	RAZZAK, ANTHONY A MD	6/21/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177209	None	None	0	In state provider	None	23 UPPER RAGSDALE DR	STE 200	MONTEREY	CA	93940	5771	27	06053	36.57529358	-121.8101334	Monterey County
43627	Fee-for-Service	1841348703	1841348703	1	1	RANKIN, GLENN B MD	11/30/1988	204D00000X	NA	Other	026	PHYSICIANS	56327	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
43636	Fee-for-Service	1982391462	1982391462	1	1	RIVERA, CESAR CRNA	6/29/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
43691	Fee-for-Service	1134100878	1134100878	1	1	RICHLIN, STEVEN B OD	2/13/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9033 WILSHIRE BLVD	STE 402	BEVERLY HILLS	CA	90211	1847	19	06037	34.06707946	-118.388943	Los Angeles County
43709	Fee-for-Service	1306834270	1306834270	1	4	RICHARD ROSENBLUM DO	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1910 S GILBERT RD	None	MESA	AZ	85204	6808	00	None	33.38055	-111.788811	Maricopa County
43765	Fee-for-Service	1417217779	1417217779	1	1	ROSS, STUART E MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128236	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
43795	Fee-for-Service	1093994006	1093994006	1	1	RILEY, TIMOTHY J CRNA	1/26/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8635 FIRESTONE BLVD	None	DOWNEY	CA	90241	5242	19	06037	33.93691837	-118.1265474	Los Angeles County
43799	Fee-for-Service	1730353699	1730353699	1	1	RAMANI, KARTHIK MD	4/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143704	45	Nephrology (Renal-Kidney)	0	In state provider	None	777 CAMPUS COMMONS	SUITE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
43802	Fee-for-Service	1225072374	1225072374	1	1	RAGSDALE, BRUCE D MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	23785	22	Pathology (M.D. only)	0	In state provider	None	134 NELSON ST	None	ARROYO GRANDE	CA	93420	3386	40	06079	35.12233737	-120.576558	San Luis Obispo County
43808	Fee-for-Service	1245244771	1245244771	1	1	ROSS, MARLOWE D MD	3/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	47784	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	19582 BEACH BLVD	STE 314	HUNTINGTON BEACH	CA	92648	5924	30	06059	33.67831649	-117.9885198	Orange County
43849	Fee-for-Service	1639168594	1639168594	1	1	REGENTS/UCDPBG/GYNECOLOG	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
43873	Fee-for-Service	1326161852	1326161852	1	1	RAHAB & ASSOCIATES LLC	9/2/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	RAHAB MEDICAL SUPPLY	826 B STREET	None	HAYWARD	CA	94541	5108	01	06001	37.67170886	-122.0847903	Alameda County
43883	Fee-for-Service	1669451100	1669451100	1	1	ROBERT N CRANK MD	11/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 4TH ST NW	None	WATERTOWN	SD	57201	1558	00	None	44.91086485	-97.12034581	Codington County
43892	Fee-for-Service	1528659232	1528659232	1	1	RUSSELL, ASHLEY CRNA	12/10/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
43947	Fee-for-Service	1962527473	1962527473	1	1	RUBINSTEIN, BENJAMIN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	11103	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
43951	Fee-for-Service	1376005223	1376005223	1	1	RADPARVAR, JOSHUA R MD	3/1/2023	207P00000X	NA	Other	026	PHYSICIANS	177436	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
43954	Fee-for-Service	1740590298	1740590298	1	1	RASHIDIAN, ALI MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114143	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	None	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
43972	Fee-for-Service	1508349242	1508349242	1	1	ROY, ASHLEY A	9/24/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
43979	Fee-for-Service	1073549499	1073549499	1	1	RUBSAMEN, REID M MD	1/1/2002	207L00000X	NA	Other	026	PHYSICIANS	58123	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
44016	Fee-for-Service	1942234257	1942234257	1	1	RANG, AARON A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66779	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
44022	Fee-for-Service	1982604815	1982604815	1	1	RUSSIAN RIVER FIRE	7/1/1981	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14100 ARMSTRONG WOODS RD	None	GUERNEVILLE	CA	95446	9511	49	06097	38.50340803	-122.9977091	Sonoma County
44024	Fee-for-Service	1992830236	1992830236	1	1	ROWELL, ELIZABETH Z MD	11/12/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53142	-	NOT APPLICABLE	0	In state provider	None	14181 TELEGRAPH ROAD	None	WHITTIER	CA	90604	2832	19	06037	33.92892082	-118.0299538	Los Angeles County
44046	Fee-for-Service	1922176916	1922176916	1	1	RAWITSCHER, LEE A MD	1/23/2020	193400000X	NA	Other	026	PHYSICIANS	60139	36	Psychiatry	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
44049	Fee-for-Service	1023205861	1023205861	1	1	RENOVATO, ALBERT D LMFT	3/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
44065	Fee-for-Service	1841853793	1841853793	1	1	REDDY, SRAVYA MD	1/28/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
44082	Fee-for-Service	1376888446	1376888446	1	1	RODRIGUEZ, SASHA C CRNA	1/17/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
44092	Fee-for-Service	1962195511	1962195511	1	1	ROSEMEAD HEALTHCARE CENTER	5/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	4096 EASY ST	None	EL MONTE	CA	91731	1054	19	06037	34.08334187	-118.0619606	Los Angeles County
44100	Fee-for-Service	1659546265	1659546265	1	1	REECE, MIRIAM GS REECE MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116454	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
44108	Fee-for-Service	1023308921	1023308921	1	1	RICKERT, KATHLEEN D MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140439	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
44143	Fee-for-Service	1164415238	1164415238	1	3	REGENTS OF THE UNIV OF CA	1/1/1992	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
44235	Fee-for-Service	1679590376	1679590376	1	1	REINHARTZ, OLAF MD	9/1/1998	208G00000X	NA	General Surgery	026	PHYSICIANS	66579	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
44248	Fee-for-Service	1376084558	1376084558	1	1	RAHIMY, ELHAM MD	7/22/2022	2085R0001X	NA	Other	026	PHYSICIANS	156859	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44264	Fee-for-Service	1619325651	1619325651	1	1	ROHR, CASSANDRA D LCSW	7/19/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
44295	Fee-for-Service	1528485547	1528485547	1	1	ROSSER, JOELLE MD	12/1/2020	208M00000X	NA	Other	026	PHYSICIANS	154936	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
44324	Fee-for-Service	1851354542	1851354542	1	1	RAPPAPORT, LINDA M LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	6792	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
44326	Fee-for-Service	1437112851	1437112851	1	1	RAPPARD, GEORGE MD INC	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	63419	30	Radiology	0	In state provider	None	410 ARDEN AVE	STE 101	GLENDALE	CA	91203	4004	19	06037	34.15842441	-118.2618749	Los Angeles County
44348	Fee-for-Service	1154422087	1154422087	1	1	REIMANN, JOACHIM MD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PROFESSIONAL & PERSONAL	3530 CAMINO DEL RIO N	STE 103	SAN DIEGO	CA	92108	1744	37	06073	32.7786731	-117.1181297	San Diego County
44369	Fee-for-Service	1740883206	1740883206	1	1	REICHENBERGER, KATHLEEN M PT	5/18/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
44370	Fee-for-Service	1316248420	1316248420	1	1	ROSS, RACHEL P MD	5/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110756	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
44383	Fee-for-Service	1043208945	1043208945	2	1	REGENTS OF THE UNIVERSITY OF	7/23/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	3301 C STREET	STE 1413	SACRAMENTO	CA	95816	3367	34	06067	38.579877	-121.456143	Sacramento County
44430	Fee-for-Service	1164415238	1164415238	1	3	REGENTS OF THE UNIV OF CA	4/11/2022	2084P0800X	NA	Psychiatry	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
44437	Fee-for-Service	1154394385	1154394385	1	1	REICH, JONATHAN D MD	11/19/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
44498	Fee-for-Service	1861416000	1861416000	1	1	ROBERTSON, EDWARD J MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87107	02	General Surgery	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
44520	Fee-for-Service	1679590376	1679590376	1	1	REINHARTZ, OLAF MD	9/1/1998	208G00000X	NA	General Surgery	026	PHYSICIANS	66579	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
44570	Fee-for-Service	1295725398	1295725398	1	1	ROACH, ROBERT MD	8/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170188	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
44573	Fee-for-Service	1457810285	1457810285	1	1	REZK, TAMER MD	8/24/2023	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	178729	None	None	0	In state provider	None	25461 RANCHO NIGUEL ROAD	None	LAGUNA NIGUEL	CA	92677	7304	30	06059	33.55527857	-117.6857875	Orange County
44588	Fee-for-Service	1407202377	1407202377	1	1	ROESLER, ELIZABETH C MD	9/26/2022	208600000X	NA	General Surgery	026	PHYSICIANS	180805	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
44593	Fee-for-Service	1730233768	1730233768	1	1	RUSSELL SEHEULT DDS APC	7/26/1993	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	1180 NEVADA ST	STE 100	REDLANDS	CA	92374	2894	36	06071	34.06899156	-117.2174339	San Bernardino County
44601	Fee-for-Service	1982776043	1982776043	1	1	ROMANKO, KARA L LAC	1/31/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2460 MISSION ST	SUITE 212	SAN FRANCISCO	CA	94110	2458	38	06075	37.75766352	-122.4189992	San Francisco County
44665	Fee-for-Service	1255330544	1255330544	1	1	RICHARD L LOZANO	9/22/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	290 BIG RUN RD	None	LEXINGTON	KY	40503	2903	00	None	38.00048603	-84.53126022	Fayette County
44714	Fee-for-Service	1699809657	1699809657	1	1	RIAHIKASHANI, SEDIGHEH D	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
44719	Fee-for-Service	1164415238	1164415238	1	3	REGENTS OF THE UNIV OF CA	8/11/2022	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
44724	Fee-for-Service	1154394385	1154394385	1	1	REICH, JONATHAN D MD	11/19/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
44766	Fee-for-Service	1922042480	1922042480	1	1	RAP0PORT, ALAN M MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87186	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	#B200	LOS ANGELES	CA	90095	0000	19	06037	34.06473399	-118.445865	Los Angeles County
44800	Fee-for-Service	1053580688	1053580688	2	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5979 HARPS COURT	None	SAN DIEGO	CA	92114	5540	37	06073	32.70064303	-117.0689283	San Diego County
44862	Fee-for-Service	1013900778	1013900778	1	1	RHEUMATOLOGY DIAGNOSTICS	2/9/1995	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY, INC.	10755 VENICE BLVD	None	LOS ANGELES	CA	90034	6214	19	06037	34.01806598	-118.4083405	Los Angeles County
44876	Fee-for-Service	1003406588	1003406588	1	1	RECOVERY HOSPICE INC	5/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7017 VAN NUYS BLVD	SUITE 4	VAN NUYS	CA	91405	3095	19	06037	34.19799657	-118.4487934	Los Angeles County
44878	Fee-for-Service	1326534819	1326534819	1	1	REYNOSO, EVANGELINA LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	46 3RD AVE	SUITE E	CHULA VISTA	CA	91910	0000	37	06073	32.64985948	-117.0844722	San Diego County
44879	Fee-for-Service	1609928076	1609928076	1	1	RATNESAR, NEETHI A MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71595	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
44885	Fee-for-Service	1114300209	1114300209	1	1	RAYOS, KAREN ANN P MD	10/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158600	08	Family Practice	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
44887	Fee-for-Service	1508320326	1508320326	1	1	RENNIX, PORTER C RCP	7/26/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44941	Fee-for-Service	1013065994	1013065994	1	1	RAGAB, HESHAM MD	2/1/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70773	40	Pediatrics	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
44960	Fee-for-Service	1487945762	1487945762	1	1	RIGGS, SUSAN D LMFT	8/25/2020	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4540 HARLIN DR	None	SACRAMENTO	CA	95826	9716	34	06067	38.535831	-121.3573905	Sacramento County
44963	Fee-for-Service	1447204250	1447204250	1	1	ROOSSIN, MICHAEL C MD	1/31/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52114	30	Radiology	0	In state provider	None	355 PLACENTIA AVE	STE 207	NEWPORT BEACH	CA	92663	3311	30	06059	33.62672719	-117.9312941	Orange County
44983	Fee-for-Service	1053463703	1053463703	1	1	REED, MICHAEL J MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84632	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
45008	Fee-for-Service	1164415238	1164415238	1	3	REGENTS OF THE UNIV OF CA	8/4/2021	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
45041	Fee-for-Service	1720641103	1720641103	1	1	ROBLES, EMILIO DO	7/30/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	20347	20	Orthopedic Surgery	0	In state provider	None	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	10	06019	36.83939464	-119.6661479	Fresno County
45120	Fee-for-Service	1336228840	1336228840	1	1	RING, ROBERT A OD	11/1/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3231 WARING CT	STE B	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
45164	Fee-for-Service	1003406588	1003406588	1	1	RECOVERY HOSPICE INC	5/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7017 VAN NUYS BLVD	SUITE 4	VAN NUYS	CA	91405	3095	19	06037	34.19799657	-118.4487934	Los Angeles County
45229	Fee-for-Service	1235294349	1235294349	1	1	RADOVICH, MARTHA L	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
45233	Fee-for-Service	1205267911	1205267911	1	1	ROVELLO FREKING, DIONI A NP	2/18/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
45239	Fee-for-Service	1962467597	1962467597	1	1	ROTHSTEIN, CARRIE B MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93597	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
45240	Fee-for-Service	1619095841	1619095841	1	1	RAYES, BILAL R MD	3/31/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	104429	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
45255	Fee-for-Service	1003471939	1003471939	1	1	RUSSO, HANA M	7/3/2023	207ZP0101X	NA	Other	026	PHYSICIANS	176979	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45298	Fee-for-Service	1801994538	1801994538	1	1	RUSSELL EMERY MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
45340	Fee-for-Service	1538152541	1538152541	1	2	REGENTS/UCDPBG/PED PULM	9/14/2004	2080P0214X	NA	Pulmonology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
45359	Fee-for-Service	1760515266	1760515266	1	1	RHOADES, RACHEAL A LMFT	1/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	541 LEDGE ST	None	SAN MARCOS	CA	92078	2840	37	06073	33.10663984	-117.1766131	San Diego County
45397	Fee-for-Service	1285602946	1285602946	1	1	RANCHO PHYSICAL THERAPY, INC	12/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	24021 ALESSANDRO	109-112A	MORENO VALLEY	CA	92553	6707	33	06065	33.9171415	-117.2423475	Riverside County
45449	Fee-for-Service	1366670655	1366670655	1	1	RECOVERY MEDICAL SERVICES	12/16/2013	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	1630 S SINCLAIR ST	None	ANAHEIM	CA	98206	5927	30	06059	33.807699	-117.882442	Orange County
45502	Fee-for-Service	1053846410	1053846410	1	1	RAGAVAN, MEERA MD	11/17/2023	207R00000X	NA	Other	026	PHYSICIANS	158519	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
45568	Fee-for-Service	1386831360	1386831360	1	1	RAY, JON P CO	11/18/2015	174400000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2900 FRESNO ST	STE 108	FRESNO	CA	93721	1439	10	06019	36.74256783	-119.7827878	Fresno County
45605	Fee-for-Service	1740575216	1740575216	1	1	RIZVI, SYED A MD	2/8/2024	207R00000X	NA	Other	026	PHYSICIANS	173909	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
45617	Fee-for-Service	1649380080	1649380080	1	1	ROBINSON, DAVID DO	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6202	36	Psychiatry	0	In state provider	None	1811 GRAND CANAL BLVD	STE 8	STOCKTON	CA	95207	8107	39	06077	37.98649588	-121.3277333	San Joaquin County
45643	Fee-for-Service	1336150234	1336150234	1	1	RAMRAKHIANI, CHEENA MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87538	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
45654	Fee-for-Service	1609150853	1609150853	1	1	RANDOLPH, MARIANNA LCSW	2/12/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
45660	Fee-for-Service	1225052244	1225052244	1	1	RUBEN, JAMES B MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	55158	18	Ophthalmology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
45693	Fee-for-Service	1821704065	1821704065	1	1	RESURRECCION CORPORATION	9/26/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22418 CATSKILL AVE	None	CARSON	CA	90745	3905	19	06037	33.82275499	-118.2713669	Los Angeles County
45744	Fee-for-Service	1508051251	1508051251	1	1	ROBINSON, MARK D MD	11/16/2018	207R00000X	NA	Other	026	PHYSICIANS	61971	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
45759	Fee-for-Service	1578897898	1578897898	1	1	RAKER, DANIEL K	8/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
45765	Fee-for-Service	1336660992	1336660992	1	1	RAMOS VERGARA, JARED	9/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
45775	Fee-for-Service	1417049966	1417049966	1	1	ROAM/AIR LIFE	6/1/1992	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2911 E TULARE ST	None	FRESNO	CA	93721	1502	10	06019	36.74323101	-119.7756095	Fresno County
45783	Fee-for-Service	1821777046	1821777046	1	1	RAO, VASUDHA OD	9/3/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 MALL VIEW RD	None	BAKERSFIELD	CA	93306	3050	15	06029	35.39462173	-118.9518506	Kern County
45788	Fee-for-Service	1477993533	1477993533	1	1	RAY, DAMIAN M MD	2/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161545	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
45791	Fee-for-Service	1548393382	1548393382	1	1	RUSS, SHIRLEY A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61371	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
45794	Fee-for-Service	1831767979	1831767979	1	1	ROBILLARD, JOSEPH C NP	1/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
45849	Fee-for-Service	1114635703	1114635703	1	1	RUGG, LACEY MARIE	11/17/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1826 HILLSIDE AVE	None	NORCO	CA	92860	3025	33	06065	33.90864867	-117.543497	Riverside County
45932	Fee-for-Service	1336150234	1336150234	1	1	RAMRAKHIANI, CHEENA MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87538	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
45936	Fee-for-Service	1912913849	1912913849	1	1	RUIZ, MATTHEW L CRNA	5/3/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
45949	Fee-for-Service	1225052244	1225052244	1	1	RUBEN, JAMES B MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	55158	01	General Practice	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
45951	Fee-for-Service	1730137464	1730137464	1	1	ROSATI, NICHOLAS J DO MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44626	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
45972	Fee-for-Service	1467426478	1467426478	1	1	RAHMAN, NADEEM U MD	11/12/2008	208800000X	NA	Other	026	PHYSICIANS	74920	34	Urology and Urological Surgery	0	In state provider	None	6113 N FRESNO ST	None	FRESNO	CA	93710	5207	10	06019	36.82539	-119.7814385	Fresno County
45979	Fee-for-Service	1457879413	1457879413	1	1	R & C LOGISTIC SERVICES, LLC	8/25/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	23890 ALESSANDRO BOULEVA	B2	MORENO VALLEY	CA	92553	8801	33	06065	33.9173943	-117.2455929	Riverside County
46021	Fee-for-Service	1356330203	1356330203	1	2	REGENTS/UCDPBG/NEUROLOGY	4/8/2021	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
46038	Fee-for-Service	1932260106	1932260106	1	1	RAHNEMUN, MARYAM MD INC	10/24/2005	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53377	08	Family Practice	0	In state provider	None	14150 CULVER DR	105	IRVINE	CA	92604	0315	30	06059	33.70834263	-117.7839373	Orange County
46085	Fee-for-Service	1114556073	1114556073	1	1	RAJA, UZAIR M MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
46108	Fee-for-Service	1578073508	1578073508	1	1	RHEE, SIRINTIP PHD	12/18/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
46122	Fee-for-Service	1184815284	1184815284	1	1	RYU, JENICA M MD	3/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	99435	01	General Practice	0	In state provider	None	1520 SAN PABLO STREET	SUITE 1300	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
46123	Fee-for-Service	1629185301	1629185301	1	1	REASOR, EVAN K MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42372	47	Miscellaneous	0	In state provider	None	1826 SONOMA ST	None	REDDING	CA	96001	2535	45	06089	40.57561432	-122.3932366	Shasta County
46137	Fee-for-Service	1114635703	1114635703	1	1	RUGG, LACEY MARIE	11/17/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1826 HILLSIDE AVE	None	NORCO	CA	92860	3025	33	06065	33.90864867	-117.543497	Riverside County
46139	Fee-for-Service	1659593648	1659593648	1	1	ROLL, FREDERICK J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43906	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
46141	Fee-for-Service	1396198958	1396198958	1	5	RIVER CITY MEDICAL GROUP INC	5/22/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2928 EASTERN AVE	None	SACRAMENTO	CA	95821	4210	34	06067	38.618703	-121.3635915	Sacramento County
46144	Fee-for-Service	1043248917	1043248917	1	1	ROGUE ANESTHESIA LLC	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	658 NORTH MAIN STREET	None	ASHLAND	OR	97520	1710	00	None	42.207541	-122.7220128	Jackson County
46178	Fee-for-Service	1275558876	1275558876	1	1	RALPHS GROCERY COMPANY	9/4/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #87	1050 N WESTERN AVE	None	SAN PEDRO	CA	90732	2428	19	06037	33.75251896	-118.3075195	Los Angeles County
46180	Fee-for-Service	1083999767	1083999767	1	1	RADY CHILDRENS HOSPITAL	5/1/2013	No Taxonomy Provided	NA	None	065	PEDIATRIC SUBACUTE CARE/LTC	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
46271	Fee-for-Service	1851799522	1851799522	1	1	RIVERA, MATEO G CRNA	6/19/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 GARCES HWY	None	BAKERSFIELD	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
46312	Fee-for-Service	1356330203	1356330203	1	2	REGENTS/UCDPBG/NEUROLOGY	10/20/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
46327	Fee-for-Service	1932260106	1932260106	1	1	RAHNEMUN, MARYAM MD INC	10/24/2005	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53377	01	General Practice	0	In state provider	None	14150 CULVER DR	105	IRVINE	CA	92604	0315	30	06059	33.70834263	-117.7839373	Orange County
46340	Fee-for-Service	1770534349	1770534349	1	1	RANJIT S RAJPAL MD CARDIO	9/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35339	06	Cardiovascular Disease (M.D. only)	0	In state provider	VASCULAR CONSULTANTS INC	860 E ALMOND AVE	None	MADERA	CA	93637	5603	20	06039	36.9454636	-120.0479548	Madera County
46354	Fee-for-Service	1962027607	1962027607	1	1	RNPLUS HOSPICE CARE INC	3/31/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22600 SAVI RANCH PARKWAY	A4	YORBA LINDA	CA	92887	4606	30	06059	33.87500251	-117.7425073	Orange County
46357	Fee-for-Service	1073355699	1073355699	1	1	RAYMUNDO, KAREN PT	6/18/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	32605 TEMECULA PKWY	103	TEMECULA	CA	92592	6837	33	06065	33.48367403	-117.088031	Riverside County
46393	Fee-for-Service	1619989811	1619989811	1	1	RUSSELL, VIRGINIA MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64566	None	None	0	In state provider	None	5901 W OLYMPIC BLVD	STE 202	LOS ANGELES	CA	90036	4663	19	06037	34.05764121	-118.3603115	Los Angeles County
46399	Fee-for-Service	1861100158	1861100158	1	1	RENEW SURGERY CENTERS INC	7/5/2023	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8218 GARFIELD AVE	STE 101	BELL GARDENS	CA	90201	6212	19	06037	33.95628913	-118.1603818	Los Angeles County
46480	Fee-for-Service	1457344228	1457344228	1	1	ROCKY MOUNTAIN ORTHOPAEDIC	12/24/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	None	627 25 1/2 ROAD	None	GRAND JUNCTION	CO	81505	6401	00	None	39.09605274	-108.5802248	Mesa County
46504	Fee-for-Service	1457319543	1457319543	1	1	REYNOLDS, MICHAEL J MD	11/15/2018	207L00000X	NA	Other	026	PHYSICIANS	155373	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
46547	Fee-for-Service	1043518277	1043518277	1	1	ROSEBUD HOLDINGS LLC A	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CA LIMITED LIABILITY COM	3280 WASHINGTON STREET	None	PLACERVILLE	CA	95667	5838	09	06017	38.72270909	-120.7893981	El Dorado County
46558	Fee-for-Service	1336478874	1336478874	1	1	RHEE, JENNIFER MD	7/4/2020	207R00000X	NA	Other	026	PHYSICIANS	117407	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
46582	Fee-for-Service	1093918187	1093918187	1	1	RITZ, ELIZABETH C MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112465	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PLACE	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
46597	Fee-for-Service	1427227917	1427227917	1	1	RAJA, REKHA DO	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	7434	36	Psychiatry	0	In state provider	None	5016 CHESEBRO ROAD	SUITE 200	AGOURA HILLS	CA	91301	2277	19	06037	34.14134802	-118.7392827	Los Angeles County
46598	Fee-for-Service	1356330203	1356330203	1	2	REGENTS/UCDPBG/NEUROLOGY	5/1/1999	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
46607	Fee-for-Service	1962490672	1962490672	1	1	RALPH L MORRIS	8/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 ANDERSON DR	None	ABERDEEN	WA	98520	1006	00	None	46.979334	-123.8464165	Grays Harbor County
46613	Fee-for-Service	1568455590	1568455590	1	1	REGENTS/UCDPBG/SUR TRAUM	1/23/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
46623	Fee-for-Service	1861569626	1861569626	1	1	RYAN, KATHLEEN M CRNA	6/15/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
46630	Fee-for-Service	1770534349	1770534349	1	1	RANJIT S RAJPAL MD CARDIO	9/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35339	41	Internal Medicine	0	In state provider	VASCULAR CONSULTANTS INC	860 E ALMOND AVE	None	MADERA	CA	93637	5603	20	06039	36.9454636	-120.0479548	Madera County
46635	Fee-for-Service	1962027607	1962027607	1	1	RNPLUS HOSPICE CARE INC	3/31/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22600 SAVI RANCH PARKWAY	A4	YORBA LINDA	CA	92887	4606	30	06059	33.87500251	-117.7425073	Orange County
46644	Fee-for-Service	1316106859	1316106859	1	1	RAO, VIKRAM R MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121594	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
46657	Fee-for-Service	1013295021	1013295021	1	1	ROSENBAUM, JASON N MD	8/30/2021	207ZP0007X	NA	Other	026	PHYSICIANS	173045	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
46682	Fee-for-Service	1639706849	1639706849	1	1	RUTTEN, SONIA L MD	6/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178443	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
46688	Fee-for-Service	1366821480	1366821480	1	1	RODRIGUEZ, VIVIAN LMFT	5/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
46739	Fee-for-Service	1043244296	1043244296	1	1	REZNIK, GARY MD	2/27/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	67314	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
46784	Fee-for-Service	1023458239	1023458239	1	1	RIOS-GASTELUM, CLAUDIA	1/16/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2831 CAMINO DEL RIO SOUT	STE. 206	SAN DIEGO	CA	92108	3827	37	06073	32.77018113	-117.1334016	San Diego County
46790	Fee-for-Service	1578779450	1578779450	1	1	RAFAL M KEDZIERSKI MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
46806	Fee-for-Service	1720036304	1720036304	1	1	REDD, JASON M MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77465	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
46817	Fee-for-Service	1669497996	1669497996	1	1	ROBERTS, ANNE C MD	3/1/1995	2085R0204X	NA	Other	026	PHYSICIANS	58654	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H756	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
46855	Fee-for-Service	1356715262	1356715262	1	1	RODRIGUEZ, ALEXANDER J MD	5/29/2024	207L00000X	NA	Other	026	PHYSICIANS	179405	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46884	Fee-for-Service	1184772147	1184772147	1	1	ROSENBLATE, HOWARD J MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	11388	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
46902	Fee-for-Service	1568455590	1568455590	1	1	REGENTS/UCDPBG/SUR TRAUM	6/23/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
46948	Fee-for-Service	1942491634	1942491634	1	1	REKUC, EMILY K DO	1/13/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	11655	None	None	0	In state provider	None	81719 DOCTOR CARREON	C-1	INDIO	CA	92201	0600	33	06065	33.70738353	-116.2386945	Riverside County
46989	Fee-for-Service	1962437608	1962437608	1	1	ROSEN, ALAN H MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23932	40	Pediatrics	0	In state provider	None	23847 HOLMAN HWY	# 203	MONTEREY	CA	93940	5904	27	06053	36.57646178	-121.9139941	Monterey County
47002	Fee-for-Service	1245362979	1245362979	1	1	RIKKI RAP, INC	1/5/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8030 SOQUEL AVENUE	SUITE 103	SANTA CRUZ	CA	95062	2096	44	06087	36.98236333	-121.9670379	Santa Cruz County
47004	Fee-for-Service	1114494259	1114494259	1	1	ROJAS, ALBA	3/22/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8865 INDEPENCENCE AVE	26	CANOGA PARK	CA	91304	1880	19	06037	34.23168786	-118.5907632	Los Angeles County
47024	Fee-for-Service	1447510656	1447510656	1	1	RENDON, JUAN C MD	9/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128756	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
47026	Fee-for-Service	1043244296	1043244296	1	1	REZNIK, GARY MD	2/27/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	67314	41	Internal Medicine	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
47028	Fee-for-Service	1801838610	1801838610	1	1	ROSETE, ROLLIE D MD	5/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53682	41	Internal Medicine	0	In state provider	None	4600 S TRACY BLVD	STE 107	TRACY	CA	95377	8105	39	06077	37.698111	-121.4345315	San Joaquin County
47055	Fee-for-Service	1700026481	1700026481	1	1	ROUTT DIALYSIS, LLC	1/21/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	1500 E 2ND ST	STE 101	RENO	NV	89502	1189	00	None	39.52743427	-119.7932613	Washoe County
47091	Fee-for-Service	1063929586	1063929586	1	1	RIVERA, JENNIFER LMFT	9/6/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	134164	-	NOT APPLICABLE	0	In state provider	None	44443 N 10TH STREET WEST	SUITE A	LANCASTER	CA	93534	3346	19	06037	34.69074211	-118.1480945	Los Angeles County
47121	Fee-for-Service	1841382025	1841382025	1	1	RANGARAJAN, ALAGIASINGAM MD	7/31/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31172	None	None	0	In state provider	None	3560 SANTA ANITA AVE	H	EL MONTE	CA	91731	2454	19	06037	34.07477325	-118.0414594	Los Angeles County
47141	Fee-for-Service	1689784340	1689784340	1	1	RALEYS	1/18/1995	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5159 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	5750	34	06067	38.597409	-121.345047	Sacramento County
47145	Fee-for-Service	1316345762	1316345762	1	2	ROHRER, VICTORIA R LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1151 BROADWAY	STE 204	SONOMA	CA	95476	7571	49	06097	38.28016015	-122.4596884	Sonoma County
47235	Fee-for-Service	1225063621	1225063621	1	1	ROWE, JODI LCSW	4/16/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	18345 VENTURA BLVD	STE 300	TARZANA	CA	91356	4242	19	06037	34.16738049	-118.5325057	Los Angeles County
47241	Fee-for-Service	1770876450	1770876450	1	1	REINERS, NAVDEESH K S MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125093	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
47246	Fee-for-Service	1063994275	1063994275	1	1	ROBINSON, CONSTANCE M CNP	3/4/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9700 DE SOTO	None	CHATSWORTH	CA	91311	4409	19	06037	34.246692	-118.588543	Los Angeles County
47249	Fee-for-Service	1861520603	1861520603	1	1	RUCKER, RICHARD M MD	7/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	29	Pulmonary Diseases (M.D. only)	0	In state provider	LOS ALAMITOS PULMONARY	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
47253	Fee-for-Service	1790909109	1790909109	1	1	RIOS, KRISTINA O	2/11/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
47266	Fee-for-Service	1912288390	1912288390	1	1	RASOOLI, LEYLA S PSYD	2/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	3200 E GUASTI RD	STE 100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
47270	Fee-for-Service	1962437608	1962437608	1	1	ROSEN, ALAN H MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23847 HOLMAN HWY	# 203	MONTEREY	CA	93940	5904	27	06053	36.57646178	-121.9139941	Monterey County
47277	Fee-for-Service	1396976734	1396976734	1	1	RANCHO PHYSICAL THERAPY, INC	4/14/2020	225100000X	NA	Physical Therapist	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.	30428 HAUN RD.	STE. 810	MENIFEE	CA	92584	6824	33	06065	33.67819649	-117.1755448	Riverside County
47291	Fee-for-Service	1114494259	1114494259	1	1	ROJAS, ALBA	3/22/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8865 INDEPENCENCE AVE	26	CANOGA PARK	CA	91304	1880	19	06037	34.23168786	-118.5907632	Los Angeles County
47297	Fee-for-Service	1477571537	1477571537	1	1	RAND, LARRY MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53235	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
47309	Fee-for-Service	1043324742	1043324742	1	1	RIZKALLA, SUZANNE S MD	11/15/2012	207R00000X	NA	Other	026	PHYSICIANS	55643	41	Internal Medicine	0	In state provider	None	25815 BARTON RD	STE C102	LOMA LINDA	CA	92354	3857	36	06071	34.04825519	-117.2408344	San Bernardino County
47368	Fee-for-Service	1568539401	1568539401	1	1	ROSENGART, RONALD M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	20530	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
47386	Fee-for-Service	1528116324	1528116324	1	1	RUPP, ELIZABETH A MD	9/1/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	83059	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
47411	Fee-for-Service	1821007709	1821007709	1	1	REDDY, ROOPA MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73759	41	Internal Medicine	0	In state provider	None	1360 W 6TH ST	STE 200	SAN PEDRO	CA	90732	3561	19	06037	33.73886546	-118.3075065	Los Angeles County
47486	Fee-for-Service	1679923387	1679923387	1	1	RODEFFER, CARSON D MD	4/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168432	15	Obstetrics (D.O. only)	0	In state provider	None	1552 COFFEE RD	FL 1	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
47487	Fee-for-Service	1770934291	1770934291	1	1	RELIEF HOME HEALTH CARE INC	8/5/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7335 VAN NUYS BLVD	STE 203	VAN NUYS	CA	91405	1969	19	06037	34.203843	-118.448776	Los Angeles County
47510	Fee-for-Service	1871911669	1871911669	1	1	ROBERT JASON TERRITO	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7373 PERKINS RD	None	BATON ROUGE	LA	70808	4326	00	None	30.39804	-91.1122425	East Baton Rouge Parish
47512	Fee-for-Service	1598714495	1598714495	1	1	RAHMANI, DARUSH DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1850 HICKORY ST	STE 203	ABILENE	TX	79601	2305	00	None	32.47048864	-99.73491542	Taylor County
47533	Fee-for-Service	1861520603	1861520603	1	1	RUCKER, RICHARD M MD	7/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	01	General Practice	0	In state provider	LOS ALAMITOS PULMONARY	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
47548	Fee-for-Service	1760571467	1760571467	1	1	RIVERS, ANGELA E MD	10/20/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	170430	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
47558	Fee-for-Service	1912288390	1912288390	1	1	RASOOLI, LEYLA S PSYD	10/14/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ICES	3200 E GUASTI RD	STE 100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
47564	Fee-for-Service	1396976734	1396976734	1	1	RANCHO PHYSICAL THERAPY, INC	4/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	30428 HAUN RD.	STE. 810	MENIFEE	CA	92584	6824	33	06065	33.67819649	-117.1755448	Riverside County
47580	Fee-for-Service	1184632077	1184632077	1	1	ROCCHI, STEVEN A OD	10/17/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1550 MYERS ST	STE A	OROVILLE	CA	95965	4965	04	06007	39.51183854	-121.5543164	Butte County
47585	Fee-for-Service	1649364274	1649364274	1	1	ROBERTS, GABRIELE E LMFT	10/13/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5790 MAGNOLIA AVE	SUITE 202	RIVERSIDE	CA	92506	3580	33	06065	33.96267292	-117.3905848	Riverside County
47590	Fee-for-Service	1639257736	1639257736	1	1	RASHID,SAMINA MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71777	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
47617	Fee-for-Service	1629121488	1629121488	1	1	RUTKOWSKI, KENNETH T PT	8/19/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
47625	Fee-for-Service	1407326796	1407326796	1	1	RADIUM HOME HEALTH CARE INC	3/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 326	GLENDALE	CA	91204	1389	19	06037	34.145289	-118.255096	Los Angeles County
47635	Fee-for-Service	1366581977	1366581977	1	1	RICE, GEORGE MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96439	08	Family Practice	0	In state provider	None	15107 VAN OWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
47672	Fee-for-Service	1528116324	1528116324	1	1	RUPP, ELIZABETH A MD	9/1/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	83059	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
47674	Fee-for-Service	1780610949	1780610949	1	1	RAO, AARATI V S MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55030	78	Neoplastic Diseases/Oncology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
47677	Fee-for-Service	1790769495	1790769495	1	1	REYES, KATHERINE M MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54038	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
47706	Fee-for-Service	1619402955	1619402955	1	1	REZAEI MIRGHAED, MONA MD	8/17/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	171091	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
47714	Fee-for-Service	1447235783	1447235783	1	1	REINER, BRUCE I MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87856	None	None	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
47769	Fee-for-Service	1467480723	1467480723	1	1	ROSS, BRENDA	1/31/1990	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71304	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
47775	Fee-for-Service	1679923387	1679923387	1	1	RODEFFER, CARSON D MD	4/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168432	09	Gynecology (D.O. only)	0	In state provider	None	1552 COFFEE RD	FL 1	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
47819	Fee-for-Service	1205153525	1205153525	1	1	RAJYAGURU, PARTH S MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120071	41	Internal Medicine	0	In state provider	None	1701 CESAR CHAVEZ AVE	SUITE 402	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
47822	Fee-for-Service	1043415508	1043415508	1	1	ROBERTS, TERESE J LCSW	1/23/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11600 WASHINGTON PL	SUITE 102B	LOS ANGELES	CA	90066	5000	19	06037	34.00465708	-118.4208535	Los Angeles County
47825	Fee-for-Service	1861520603	1861520603	1	1	RUCKER, RICHARD M MD	7/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61070	41	Internal Medicine	0	In state provider	LOS ALAMITOS PULMONARY	10931 CHERRY ST	STE 300	LOS ALAMITOS	CA	90720	2445	30	06059	33.803811	-118.0679885	Orange County
47833	Fee-for-Service	1508543281	1508543281	1	1	REDWOOD KERNVILLE OPCO LLC	10/17/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	32 BURLANDO RD	None	KERNVILLE	CA	93238	0000	15	06029	35.75448646	-118.4265302	Kern County
47889	Fee-for-Service	1922034255	1922034255	1	1	RENDON, STEWART E MD	6/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78664	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
47899	Fee-for-Service	1548675259	1548675259	1	1	RASOULI, MOHAMMADREZA MD	6/30/2020	207L00000X	NA	Other	026	PHYSICIANS	162868	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47915	Fee-for-Service	1033220611	1033220611	1	1	ROSS, PHILLIP L MD	10/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91162	34	Urology and Urological Surgery	0	In state provider	None	2222 EAST ST	STE 250	CONCORD	CA	94520	2096	07	06013	37.98125538	-122.0329375	Contra Costa County
47954	Fee-for-Service	1952582793	1952582793	1	1	ROA, MARGO L LCSW	8/28/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
47962	Fee-for-Service	1780610949	1780610949	1	1	RAO, AARATI V S MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55030	68	Hematology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
47968	Fee-for-Service	1952344624	1952344624	1	1	RITTER, BRUCE A OD	5/3/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1151 GALLERIA BLVD	STE 239	ROSEVILLE	CA	95678	1944	31	06061	38.7727518	-121.2715967	Placer County
48011	Fee-for-Service	1245303122	1245303122	1	1	RUTMAN, MICHAEL N DO	1/6/2011	207R00000X	NA	Other	026	PHYSICIANS	4641	None	None	0	In state provider	None	317 N EL CAMINO REAL	STE 502	ENCINITAS	CA	92024	2816	37	06073	33.05428107	-117.2615637	San Diego County
48023	Fee-for-Service	1396557948	1396557948	1	1	ROCK, GYNETH OD	11/20/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5777 GREENBACK LANE	SUITE 100	SACRAMENTO	CA	95841	2013	34	06067	38.682756	-121.327839	Sacramento County
48036	Fee-for-Service	1942295340	1942295340	1	1	RAO, SUDHA MD	6/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	54908	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
48077	Fee-for-Service	1942523691	1942523691	1	1	RAHMANKHAH, SOUDABEH MFT	4/15/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1241 CARLSBAD VILLAGE DR	STE C1	CARLSBAD	CA	92008	1960	37	06073	33.16424532	-117.3405818	San Diego County
48113	Fee-for-Service	1952411613	1952411613	1	1	RALEYS	2/20/1976	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3430 TULLY RD	None	MODESTO	CA	95350	0840	50	06099	37.68901647	-121.0124736	Stanislaus County
48130	Fee-for-Service	1497006126	1497006126	1	1	REEDLEY COMMUNITY HOSPITAL	2/1/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1150 E WASHINGTON AVE	None	REEDLEY	CA	93654	4239	10	06019	36.59150149	-119.437146	Fresno County
48182	Fee-for-Service	1417494006	1417494006	1	1	REMIGIO, REINA M PHD	4/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
48186	Fee-for-Service	1275762049	1275762049	1	1	REYNA, LINDA LCSW	1/16/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1670 E 120TH ST	STE 1003, 1E04, 2E07, 21	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
48193	Fee-for-Service	1841361763	1841361763	1	1	RAWAL, NIRAJ B MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73636	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
48207	Fee-for-Service	1336228840	1336228840	1	2	RING, ROBERT A OD	1/1/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13223 BLACK MOUNTAIN RD	SUITE 6	SAN DIEGO	CA	92129	2659	37	06073	32.95846689	-117.1269225	San Diego County
48214	Fee-for-Service	1972251007	1972251007	1	1	RAZAFINDRABE, LANDY M PT	9/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
48246	Fee-for-Service	1346552023	1346552023	1	1	RATNARATHORN, MONDHIPA MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113146	07	Dermatology	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 203	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
48250	Fee-for-Service	1780610949	1780610949	1	1	RAO, AARATI V S MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55030	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
48269	Fee-for-Service	1598184293	1598184293	1	1	RAGHU, PREETHI R MD	6/12/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160480	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48283	Fee-for-Service	1639610066	1639610066	1	1	REGNIER, SHANE M MD	6/15/2022	207L00000X	NA	Other	026	PHYSICIANS	156858	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
48302	Fee-for-Service	1952349417	1952349417	1	3	RIGGS, JOHN J OD FAAO	9/15/1981	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OF OPTOMETRY	3257 CAMINO DE LOS COCHE	SUITE 201	CARLSBAD	CA	92009	8976	37	06073	33.0762053	-117.2390235	San Diego County
48334	Fee-for-Service	1174388276	1174388276	1	1	ROSENAU, KASHIA PHD	7/24/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
48342	Fee-for-Service	1265497283	1265497283	1	1	RANA, HAMENDRA T MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	30625	41	Internal Medicine	0	In state provider	None	1913 E 17TH ST	STE 106	SANTA ANA	CA	92705	8627	30	06059	33.76000545	-117.8399925	Orange County
48411	Fee-for-Service	1528146693	1528146693	1	1	RAVISHANKAR, PRATHIBHA	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84902	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
48419	Fee-for-Service	1497006126	1497006126	1	1	REEDLEY COMMUNITY HOSPITAL	12/10/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1150 E WASHINGTON AVE	None	REEDLEY	CA	93654	4239	10	06019	36.59150149	-119.437146	Fresno County
48425	Fee-for-Service	1003994906	1003994906	1	1	RECIO, JOSE L MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38123	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
48442	Fee-for-Service	1962580670	1962580670	1	1	ROBERTSON, SARAH MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54599	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
48444	Fee-for-Service	1467869354	1467869354	1	1	ROBERTSON, JAY DO	3/13/2020	208600000X	NA	General Surgery	026	PHYSICIANS	17332	02	General Surgery	0	In state provider	None	584 N SUNRISE AVE	STE 100	ROSEVILLE	CA	95661	2862	31	06061	38.75842021	-121.2528302	Placer County
48484	Fee-for-Service	1497738678	1497738678	1	1	RODRIGUEZ, RUBY M CRNA	5/15/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
48494	Fee-for-Service	1548487036	1548487036	1	1	RAJAN, ANITA A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78408	01	General Practice	0	In state provider	None	18111 NORDHOFF ST	None	NORTHRIDGE	CA	91330	0001	19	06037	34.239213	-118.527768	Los Angeles County
48552	Fee-for-Service	1609142892	1609142892	1	1	RICHARDSON, DANIELLE M MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127555	01	General Practice	0	In state provider	None	949 PALM AVE	None	IMPERIAL BEACH	CA	91932	1503	37	06073	32.58380109	-117.1133687	San Diego County
48576	Fee-for-Service	1235464033	1235464033	1	1	RAINUSSO, KARA M NP	10/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48601	Fee-for-Service	1932241916	1932241916	1	2	RAYMOND CHOW	8/16/2019	193200000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9253 TELEGRAPH RD	None	PICO RIVERA	CA	90660	5423	19	06037	33.95759376	-118.1049746	Los Angeles County
48652	Fee-for-Service	1356605216	1356605216	1	1	RED BLUFF UNION ELEMENTARY	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	1755 AIRPORT BLVD	None	RED BLUFF	CA	96080	4514	52	06103	40.15638592	-122.2505326	Tehama County
48707	Fee-for-Service	1497006126	1497006126	1	1	REEDLEY COMMUNITY HOSPITAL	5/22/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1150 E WASHINGTON AVE	None	REEDLEY	CA	93654	4239	10	06019	36.59150149	-119.437146	Fresno County
48719	Fee-for-Service	1336189877	1336189877	1	1	RAJAGOPAL, VISHNUPRIYA	10/19/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76836	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
48773	Fee-for-Service	1659725380	1659725380	1	1	RAZZANO, DANA M MD	4/27/2022	207ZP0102X	NA	Other	026	PHYSICIANS	167522	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48790	Fee-for-Service	1457774788	1457774788	1	1	RAVICHANDRAN, YAGNARAM MD	12/8/2022	2080P0204X	NA	Other	026	PHYSICIANS	183490	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
48798	Fee-for-Service	1851928386	1851928386	1	1	ROURKE, KYLE MD	6/10/2024	207PE0004X	NA	Other	026	PHYSICIANS	186238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
48808	Fee-for-Service	1639280480	1639280480	1	1	RIVA-CAMBRIN, JAY K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MEDICAL DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
48809	Fee-for-Service	1215096847	1215096847	1	1	RAPIER, RODERICK C MD	9/18/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67058	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
48833	Fee-for-Service	1043488000	1043488000	1	1	RAFI, RABIA R MD	10/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120957	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
48865	Fee-for-Service	1629069638	1629069638	1	1	ROBERT WOOD JOHNSON UNIVERSI	5/16/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL AT HAMILTO	1 HAMILTON HEALTH PL	None	HAMILTON	NJ	08690	3542	00	None	40.21636541	-74.67339143	Mercer County
48883	Fee-for-Service	1073770400	1073770400	1	1	REYNOLDS, CHARLES M MD	8/28/2017	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
48900	Fee-for-Service	1063588119	1063588119	1	1	RAY, CHARLES W MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	40919	02	General Surgery	0	In state provider	None	12470 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96774843	-118.0457572	Los Angeles County
48909	Fee-for-Service	1659469575	1659469575	1	1	ROSENTHAL, MARC J MD	4/24/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56856	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3440 LOMITA BLVD	STE 120	TORRANCE	CA	90505	4814	19	06037	33.81328127	-118.3452927	Los Angeles County
48953	Fee-for-Service	1639520935	1639520935	1	1	RUBIO, SERGIO R MD	5/5/2022	207R00000X	NA	Other	026	PHYSICIANS	154284	None	None	0	In state provider	None	515 MICHELTORENA ST	C	SANTA BARBARA	CA	93103	2257	42	06083	34.43172339	-119.7024817	Santa Barbara County
48969	Fee-for-Service	1770714396	1770714396	1	1	REHM, KENNETH B DPM	8/5/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1600 S IMPERIAL AVE	#3	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
48976	Fee-for-Service	1669091450	1669091450	1	1	RAHMAN, MILTON DO	9/21/2023	207P00000X	NA	Other	026	PHYSICIANS	20493	None	None	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
48996	Fee-for-Service	1497006126	1497006126	1	1	REEDLEY COMMUNITY HOSPITAL	5/22/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1150 E WASHINGTON AVE	None	REEDLEY	CA	93654	4239	10	06019	36.59150149	-119.437146	Fresno County
49006	Fee-for-Service	1336189877	1336189877	1	1	RAJAGOPAL, VISHNUPRIYA	10/19/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76836	08	Family Practice	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
49016	Fee-for-Service	1700953577	1700953577	1	1	RIVERA, LISA NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	22550 E SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
49047	Fee-for-Service	1750517165	1750517165	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1382 TOBIAS DRIVE	None	CHULA VISTA	CA	91911	4452	37	06073	32.60692253	-117.0551696	San Diego County
49057	Fee-for-Service	1871698688	1871698688	1	1	RAO,SURENDRA D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KAUAI MEDICAL CLINIC	3-3420 KUHIO HIGHWAY	SUITE B	LIHUE	HI	96766	1098	00	None	21.98560043	-159.3663628	Kauai County
49058	Fee-for-Service	1235137712	1235137712	1	1	ROSENBLOOM, ROBERT C MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
49068	Fee-for-Service	1972577955	1972577955	1	1	ROSARIO, ROMMEL U MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
49074	Fee-for-Service	1376621854	1376621854	1	1	READ, FRANK MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56073	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
49098	Fee-for-Service	1215096847	1215096847	1	1	RAPIER, RODERICK C MD	9/18/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67058	10	Gastroenterology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
49136	Fee-for-Service	1184946147	1184946147	1	1	RAWLINSON, NEIL J MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116355	22	Pathology (M.D. only)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
49140	Fee-for-Service	1053546416	1053546416	1	1	RASHTAK, SHADI MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149698	07	Dermatology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
49148	Fee-for-Service	1629069638	1629069638	1	1	ROBERT WOOD JOHNSON UNIVERSI	5/16/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL AT HAMILTO	1 HAMILTON HEALTH PL	None	HAMILTON	NJ	08690	3542	00	None	40.21636541	-74.67339143	Mercer County
49158	Fee-for-Service	1194755918	1194755918	1	1	ROCHE, NIALL E MD	3/31/1992	174400000X	NA	Other	026	PHYSICIANS	52808	83	Rheumatology	0	In state provider	None	39225 STATE ST	None	FREMONT	CA	94538	1437	01	06001	37.54906006	-121.9828044	Alameda County
49187	Fee-for-Service	1417378548	1417378548	1	1	RANGEL, ARTURO LMFT	6/5/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
49200	Fee-for-Service	1871638650	1871638650	1	1	RILVERIA, NORMA T NP	8/22/2023	163WP0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
49211	Fee-for-Service	1972739399	1972739399	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1805 IONAIN STREET	None	SAN DIEGO	CA	92154	2821	37	06073	32.57029045	-117.0949339	San Diego County
49220	Fee-for-Service	1275846693	1275846693	1	1	RIZVI, HUMA	2/20/2025	207R00000X	NA	Other	026	PHYSICIANS	132332	41	Internal Medicine	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
49235	Fee-for-Service	1083995930	1083995930	1	1	RIZZUTO, CORY PSYD	12/31/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
49241	Fee-for-Service	1326130238	1326130238	1	1	ROSS, PATRICK A MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80118	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
49276	Fee-for-Service	1700840212	1700840212	1	1	ROCHA CAMPOS, GUILHERME	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81177	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
49280	Fee-for-Service	1679542120	1679542120	1	1	RAVI, LINGAMURTHY MD	2/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54949	None	None	0	In state provider	None	845 S FAIRMONT AVE	# 8	LODI	CA	99240	5116	39	06077	38.123217	-121.285878	San Joaquin County
49298	Fee-for-Service	1336373851	1336373851	1	1	RASMUSSEN, MICHAEL R MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123505	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
49312	Fee-for-Service	1518037498	1518037498	1	1	REIS, BRIAN J DC	4/18/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2031 SIXTH AVE	None	BERKELEY	CA	94710	2006	01	06001	37.86709575	-122.2973759	Alameda County
49316	Fee-for-Service	1770555393	1770555393	1	1	RYAN, PAUL M MD	9/29/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	172740	None	None	0	In state provider	None	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
49338	Fee-for-Service	1124332325	1124332325	1	1	RISMAN, JENNY C MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113384	10	Gastroenterology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
49341	Fee-for-Service	1366523847	1366523847	1	1	RUSSELL, CINDY L MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	47115	24	Plastic Surgery	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
49342	Fee-for-Service	1265792071	1265792071	1	1	RIVER SPRINGS CHARTER SCHOOL	11/13/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	27740 JEFFERSON AVE	None	TEMECULA	CA	92590	2698	33	06065	33.51125648	-117.1580448	Riverside County
49348	Fee-for-Service	1790318525	1790318525	1	1	ROY, CASSANDRA A NP	12/11/2024	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
49360	Fee-for-Service	1023199254	1023199254	1	1	ROMERO, MABEL MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82749	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49372	Fee-for-Service	1710382239	1710382239	1	1	ROBERTS, APHRODITE CNP	1/14/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
49379	Fee-for-Service	1063504447	1063504447	1	1	RODRIGUEZ, MARTINA S MD	11/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	72787	45	Nephrology (Renal-Kidney)	0	In state provider	None	1595 SOQUEL DR	None	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
49409	Fee-for-Service	1013041151	1013041151	1	2	RMG MEDICAL GROUP INC	3/21/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1514 E WHITTIER BLVD	SUITE 205	WHITTIER	CA	90603	0000	19	06037	33.9390597	-117.929877	Orange County
49429	Fee-for-Service	1427578061	1427578061	1	1	RAJAKUMAR, NIMESH MD	8/11/2021	207R00000X	NA	Other	026	PHYSICIANS	172988	None	None	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
49431	Fee-for-Service	1861870230	1861870230	1	1	RANDHAWA, GURINDER K MD INC	9/14/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	67417	01	General Practice	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
49434	Fee-for-Service	1992341184	1992341184	1	1	REYES, STEPHANIE M LCSW	10/25/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
49474	Fee-for-Service	1578836375	1578836375	1	1	RODRIGUEZ, CORAL CCC-SLP	4/14/2025	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
49478	Fee-for-Service	1457641771	1457641771	1	1	RISSMILLER, BRIAN J MD	3/1/2021	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
49486	Fee-for-Service	1649476847	1649476847	1	1	REDDEN, HILARY R	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
49490	Fee-for-Service	1538694534	1538694534	1	1	ROSALES GONZALES, MARLENNE	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79189	-	NOT APPLICABLE	0	In state provider	LCSW	7601 CANBY AVENUE	SUITE 3	RESEDA	CA	91335	2979	19	06037	34.20872085	-118.5347527	Los Angeles County
49492	Fee-for-Service	1164415238	1164415238	1	1	REGENTS OF THE UNIV OF CA	9/22/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
49503	Fee-for-Service	1205147659	1205147659	1	1	ROOS, JASON D DO	10/23/2020	207YS0123X	NA	ENT/Otolaryngology	026	PHYSICIANS	18178	04	Otology, Laryngology, Rhinology	0	In state provider	None	5530 AVENUE DE LOS ROBLE	None	VISALIA	CA	93291	5174	54	06107	36.328365	-119.3525775	Tulare County
49528	Fee-for-Service	1326130238	1326130238	1	1	ROSS, PATRICK A MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80118	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
49567	Fee-for-Service	1821027293	1821027293	1	1	ROWBOTHAM, MICHAEL C MD	1/3/1992	2084N0400X	NA	Neurology	026	PHYSICIANS	45080	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
49575	Fee-for-Service	1033310883	1033310883	1	1	RAHIM, USMAN G MD	5/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140939	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
49587	Fee-for-Service	1366699134	1366699134	1	1	ROGERS, CELESTINA M	12/17/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1440 N HARBOR BLVD	9TH FLOOR	FULLERTON	CA	92835	4122	30	06059	33.88513341	-117.926041	Orange County
49632	Fee-for-Service	1679508675	1679508675	1	1	RAICHEL-STIVI, SVETLANA MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	62626	08	Family Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49634	Fee-for-Service	1558976944	1558976944	1	1	REGENCY HOSPICE CARE INC	6/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5242 KATELLA AVE	STE 103A	LOS ALAMITOS	CA	90720	2861	30	06059	33.80291352	-118.042263	Orange County
49648	Fee-for-Service	1184696320	1184696320	1	1	RANIN, CARLOS A MD	3/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133910	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
49658	Fee-for-Service	1053659854	1053659854	1	1	RHEAUME, ALEXANDER PT	12/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
49662	Fee-for-Service	1962482513	1962482513	1	7	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2248 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1474	34	06067	38.554983	-121.458555	Sacramento County
49667	Fee-for-Service	1063504447	1063504447	1	1	RODRIGUEZ, MARTINA S MD	11/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	72787	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	None	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
49722	Fee-for-Service	1326096892	1326096892	1	1	RONNAU, KELLEN J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
49758	Fee-for-Service	1023128246	1023128246	1	1	REBHUN, DONALD J MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	47963	41	Internal Medicine	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
49761	Fee-for-Service	1902240344	1902240344	1	1	RESTREPO, JULIAN MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136382	01	General Practice	0	In state provider	None	9675 MONTE VISTA AVE	STE C	MONTCLAIR	CA	91763	2233	36	06071	34.079004	-117.6982135	San Bernardino County
49768	Fee-for-Service	1588950091	1588950091	1	1	RIZVI, SAQIB S MD	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138837	01	General Practice	0	In state provider	None	601 VAN NESS AVE	None	SAN FRANCISCO	CA	94102	3200	38	06075	37.78149353	-122.4206703	San Francisco County
49780	Fee-for-Service	1164415238	1164415238	1	1	REGENTS OF THE UNIV OF CA	8/10/2021	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
49784	Fee-for-Service	1720010556	1720010556	1	1	ROBERTS, CRAIG M DPM	6/1/1996	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2678 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	4708	19	06037	33.97394914	-118.2229166	Los Angeles County
49805	Fee-for-Service	1184065922	1184065922	2	1	RIZVI, NADIA MD	6/13/2023	207R00000X	NA	Other	026	PHYSICIANS	168251	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
49840	Fee-for-Service	1952856122	1952856122	1	1	RODRIGUEZ-BAYES, MONICA A OD	2/3/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	360 SIERRA COLLEGE DR	STE 100	GRASS VALLEY	CA	95945	7735	29	06057	39.23622963	-121.0549676	Nevada County
49884	Fee-for-Service	1508012154	1508012154	1	1	REEJHSINGHANI, RISHEEN S MD	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129653	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 O'FARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
49918	Fee-for-Service	1679508675	1679508675	1	1	RAICHEL-STIVI, SVETLANA MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	62626	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49924	Fee-for-Service	1558976944	1558976944	1	1	REGENCY HOSPICE CARE INC	6/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5242 KATELLA AVE	STE 103A	LOS ALAMITOS	CA	90720	2861	30	06059	33.80291352	-118.042263	Orange County
49945	Fee-for-Service	1043648819	1043648819	1	1	REDLANDS PODIATRY GROUP PC	10/4/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	16 E FERN AVE	SUITE A	REDLANDS	CA	92373	4000	36	06071	34.05074826	-117.1781289	San Bernardino County
49948	Fee-for-Service	1952452310	1952452310	1	1	RAYMOND BETCHER, MD	1/30/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	777 HEMLOCK ST	None	MACON	GA	31201	2102	00	None	32.83300602	-83.63616787	Bibb County
49950	Fee-for-Service	1962482513	1962482513	1	7	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2248 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1474	34	06067	38.554983	-121.458555	Sacramento County
49969	Fee-for-Service	1104269901	1104269901	1	1	ROBLES, ANAMARIA J MD	8/1/2021	208600000X	NA	General Surgery	026	PHYSICIANS	134048	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
49995	Fee-for-Service	1407855240	1407855240	1	17	ROCKY MOUNTAIN HOLDINGS, LLC	3/23/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	257 AIRPORT RD	None	GALLATIN	TN	37066	4747	00	None	36.4020111	-86.40455675	Sumner County
50027	Fee-for-Service	1700189461	1700189461	1	1	RICKARD, LEROY N LMFT	5/4/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125024	-	NOT APPLICABLE	0	In state provider	None	3533 MT VERNON AVENUE	None	BAKERSFIELD	CA	93306	1545	15	06029	35.405721	-118.9674835	Kern County
50043	Fee-for-Service	1689887622	1689887622	1	1	REYES, DAVID M MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62406	01	General Practice	0	In state provider	None	657 E ARROW HIGHWAY	STE G	GLENDORA	CA	91740	6013	19	06037	34.10676746	-117.850923	Los Angeles County
50045	Fee-for-Service	1861418196	1861418196	1	1	RAMSAY, JAMES G MD	3/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55630	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
50062	Fee-for-Service	1558115907	1558115907	1	1	RZRRX INC	12/20/2024	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	440 N MOUNTAIN AVE	106	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
50067	Fee-for-Service	1164415238	1164415238	1	1	REGENTS OF THE UNIV OF CA	8/27/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
50104	Fee-for-Service	1932513306	1932513306	1	1	RYAN, GLEN MD	12/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	142109	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
50105	Fee-for-Service	1134626617	1134626617	1	1	ROOPREDDY, MEGANA R MD	9/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164767	None	None	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
50151	Fee-for-Service	1609841048	1609841048	1	1	ROSEN, CLARK A MD	11/14/2017	174400000X	NA	Other	026	PHYSICIANS	152101	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
50162	Fee-for-Service	1790217842	1790217842	1	1	REDDY, ANEELA MD	6/28/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161798	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
50187	Fee-for-Service	1730109323	1730109323	1	1	RANGANATH, VEENA K MD	1/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78618	83	Rheumatology	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
50237	Fee-for-Service	1962482513	1962482513	1	7	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2248 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1474	34	06067	38.554983	-121.458555	Sacramento County
50249	Fee-for-Service	1295174969	1295174969	1	1	RODRIGUEZ, JOSEPH F MD	9/20/2021	208800000X	NA	Other	026	PHYSICIANS	168973	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
50257	Fee-for-Service	1639111099	1639111099	1	1	RAJGOPAL, UJWALA D MD FACS	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56387	None	None	0	In state provider	None	320 SANTA FE DR	STE 300	ENCINITAS	CA	92024	5140	37	06073	33.038847	-117.285579	San Diego County
50289	Fee-for-Service	1760434898	1760434898	1	1	RECHTSCHAFFEN, HANNE DO	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7915	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
50343	Fee-for-Service	1700285103	1700285103	1	1	ROBERTO, SAVERIO M DO	10/3/2019	207R00000X	NA	Other	026	PHYSICIANS	17436	41	Internal Medicine	0	In state provider	None	4700 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.440899	-122.6643975	Sonoma County
50355	Fee-for-Service	1164415238	1164415238	1	1	REGENTS OF THE UNIV OF CA	8/17/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
50375	Fee-for-Service	1306288790	1306288790	1	1	RUCKER, JESSICA R PSY	10/14/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
50433	Fee-for-Service	1528210416	1528210416	1	1	ROTH, TOMER A MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112678	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
50442	Fee-for-Service	1659577468	1659577468	1	1	RUDNICK, JEREMY D MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87547	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
50500	Fee-for-Service	1215072129	1215072129	1	1	RODRIGUEZ, LAUREN G LMFT	5/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
50520	Fee-for-Service	1356925531	1356925531	1	1	READY 4 CHANGE, A LICENSED C	8/4/2021	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6845 INDIANA AVE	101	RIVERSIDE	CA	92506	4224	33	06065	33.94258863	-117.3925691	Riverside County
50527	Fee-for-Service	1962482513	1962482513	1	7	REGENTS OF THE UNIVERSITY OF	11/7/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2248 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1474	34	06067	38.554983	-121.458555	Sacramento County
50530	Fee-for-Service	1629129606	1629129606	1	1	ROSENGART, AXEL MD	4/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134721	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
50544	Fee-for-Service	1689610503	1689610503	1	1	ROOS, FILIP MD	3/27/2014	207L00000X	NA	Other	026	PHYSICIANS	54519	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
50606	Fee-for-Service	1700998846	1700998846	1	1	RISSMAN, RAQUEL L MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82394	40	Pediatrics	0	In state provider	None	9850 GENESEE AVE	STE 340	LA JOLLA	CA	92037	1208	37	06073	32.882913	-117.226341	San Diego County
50644	Fee-for-Service	1164415238	1164415238	1	1	REGENTS OF THE UNIV OF CA	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
50699	Fee-for-Service	1912017674	1912017674	1	1	RALEY'S	8/2/1983	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 ONSTOTT RD	None	YUBA CITY	CA	95991	3511	51	06101	39.1324428	-121.6355662	Sutter County
50711	Fee-for-Service	1568056364	1568056364	1	1	RETKA, GRETCHEN BIRTH DOULA	7/6/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
50743	Fee-for-Service	1013681030	1013681030	1	1	ROMERO, RAMONA LCSW	3/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	74225 HWY 111	STE C	PALM DESERT	CA	92260	9398	33	06065	33.72116164	-116.3700359	Riverside County
50753	Fee-for-Service	1801837950	1801837950	1	1	RICHARD A. SELIGSON, M.D.	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
50795	Fee-for-Service	1235367475	1235367475	1	1	RINEWALT, DANIEL E MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154226	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50816	Fee-for-Service	1184192817	1184192817	1	1	RAMONES, VIVENCIA G	1/24/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9158 AEGINA COURT	None	ELK GROVE	CA	95758	5105	34	06067	38.424699	-121.452138	Sacramento County
50825	Fee-for-Service	1457445843	1457445843	1	1	RAMAN, VANDANA MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55418	41	Internal Medicine	0	In state provider	None	500 LENNON LANE	None	WALNUT CREEK	CA	94598	2415	07	06013	37.92948868	-122.0315914	Contra Costa County
50866	Fee-for-Service	1861576480	1861576480	1	1	ROMO, MARY S MD INC	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	64064	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5101 FLORENCE AVE	STE 5	BELL	CA	90201	3801	19	06037	33.96904913	-118.1757922	Los Angeles County
50891	Fee-for-Service	1386721959	1386721959	1	2	ROSANNA W .ISKANDER MD INC.	7/26/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	TER	1330 W COVINA BLVD	102	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
50894	Fee-for-Service	1356378160	1356378160	1	2	REYES, MARVIN T MD	4/14/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	81335	77	Infectious Disease	0	In state provider	None	9920 TALBERT	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
50899	Fee-for-Service	1912929290	1912929290	1	1	RINER, ROBERT M MD	2/1/1982	207P00000X	NA	Other	026	PHYSICIANS	32166	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
50904	Fee-for-Service	1629064753	1629064753	1	1	RAMOS, OTTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 SW 60TH CT	STE 206	MIAMI	FL	33155	4077	00	None	25.74153817	-80.29306992	Miami-Dade County
50914	Fee-for-Service	1831487669	1831487669	1	1	REYNA, YALITTZA	12/2/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1030 NEVADA ST.	SUITE 103	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
50928	Fee-for-Service	1962686477	1962686477	1	1	REDJAL, NASSER MD APC	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41807	03	Allergy	0	In state provider	None	15243 VANOWEN ST	STE 304	VAN NUYS	CA	91405	3652	19	06037	34.19394848	-118.4654115	Los Angeles County
50940	Fee-for-Service	1871726265	1871726265	1	1	RISSER, JEFFREY D	3/9/2020	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 E BIDWELL ST	215	FOLSOM	CA	95630	6441	34	06067	38.65914	-121.1281065	Sacramento County
50946	Fee-for-Service	1346509031	1346509031	1	1	REDDY, REDDIWANDLA SEENU MD	7/31/1985	193200000X	NA	Other	026	PHYSICIANS	38098	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	8881 FLETCHER PKWY	STE 240	LA MESA	CA	91942	3190	37	06073	32.78442148	-117.0073814	San Diego County
50953	Fee-for-Service	1104094176	1104094176	1	1	RODRIGUEZ, NINA MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104820	40	Pediatrics	0	In state provider	None	33353 YUCAIPA BOULEVARD	None	YUCAIPA	CA	92399	2018	36	06071	34.03379369	-117.0765405	San Bernardino County
50958	Fee-for-Service	1699009258	1699009258	1	1	RASOULI, MARGARET LEILA	3/24/2014	193400000X	NA	Other	026	PHYSICIANS	70058	None	None	0	In state provider	INC	22 ODYSSEY	SUITE 250	IRVINE	CA	92618	9265	30	06059	33.66719598	-117.7642461	Orange County
50969	Fee-for-Service	1346372026	1346372026	1	1	RUPPERT, MARY E DO	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5541	08	Family Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
50983	Fee-for-Service	1164522751	1164522751	1	1	RICHARD M TENGLIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	0000	00	None	44.05854729	-103.2246985	Pennington County
51016	Fee-for-Service	1912122060	1912122060	1	1	RASIM SOMER DILER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA STREET	None	PITTSBURGH	PA	15213	0000	00	None	40.44350017	-79.95952606	Allegheny County
51068	Fee-for-Service	1467401067	1467401067	2	1	RATINER, NATALIA L MD	3/10/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	40887	13	Neurology (M.D. only)	0	In state provider	None	13713 BURBANK BLVD	None	VAN NUYS	CA	91401	5040	19	06037	34.1721843	-118.4319513	Los Angeles County
51081	Fee-for-Service	1235367475	1235367475	1	1	RINEWALT, DANIEL E MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154226	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51102	Fee-for-Service	1184192817	1184192817	1	1	RAMONES, VIVENCIA G	1/24/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9158 AEGINA COURT	None	ELK GROVE	CA	95758	5105	34	06067	38.424699	-121.452138	Sacramento County
51105	Fee-for-Service	1710534128	1710534128	1	1	ROSS WAY NON-EMERGENCY TRANS	5/7/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PORTATION LLC	180 PROMENADE	300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
51111	Fee-for-Service	1497775985	1497775985	1	1	ROSENBERG, ERIK M DC	1/1/2003	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO SPORTS & SPINE	7612 LINDA VISTA RD	STE 109	SAN DIEGO	CA	92111	5313	37	06073	32.80163018	-117.1577046	San Diego County
51113	Fee-for-Service	1457445843	1457445843	1	1	RAMAN, VANDANA MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55418	68	Hematology	0	In state provider	None	500 LENNON LANE	None	WALNUT CREEK	CA	94598	2415	07	06013	37.92948868	-122.0315914	Contra Costa County
51144	Fee-for-Service	1003977307	1003977307	1	1	ROSENFELD, PAULA M LMFT	5/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
51162	Fee-for-Service	1316187313	1316187313	1	1	ROGERS, NATALIE L LMFT	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
51234	Fee-for-Service	1346509031	1346509031	1	1	REDDY, REDDIWANDLA SEENU MD	7/31/1985	193200000X	NA	Other	026	PHYSICIANS	38098	41	Internal Medicine	0	In state provider	INC	8881 FLETCHER PKWY	STE 240	LA MESA	CA	91942	3190	37	06073	32.78442148	-117.0073814	San Diego County
51239	Fee-for-Service	1073521688	1073521688	1	1	ROBINSON, DEREK T	3/5/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	534 E PINE ST	STE A	STOCKTON	CA	95204	5536	39	06077	37.97439027	-121.2897236	San Joaquin County
51242	Fee-for-Service	1407875065	1407875065	1	1	RIVERA, ABRAHAM MD	9/29/2023	208VP0000X	NA	Other	026	PHYSICIANS	162881	None	None	0	In state provider	None	18035 BROOKHURST ST	1200	FOUNTAIN VALLEY	CA	92708	6738	30	06059	33.701184	-117.9544385	Orange County
51275	Fee-for-Service	1083655096	1083655096	1	1	RUBEN, JASON B MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	PUEBLO AT BATH	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
51289	Fee-for-Service	1053666370	1053666370	1	1	REED, KELLY L DO	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15550	07	Dermatology	0	In state provider	None	4060 4TH AVE	STE 415	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
51312	Fee-for-Service	1093739708	1093739708	1	1	RANDOLPH, AMELIA MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77253	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
51313	Fee-for-Service	1447303565	1447303565	1	1	RISTOW, BRYAN H MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	80192	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2100 WEBSTER ST	#516	SAN FRANCISCO	CA	94115	2351	38	06075	37.7904826	-122.4324477	San Francisco County
51319	Fee-for-Service	1508874207	1508874207	1	1	RITER, BENJAMIN D MD	9/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171928	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
51321	Fee-for-Service	1396771747	1396771747	1	1	RINALD EXUM	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3050 TWIN RIVERS DR	None	ARKADELPHIA	AR	71923	4218	00	None	34.123185	-93.088503	Clark County
51350	Fee-for-Service	1053326744	1053326744	1	1	RELY-ON PHARMACY INC	12/1/2001	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	VALUE CARE PHARMACY	1045 N SHEPARD ST	None	ANAHEIM	CA	92806	2817	30	06059	33.850597	-117.8524872	Orange County
51363	Fee-for-Service	1548308273	1548308273	1	1	RUSSIN, LINCOLN D MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86200	30	Radiology	0	In state provider	None	810 COURT ST	None	JACKSON	CA	95642	2132	03	06005	38.35281592	-120.7677393	Amador County
51380	Fee-for-Service	1205298536	1205298536	1	1	RODRIGUEZ, LINDA S LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
51400	Fee-for-Service	1457445843	1457445843	1	1	RAMAN, VANDANA MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55418	78	Neoplastic Diseases/Oncology	0	In state provider	None	500 LENNON LANE	None	WALNUT CREEK	CA	94598	2415	07	06013	37.92948868	-122.0315914	Contra Costa County
51422	Fee-for-Service	1861627572	1861627572	1	1	RINGNES, ANDREW P MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130633	20	Orthopedic Surgery	0	In state provider	None	10051 LAKE AVE	STE 3	TRUCKEE	CA	96161	4870	29	06057	39.32550268	-120.2025066	Nevada County
51428	Fee-for-Service	1104259183	1104259183	1	1	REDDY, RAJESH MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117918	05	Anesthesiology	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
51430	Fee-for-Service	1710041736	1710041736	1	1	RAMOS, GLADYS A MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82931	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51436	Fee-for-Service	1164559787	1164559787	1	1	REGIONAL EMERGENCY	4/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP INC	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
51442	Fee-for-Service	1932132974	1932132974	1	1	RONQUILLO, RICARDO B MD	4/29/1999	207L00000X	NA	Other	026	PHYSICIANS	76604	01	General Practice	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
51454	Fee-for-Service	1225207913	1225207913	1	1	REED, SARA S NP	12/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
51503	Fee-for-Service	1700891272	1700891272	1	1	RIMPLE, DIANE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
51510	Fee-for-Service	1245027184	1245027184	1	1	REID, WINSOME P	5/16/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
51540	Fee-for-Service	1881035681	1881035681	1	1	RADHAKRISHNA, ROHAN C	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126307	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
51548	Fee-for-Service	1619056660	1619056660	1	1	RP HEALTHCARE INC	12/1/2002	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2456 W 3RD ST	None	SANTA ROSA	CA	95401	6425	49	06097	38.437668	-122.769207	Sonoma County
51595	Fee-for-Service	1730602038	1730602038	1	1	RAWY, MUSTAFA MD	8/10/2020	390200000X	NA	Other	026	PHYSICIANS	165085	08	Family Practice	0	In state provider	None	1107 POPLAR	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
51670	Fee-for-Service	1013250869	1013250869	1	1	REED, JARRED P MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134037	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
51688	Fee-for-Service	1487971966	1487971966	1	1	ROSICKER, RITA MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123833	08	Family Practice	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
51714	Fee-for-Service	1962464586	1962464586	1	1	RADIATION ONCOLOGY ASSOCIATE	9/1/2000	174400000X	NA	Other	022	PHYSICIANS GROUP	-	31	Roentgenology, Radiology (M.D. only)	0	In state provider	MEDICAL GROUP INC	7257 N FRESNO STREET	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
51745	Fee-for-Service	1518053131	1518053131	1	1	RAMA, ANIL MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63386	13	Neurology (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
51758	Fee-for-Service	1083649354	1083649354	1	1	REGENTS OF THE UNIVERSITY OF	10/15/2020	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	H SYSTEM	1500 EAST MEDICAL CENTER	2ND FLOOR TAUBMAN CTR RE	ANN ARBOR	MI	48109	0329	00	None	42.28391347	-83.72716554	Washtenaw County
51768	Fee-for-Service	1902332984	1902332984	1	1	RAMIREZ, LESLIE MD	5/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158629	08	Family Practice	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
51780	Fee-for-Service	1194950147	1194950147	1	1	RAMIREZ, CHRISTINA M LMFT	8/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
51798	Fee-for-Service	1952851701	1952851701	1	1	ROSS, RUTH A	11/14/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21475 CANYON WAY	None	COLFAX	CA	95713	0001	31	06061	39.05031182	-120.9674149	Placer County
51804	Fee-for-Service	1710968474	1710968474	1	1	RYU, JANICE K MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64233	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	STE G126	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
51808	Fee-for-Service	1265798961	1265798961	1	1	ROMAN GUTKOVICH	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 SPRINGHILL DR	STE A	NLR	AR	72217	2922	00	None	34.78355407	-92.21837227	Pulaski County
51828	Fee-for-Service	1881035681	1881035681	1	1	RADHAKRISHNA, ROHAN C	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126307	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
51831	Fee-for-Service	1629655154	1629655154	1	1	RUAN, QIAO NAN MD	10/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
51939	Fee-for-Service	1174552996	1174552996	1	1	ROSS, MONIQUE B MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49778	01	General Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
51946	Fee-for-Service	1891863247	1891863247	1	1	REINOSO, MANUAL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E RIDGE RD	STE 7	MCALLEN	TX	78503	1536	00	None	26.18364463	-98.20800116	Hidalgo County
51952	Fee-for-Service	1205178530	1205178530	1	1	RICHARDS, REBECCA MD	5/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141781	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
51984	Fee-for-Service	1407855240	1407855240	1	20	ROCKY MOUNTAIN HOLDINGS, LLC	9/17/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	3321 HANGAR LANE	None	TEXARKANA	AR	71854	3410	00	None	0	0	None
51987	Fee-for-Service	1740352590	1740352590	1	1	RESNECK, JAMES D MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29887	18	Ophthalmology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
52000	Fee-for-Service	1427201128	1427201128	1	1	RAJ, VISHAL MD	9/21/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	173339	None	None	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
52001	Fee-for-Service	1962464586	1962464586	1	1	RADIATION ONCOLOGY ASSOCIATE	9/1/2000	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	MEDICAL GROUP INC	7257 N FRESNO STREET	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
52011	Fee-for-Service	1356391643	1356391643	1	1	RICHARD THOMPSON M.D.	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
52047	Fee-for-Service	1487912333	1487912333	1	2	RELIANCE IMPERIAL PHARMACY L	1/15/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 E BIRCH ST	STE 4	CALEXICO	CA	92231	5925	13	06025	32.67925063	-115.4887003	Imperial County
52054	Fee-for-Service	1174030506	1174030506	1	1	REBELLO, SIBLE NP	9/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3660 PARK SIERRA DR	208	RIVERSIDE	CA	92501	1768	33	06065	33.90330693	-117.4707039	Riverside County
52080	Fee-for-Service	1336227941	1336227941	1	1	ROACH, GARY W MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41028	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
52085	Fee-for-Service	1952851701	1952851701	1	1	ROSS, RUTH A	11/14/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21475 CANYON WAY	None	COLFAX	CA	95713	0001	31	06061	39.05031182	-120.9674149	Placer County
52091	Fee-for-Service	1710968474	1710968474	1	1	RYU, JANICE K MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64233	30	Radiology	0	In state provider	None	4501 X ST	STE G126	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
52244	Fee-for-Service	1053456806	1053456806	1	1	RAMIREZ, IVAN MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102748	30	Radiology	0	In state provider	None	FRESNO & R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
52251	Fee-for-Service	1245228972	1245228972	1	1	RENO ORTHOPAEDIC CLINIC	10/21/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4724	00	None	39.53124039	-119.8188498	Washoe County
52257	Fee-for-Service	1639918261	1639918261	1	1	ROBINSON, MARIESHA	8/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
52302	Fee-for-Service	1225473077	1225473077	1	1	RUSSELL, MATTHEW MD	8/1/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	133403	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
52311	Fee-for-Service	1609070754	1609070754	1	1	ROJAS, MARGIE A LCSW	7/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
52320	Fee-for-Service	1477662724	1477662724	1	1	RAMOS,JOSEPH R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	PO BOX 111719	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
52336	Fee-for-Service	1659561702	1659561702	1	1	ROSINTOSKI, ANJU A MFT	2/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43867	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
52370	Fee-for-Service	1689776569	1689776569	1	1	ROESKE, RICHMOND E MD PC	10/12/2004	193400000X	NA	Other	026	PHYSICIANS	64048	18	Ophthalmology	0	In state provider	None	41877 ENTERPRISE CIR N	STE 110	TEMECULA	CA	92590	5628	33	06065	33.51705818	-117.169463	Riverside County
52386	Fee-for-Service	1962968305	1962968305	1	1	ROJAS CARE SERVICES INC	5/4/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1102 LYONS ST	None	REDWOOD CITY	CA	94061	2263	41	06081	37.47161161	-122.2347233	San Mateo County
52415	Fee-for-Service	1104114099	1104114099	1	1	RENVALL, AMY E PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
52447	Fee-for-Service	1699193078	1699193078	1	1	RAZAVI, SEYED AMIRHOSSEIN M	8/25/2023	2086S0105X	NA	General Surgery	026	PHYSICIANS	176427	None	None	0	In state provider	D	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
52449	Fee-for-Service	1154368835	1154368835	1	1	ROSS, JOEL C MD INC	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	11114	04	Otology, Laryngology, Rhinology	0	In state provider	None	2160 APPIAN WAY	STE 202	PINOLE	CA	94564	2534	07	06013	37.99585174	-122.3021549	Contra Costa County
52456	Fee-for-Service	1043672959	1043672959	1	1	REILLY, ERIN E PHD	6/29/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52462	Fee-for-Service	1902546617	1902546617	1	1	ROMULO L & NOELIA M GARCIA	6/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2865 COTTAGE DR	None	CORONA	CA	92881	4182	33	06065	33.83651609	-117.5412916	Riverside County
52463	Fee-for-Service	1053381004	1053381004	1	1	RIDGE, NEAL P DO	9/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6920	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
52475	Fee-for-Service	1477740009	1477740009	1	1	RAY, ERIK SANDHU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
52479	Fee-for-Service	1881621324	1881621324	1	1	RAMACHANDRAN, RANI V MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48819	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
52507	Fee-for-Service	1043608490	1043608490	1	1	RODRIGUEZ, TIARA M PHD	1/16/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
52512	Fee-for-Service	1588630487	1588630487	1	1	ROBERT F. MCCARRON	8/25/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	78 SUTTON AVE	None	OXFORD	MA	01540	1813	00	None	42.115689	-71.8487325	Worcester County
52523	Fee-for-Service	1255440699	1255440699	1	1	RITE AID #5816	1/17/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS, INC	715 AIRPORT DR	None	BAKERSFIELD	CA	93308	4129	15	06029	35.412777	-119.039126	Kern County
52537	Fee-for-Service	1124075551	1124075551	1	1	RAO, UMA M MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78409	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
52551	Fee-for-Service	1326542341	1326542341	1	1	ROTMAN, YONATAN Z MD	5/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
52563	Fee-for-Service	1548622731	1548622731	1	1	RANGEL-GARCIA, MARICELA MD	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	151646	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
52597	Fee-for-Service	1699268292	1699268292	1	1	RAHMATNEJAD, KAMRAN MD	6/9/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	176509	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
52614	Fee-for-Service	1801653969	1801653969	1	1	REGENTS OF THE UNIVERSITY OF	3/29/2024	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
52630	Fee-for-Service	1033452750	1033452750	1	1	ROJHANI, SOLOMON N	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145712	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
52632	Fee-for-Service	1033475306	1033475306	1	1	RANGI, AMANJOT K MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132159	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
52667	Fee-for-Service	1811720485	1811720485	1	1	REED, ANA LCSW	1/8/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
52686	Fee-for-Service	1417044132	1417044132	1	1	RAEESY-NEZHAD, AMIR H	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97308	None	None	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
52760	Fee-for-Service	1679613707	1679613707	1	1	ROCCHI & SPANFELNER	7/1/1998	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIST	1550 MYERS ST	STE A	OROVILLE	CA	95965	4965	04	06007	39.51183854	-121.5543164	Butte County
52771	Fee-for-Service	1750413589	1750413589	1	1	RAMESH, JAISHRI MD	12/16/2020	207R00000X	NA	Other	026	PHYSICIANS	51723	None	None	0	In state provider	None	1197 E ARQUES AVE	None	SUNNYVALE	CA	94085	3904	43	06085	37.38051652	-121.9964175	Santa Clara County
52789	Fee-for-Service	1619980521	1619980521	1	1	REAGAN, ROVENA R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62869	01	General Practice	0	In state provider	None	8010 FROST ST	STE 301	SAN DIEGO	CA	92123	4237	37	06073	32.80026879	-117.1520059	San Diego County
52800	Fee-for-Service	1760825665	1760825665	1	1	ROSHAN, DANIEL MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147591	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
52833	Fee-for-Service	1073637385	1073637385	1	1	RIOS, TERESA LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
52843	Fee-for-Service	1114248986	1114248986	1	1	RAMIREZ, PAUL J MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115617	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
52873	Fee-for-Service	1609002971	1609002971	1	1	ROACH, TENLI A DO	7/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	1052	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
52876	Fee-for-Service	1629156484	1629156484	1	1	RUBESHAW, ROBERT I MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74691	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
52898	Fee-for-Service	1801653969	1801653969	1	1	REGENTS OF THE UNIVERSITY OF	3/29/2024	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
52908	Fee-for-Service	1568601854	1568601854	1	1	RICHMOND, AQUEELAH H MD	3/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109061	08	Family Practice	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
52914	Fee-for-Service	1609990936	1609990936	1	1	ROWLAND HEIGHTS MEDICAL	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	19237 E COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	3055	19	06037	33.98723596	-117.883516	Los Angeles County
53054	Fee-for-Service	1548922602	1548922602	1	1	RAMAN, KAVITHA CNP	1/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1161 CIRBY WAY	None	ROSEVILLE	CA	95661	4421	31	06061	38.72953129	-121.2740134	Placer County
53068	Fee-for-Service	1912093923	1912093923	1	1	ROTH, JON J MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50622	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
53076	Fee-for-Service	1619980521	1619980521	1	1	REAGAN, ROVENA R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62869	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8010 FROST ST	STE 301	SAN DIEGO	CA	92123	4237	37	06073	32.80026879	-117.1520059	San Diego County
53112	Fee-for-Service	1104438167	1104438167	1	1	REGALA, BLESSIE D	11/3/2020	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24000 ALICIA PARKWAY	STE. # 9	MISSION VIEJO	CA	92691	3929	30	06059	33.61407491	-117.6797012	Orange County
53126	Fee-for-Service	1215907415	1215907415	1	1	REICHERT, DANIEL R MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143685	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
53128	Fee-for-Service	1760408389	1760408389	1	2	RAVULA, NIROOP R MD	12/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122598	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
53158	Fee-for-Service	1164495008	1164495008	1	1	ROTH, SAMUEL J MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41016	08	Family Practice	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
53199	Fee-for-Service	1407855240	1407855240	1	8	ROCKY MOUNTAIN HOLDINGS, LLC	2/12/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2865 RAYMOND J REED BLVD	None	DEMING	NM	88030	0000	00	None	32.25169787	-107.7267661	Luna County
53231	Fee-for-Service	1689077752	1689077752	1	1	RODRIGUEZ, MIGUEL LCSW	1/31/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80602	-	NOT APPLICABLE	0	In state provider	None	2615 BRESLAUER WAY	None	REDDING	CA	96001	4247	45	06089	40.54957365	-122.3807785	Shasta County
53240	Fee-for-Service	1669553947	1669553947	1	1	RUPPEL, KATHLEEN M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	84365	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	# M-696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
53245	Fee-for-Service	1669003638	1669003638	1	1	REEDLEY COMMUNITY HOSPITAL	3/4/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2059 HILLMAN ST	None	TULARE	CA	93274	1609	54	06107	36.23477162	-119.3311633	Tulare County
53272	Fee-for-Service	1295889129	1295889129	1	1	RADMARD, MOHAMMED MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134911	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53276	Fee-for-Service	1265457865	1265457865	1	1	RALPHS GROCERY COMPANY	10/2/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #21	1745 GARFIELD AVE	None	SOUTH PASADENA	CA	91030	4923	19	06037	34.1054242	-118.1344967	Los Angeles County
53282	Fee-for-Service	1447723812	1447723812	1	1	RX PHARMACY, INC.	2/4/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3101 N SILLECT AVE.	STE. 114-116	BAKERSFIELD	CA	93308	6348	15	06029	35.38703226	-119.0379685	Kern County
53337	Fee-for-Service	1407904741	1407904741	1	1	RANIA HABAL	7/1/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
53352	Fee-for-Service	1912093923	1912093923	1	1	ROTH, JON J MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50622	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
53376	Fee-for-Service	1073742052	1073742052	1	1	RAJA, SANTHI MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108477	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
53377	Fee-for-Service	1083724744	1083724744	1	1	RALEYS	1/25/1988	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2900 GEER RD	None	TURLOCK	CA	95382	1142	50	06099	37.518939	-120.8488005	Stanislaus County
53438	Fee-for-Service	1912999400	1912999400	1	1	RAJSBAUM, MARTIN MD	3/31/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42670	18	Ophthalmology	0	In state provider	None	865 3RD AVE	STE 121	CHULA VISTA	CA	91911	1300	37	06073	32.62189562	-117.0722453	San Diego County
53440	Fee-for-Service	1689217606	1689217606	1	1	ROESER, SLOANE PT	9/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
53532	Fee-for-Service	1669003638	1669003638	1	1	REEDLEY COMMUNITY HOSPITAL	1/27/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2059 HILLMAN ST	None	TULARE	CA	93274	1609	54	06107	36.23477162	-119.3311633	Tulare County
53568	Fee-for-Service	1265075808	1265075808	1	1	RANDLES, KAREN N LPCC	11/10/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 ALHAMBRA BLVD	None	SACRAMENTO	CA	95816	3825	34	06067	38.57532638	-121.4641964	Sacramento County
53578	Fee-for-Service	1003852690	1003852690	1	1	RIDLEY, COURTNEY P MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125717	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 HOSPITAL DR	SUITE 220	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
53586	Fee-for-Service	1679988950	1679988950	1	1	ROLLING HILLS CLINIC	3/18/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14893664	-122.2178101	Tehama County
53593	Fee-for-Service	1669212528	1669212528	1	1	ROOHR, TONI	6/1/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
53600	Fee-for-Service	1124276266	1124276266	1	1	REICH, NILZA M DO	11/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7366	None	None	0	In state provider	None	411 E. YOSEMITE AVE	None	MANTECA	CA	95336	5717	39	06077	37.79744708	-121.2123031	San Joaquin County
53613	Fee-for-Service	1407964430	1407964430	1	1	RAPPA, LINDA BARBARA OD	12/9/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5959 GREENBACK LANE	#130	CITRUS HEIGHTS	CA	95621	4700	34	06067	38.681397	-121.322682	Sacramento County
53623	Fee-for-Service	1710146329	1710146329	1	1	RENDA, NATALIE C MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102457	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1048	19	06037	34.07671715	-118.3799413	Los Angeles County
53640	Fee-for-Service	1467580381	1467580381	1	1	REMIGIO, DIOMEDES M JR PA	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15026	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET ST	FIRST FLOOR	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
53643	Fee-for-Service	1457469371	1457469371	1	1	ROTUNDA, ADAM M MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81640	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53684	Fee-for-Service	1942582267	1942582267	1	1	REGMI, SURAKSHYA MD	9/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130906	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
53757	Fee-for-Service	1730547886	1730547886	1	1	RI, KO NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53764	Fee-for-Service	1255901799	1255901799	1	1	ROBERTS, NATALIA M NP	12/7/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
53794	Fee-for-Service	1417405366	1417405366	1	1	RAMOS, DANIEL G PA	9/1/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15214	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
53799	Fee-for-Service	1073792370	1073792370	1	1	RADIANT MEDTRANS INC	3/26/2008	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3564 CENTRAL AVENUE	SUITE 1B	RIVERSIDE	CA	92506	6118	33	06065	33.9535405	-117.3900105	Riverside County
53819	Fee-for-Service	1669003638	1669003638	1	1	REEDLEY COMMUNITY HOSPITAL	1/27/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2059 HILLMAN ST	None	TULARE	CA	93274	1609	54	06107	36.23477162	-119.3311633	Tulare County
53838	Fee-for-Service	1841687316	1841687316	1	1	REED, SABRINA H MD	2/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155405	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
53841	Fee-for-Service	1730236316	1730236316	1	1	REY, ALANA LMFT	7/4/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
53854	Fee-for-Service	1487973798	1487973798	1	1	RAISONI, SNEHAL MD	1/28/2025	207R00000X	NA	Other	026	PHYSICIANS	185354	41	Internal Medicine	0	In state provider	None	733 CEDAR STREET	None	GARBERVILLE	CA	95542	3201	12	06023	40.10148699	-123.7927018	Humboldt County
53876	Fee-for-Service	1679988950	1679988950	1	1	ROLLING HILLS CLINIC	3/19/2015	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14893664	-122.2178101	Tehama County
53905	Fee-for-Service	1093174971	1093174971	1	1	REYES, ELIZABETH LMFT	1/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 W MAGNOLIA BLVD	AG	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
53933	Fee-for-Service	1184791097	1184791097	1	1	ROER, LAURENCE N MD	8/31/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63702	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
53951	Fee-for-Service	1922172642	1922172642	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIF II LLC	858 FLETCHER PKWY	None	EL CAJON	CA	92020	1818	37	06073	32.8078383	-116.9730305	San Diego County
53964	Fee-for-Service	1518270503	1518270503	1	1	RAJPUT, FARZAN S MD INC	10/24/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	95017	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	280 NEWPORT CENTER DR	STE 110	NEWPORT BEACH	CA	92660	7541	30	06059	33.610266	-117.8727975	Orange County
53992	Fee-for-Service	1417451758	1417451758	1	1	REIM, KATHERINE P MD	6/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163981	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
53998	Fee-for-Service	1750830592	1750830592	1	1	RUDERMAN, RUDY LMFT	10/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
54004	Fee-for-Service	1710971353	1710971353	1	1	RUDMAN, LYNN A MD	8/23/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66225	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PHYSICIANS MED GROUP	320 W PUEBLO ST.	None	SANTA BARBARA	CA	93105	0689	42	06083	34.42954414	-119.7230551	Santa Barbara County
54051	Fee-for-Service	1477678498	1477678498	1	1	RAMOS, SHARON A	9/4/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	RMC MOB 2	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
54073	Fee-for-Service	1376724310	1376724310	1	1	ROBERTS, SHARMAINE LCSW	10/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
54099	Fee-for-Service	1104907377	1104907377	1	1	RICH, ANITA MD	10/20/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74032	None	None	0	In state provider	None	225 W HOSPITALITY LN	102	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
54107	Fee-for-Service	1669003638	1669003638	1	1	REEDLEY COMMUNITY HOSPITAL	6/21/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2059 HILLMAN ST	None	TULARE	CA	93274	1609	54	06107	36.23477162	-119.3311633	Tulare County
54117	Fee-for-Service	1679651749	1679651749	1	1	ROSENBAUM, RAYMOND S MD	1/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87167	34	Urology and Urological Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
54118	Fee-for-Service	1528058351	1528058351	1	1	REITHERMAN, RICHARD W MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42404	30	Radiology	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
54153	Fee-for-Service	1164490967	1164490967	1	1	REDDY, HANUMANDIA R MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43484	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	440 GREENFIELD AVE	STE B	HANFORD	CA	93230	3568	16	06031	36.32904	-119.6582155	Kings County
54176	Fee-for-Service	1114503612	1114503612	1	1	REIDER, KRISTEN M PT	4/22/2021	225200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
54178	Fee-for-Service	1124052360	1124052360	1	1	ROBINSON, BRIAN L. MD	10/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD # 110	None	SPRINGFIELD	OR	97477	0000	00	None	44.06977851	-123.0418746	Lane County
54188	Fee-for-Service	1407144348	1407144348	1	1	ROSENBERG, SHIRA T MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54215	Fee-for-Service	1255790671	1255790671	1	1	REITSMA, TILLIE R LMFT	10/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	123 E 9TH ST	STE. 100C	UPLAND	CA	91786	6023	36	06071	34.0961745	-117.6493095	San Bernardino County
54234	Fee-for-Service	1972039238	1972039238	1	1	ROBERTSON, SARA M MD	6/4/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
54253	Fee-for-Service	1518270503	1518270503	1	1	RAJPUT, FARZAN S MD INC	10/24/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	95017	42	Nuclear Medicine	0	In state provider	None	280 NEWPORT CENTER DR	STE 110	NEWPORT BEACH	CA	92660	7541	30	06059	33.610266	-117.8727975	Orange County
54277	Fee-for-Service	1891991493	1891991493	1	1	ROBERTSON, LINDA D LMFT	4/27/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
54287	Fee-for-Service	1063511822	1063511822	1	1	ROY, JAMES F MD	3/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35406	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
54308	Fee-for-Service	1114242450	1114242450	1	1	RODRIGUEZ, ROSA A MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111121	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
54336	Fee-for-Service	1649538240	1649538240	1	1	REDDING, KATHERINE S MD	3/20/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	174628	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
54340	Fee-for-Service	1740485150	1740485150	1	1	ROMMERO, RENEE	4/18/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
54344	Fee-for-Service	1386977643	1386977643	1	1	RATUSHNYAK, YANA LCSW	1/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
54346	Fee-for-Service	1902085228	1902085228	1	1	ROSENWEIG, RACHEL L LCSW	12/12/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	STE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
54365	Fee-for-Service	1396791018	1396791018	1	1	RUTKOWSKI, ANNE M MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77051	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
54366	Fee-for-Service	1932475548	1932475548	1	1	REJAEI, DAMOON MD	9/11/2017	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	128965	25	Physical Medicine and Rehabilitation	0	In state provider	None	1321 COTTONWOOD ST	STE 203	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
54378	Fee-for-Service	1851302368	1851302368	2	1	RITE TIME PHARMACEUTICAL	11/14/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2366 REO DRIVE	None	SAN DIEGO	CA	92139	3043	37	06073	32.675531	-117.0646352	San Diego County
54390	Fee-for-Service	1285674986	1285674986	1	1	RUFFALO, RICHARD L MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	64682	05	Anesthesiology	0	In state provider	None	23201 LAKE CENTER DR	STE 214	EL TORO	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
54395	Fee-for-Service	1942284294	1942284294	1	1	RASHID, BASHIR Q MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88291	08	Family Practice	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
54398	Fee-for-Service	1144549221	1144549221	1	1	RANKA, PANKAJ R MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122830	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
54421	Fee-for-Service	1790060697	1790060697	1	1	RIBAS, MICHELLE D MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116654	02	General Surgery	0	In state provider	None	292 POSADA LANE	SUITE C	TEMPLETON	CA	93465	4054	40	06079	35.5531447	-120.7214979	San Luis Obispo County
54478	Fee-for-Service	1407144348	1407144348	1	1	ROSENBERG, SHIRA T MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112591	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54480	Fee-for-Service	1730358532	1730358532	1	1	RAMCHANDANI, AVINASH N MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	96965	01	General Practice	0	In state provider	None	121 SOTOYOME ST	SUITE 201	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
54489	Fee-for-Service	1700338647	1700338647	1	1	RSM HEALTH INC	8/23/2017	282N00000X	NA	Hospitals	026	PHYSICIANS	9513	41	Internal Medicine	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
54519	Fee-for-Service	1427411883	1427411883	1	1	RAIKUNDALIA, MILAP D MD	3/20/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	183801	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
54538	Fee-for-Service	1457422024	1457422024	1	1	RUTLEDGE, JULIA T	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
54570	Fee-for-Service	1295720704	1295720704	1	1	RIEHLE, DOUGLAS C MD	2/28/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	49218	30	Radiology	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
54591	Fee-for-Service	1033261722	1033261722	1	1	RAINVILLE, DONALD CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
54628	Fee-for-Service	1972796563	1972796563	1	1	REDDY, MANDEEP G MD	9/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117051	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
54661	Fee-for-Service	1649311705	1649311705	1	1	RUTMAN, AMY S MD	6/1/1995	207R00000X	NA	Other	026	PHYSICIANS	74306	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	STE 606	BEVERLY HILLS	CA	90211	1793	19	06037	34.0696407	-118.3836988	Los Angeles County
54684	Fee-for-Service	1740547884	1740547884	1	1	RUBINO, BARBARA D MD	10/16/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	127916	-	NOT APPLICABLE	0	In state provider	None	2010 ZONAL AVE	OPD 4P1 RM 1-15	LOS ANGELES	CA	90033	1026	19	06037	34.05986523	-118.2057472	Los Angeles County
54710	Fee-for-Service	1427435197	1427435197	1	1	RAFIE, SAMANTHA PHD	9/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
54733	Fee-for-Service	1982995841	1982995841	1	1	RAVINDRA, VIJAY M MD	2/1/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	161999	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
54734	Fee-for-Service	1811937832	1811937832	1	1	RUTHERFORD, RICHARD R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80729	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
54778	Fee-for-Service	1013588953	1013588953	1	1	ROYLES, RENEE CCC-SLP	12/18/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
54860	Fee-for-Service	1013339761	1013339761	1	1	RICKNER, AMBER H NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
54861	Fee-for-Service	1528177326	1528177326	1	1	RAMOS, CARMELLA J LCSW	3/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
54887	Fee-for-Service	1518239888	1518239888	1	1	RAPPOLD, KELLI R RN	4/30/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
54914	Fee-for-Service	1407939572	1407939572	1	1	RAVALIN, RICHARD V MD	1/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71729	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
54917	Fee-for-Service	1821013475	1821013475	1	1	RAEBURN, SUSAN D PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
54924	Fee-for-Service	1336536150	1336536150	1	1	RAHMAN, SALMAN A MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147845	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54933	Fee-for-Service	1780976902	1780976902	1	1	REFAAT, MOTASEM I MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122720	20	Orthopedic Surgery	0	In state provider	None	290 NORTH WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
54935	Fee-for-Service	1407945777	1407945777	1	2	RIKHY, SEEMA	6/15/2018	207R00000X	NA	Other	026	PHYSICIANS	50230	41	Internal Medicine	0	In state provider	None	4303 STEVENSON BLVD	None	FREMONT	CA	94538	2645	01	06001	37.53724829	-121.9762934	Alameda County
54959	Fee-for-Service	1174940712	1174940712	1	1	RAI CARE CENTERS OF SANTA	3/5/2015	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANA LLC	2740 S BRISTOL ST	SUITE 110	SANTA ANA	CA	92704	6209	30	06059	33.70999696	-117.8854626	Orange County
54962	Fee-for-Service	1073726444	1073726444	1	1	RODRIGUEZ-BRUNO, KRISTA M MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99037	04	Otology, Laryngology, Rhinology	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
54991	Fee-for-Service	1427319532	1427319532	1	1	RIVERA, MONICA MD	11/26/2018	207L00000X	NA	Other	026	PHYSICIANS	156625	05	Anesthesiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
55018	Fee-for-Service	1215927546	1215927546	1	1	RAJESH KRISHNAMURTHY	10/6/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
55027	Fee-for-Service	1306893409	1306893409	1	1	RITTENHOUSE, DIANE R MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63550	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
55041	Fee-for-Service	1902104839	1902104839	1	1	ROCKOFF, AARON N MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121598	67	Endocrinology	0	In state provider	None	725 W LA VETA AVE	STE 220	ORANGE	CA	92886	4446	30	06059	33.78063949	-117.8603285	Orange County
55067	Fee-for-Service	1629483417	1629483417	1	1	RECINOS, SHERYL L MD	8/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144280	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
55090	Fee-for-Service	1588617088	1588617088	1	1	RAJ, JAYA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
55099	Fee-for-Service	1235155946	1235155946	1	1	RESCHKE, KATHY D MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64398	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
55142	Fee-for-Service	1427136258	1427136258	1	1	RARAS, VELARDE C MD	1/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51629	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
55169	Fee-for-Service	1407855240	1407855240	1	2	ROCKY MOUNTAIN HOLDINGS, LLC	3/29/2015	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	101 CIVIC CENTER	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
55172	Fee-for-Service	1962482513	1962482513	1	5	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	77 CADILLAC DRIVE	SUITE 240	SACRAMENTO	CA	95825	8363	34	06067	38.572551	-121.4181585	Sacramento County
55181	Fee-for-Service	1710753256	1710753256	1	1	RELOVA, NOAH PT	1/5/2024	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1019 S MAIN ST	None	MANTECA	CA	95337	5703	39	06077	37.78880388	-121.2161899	San Joaquin County
55191	Fee-for-Service	1457437238	1457437238	1	1	REEDUS, DESIREE K MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84122	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
55199	Fee-for-Service	1508905514	1508905514	1	1	RODRIGUEZ, FERNANDO J MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110137	30	Radiology	0	In state provider	None	200 W ARBOR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55204	Fee-for-Service	1407939572	1407939572	1	1	RAVALIN, RICHARD V MD	1/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71729	20	Orthopedic Surgery	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
55236	Fee-for-Service	1669055216	1669055216	1	1	RINALDI, ELIZABETH MD	12/11/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
55258	Fee-for-Service	1235135286	1235135286	1	1	ROSENFELD, GINA MD	2/28/1993	193400000X	NA	Other	026	PHYSICIANS	76842	40	Pediatrics	0	In state provider	None	910 E OHIO AVE	STE 103	ESCONDIDO	CA	92025	3439	37	06073	33.12703769	-117.0699017	San Diego County
55263	Fee-for-Service	1457839094	1457839094	1	1	RIZO, HAYDEE RCP	8/27/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
55304	Fee-for-Service	1417241498	1417241498	1	1	RAND, ETHAN B MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148428	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
55306	Fee-for-Service	1194700393	1194700393	1	1	RAVAL, JANAK K MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46723	30	Radiology	0	In state provider	None	5525 W SLAUSON AVE	None	LOS ANGELES	CA	90056	1047	19	06037	33.98912847	-118.3784926	Los Angeles County
55325	Fee-for-Service	1275600298	1275600298	1	1	RUBIN, GREGORY MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82304	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
55329	Fee-for-Service	1790023240	1790023240	1	1	ROBERT E RECORD PHD A PSYCHO	4/23/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LOGICAL CORPORATION	875 N BREA BLVD	None	BREA	CA	92821	2606	30	06059	33.93434103	-117.8932895	Orange County
55331	Fee-for-Service	1952593428	1952593428	1	1	RONAN, KIMBERLY D LCSW	7/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
55332	Fee-for-Service	1902104839	1902104839	1	1	ROCKOFF, AARON N MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121598	41	Internal Medicine	0	In state provider	None	725 W LA VETA AVE	STE 220	ORANGE	CA	92886	4446	30	06059	33.78063949	-117.8603285	Orange County
55338	Fee-for-Service	1114288545	1114288545	1	1	RYU, MINSIK PT	9/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
55381	Fee-for-Service	1790700391	1790700391	1	1	RALPHS GROCERY COMPANY	3/9/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #84	29675 THE OLD RD	None	CASTAIC	CA	91384	4570	19	06037	34.45685854	-118.6175155	Los Angeles County
55441	Fee-for-Service	1407501877	1407501877	1	1	REGENTS UNIVERSITY OF CA	8/24/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MOBILE	2211 MICHIGAN AVE	None	SANTA MONICA	CA	90404	3905	19	06037	34.02472321	-118.4713821	Los Angeles County
55461	Fee-for-Service	1962482513	1962482513	1	5	REGENTS OF THE UNIVERSITY OF	11/3/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	77 CADILLAC DRIVE	SUITE 240	SACRAMENTO	CA	95825	8363	34	06067	38.572551	-121.4181585	Sacramento County
55479	Fee-for-Service	1457437238	1457437238	1	1	REEDUS, DESIREE K MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84122	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
55484	Fee-for-Service	1801329990	1801329990	1	1	RODRIGUEZ, REBECCA MD	9/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157083	None	None	0	In state provider	None	865 3RD AVE	STE 101	CHULA VISTA	CA	91911	1349	37	06073	32.62189562	-117.0722453	San Diego County
55519	Fee-for-Service	1992740567	1992740567	1	1	RAJU, SUJATHA MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2420 PROFESSIONAL COURT	SUITE 150	LAS VEGAS	NV	89128	0837	00	None	36.203769	-115.2550845	Clark County
55552	Fee-for-Service	1619086840	1619086840	1	1	RHEE, SUE J MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93038	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
55574	Fee-for-Service	1558990705	1558990705	1	1	RUPP, ALAN DO	6/19/2023	207P00000X	NA	Other	026	PHYSICIANS	21023	None	None	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
55612	Fee-for-Service	1407849128	1407849128	2	1	REINHARDT, DAVID J PHD	10/23/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3008 OSTROM AVE	None	LONG BEACH	CA	90808	4227	19	06037	33.810975	-118.1010505	Los Angeles County
55646	Fee-for-Service	1639478191	1639478191	1	1	ROBERTSON, ASHA M MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124302	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
55661	Fee-for-Service	1376137992	1376137992	1	1	RAMOLIA OPTOMETRIC ASSOCIATE	6/20/2022	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7720 EL CAMINO REAL	STE G	CARLSBAD	CA	92009	8508	37	06073	33.08263911	-117.2670028	San Diego County
55685	Fee-for-Service	1396760997	1396760997	1	1	RALPHS GROCERY COMPANY	7/9/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #704	16940 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7406	19	06037	34.25750648	-118.5012855	Los Angeles County
55693	Fee-for-Service	1861965436	1861965436	1	1	RECCHIONI, CASSANDRA CNP	2/26/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
55707	Fee-for-Service	1467425512	1467425512	1	1	ROGER FINK	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	390 E LONGVIEW ST	None	FAYETTEVILLE	AR	72703	4618	00	None	36.111726	-94.1517135	Washington County
55735	Fee-for-Service	1659569713	1659569713	1	1	ROBIN, JENNIE K MD	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105295	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
55750	Fee-for-Service	1962482513	1962482513	1	5	REGENTS OF THE UNIVERSITY OF	3/23/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	77 CADILLAC DRIVE	SUITE 240	SACRAMENTO	CA	95825	8363	34	06067	38.572551	-121.4181585	Sacramento County
55786	Fee-for-Service	1003089962	1003089962	1	1	RIOS, MARIA F P LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104906	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
55790	Fee-for-Service	1760591564	1760591564	1	1	RAHEJA, ASHOK K MD INC	1/31/1990	207R00000X	NA	Other	026	PHYSICIANS	36879	41	Internal Medicine	0	In state provider	None	3621 E MARTIN LUTHER	KING JR BLVD STE 10	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
55791	Fee-for-Service	1871576124	1871576124	1	1	REDDY, VODUR C MD	12/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38271	34	Urology and Urological Surgery	0	In state provider	None	16017 TUSCOLA RD	STE D	APPLE VALLEY	CA	92307	1317	36	06071	34.542252	-117.2692645	San Bernardino County
55797	Fee-for-Service	1770554321	1770554321	1	1	RAVI, NANDAKUMAR B MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64007	41	Internal Medicine	0	In state provider	None	9870 BRIMHALL RD	UNIT 100	BAKERSFIELD	CA	93312	2798	15	06029	35.36881694	-119.1119759	Kern County
55812	Fee-for-Service	1730252917	1730252917	1	1	ROSCHAK, THOMAS MD	1/1/1979	207RH0003X	NA	Oncology	026	PHYSICIANS	24369	68	Hematology	0	In state provider	None	11971 HERITAGE OAK PL	None	AUBURN	CA	95603	2461	31	06061	38.94065909	-121.0994525	Placer County
55848	Fee-for-Service	1407904451	1407904451	1	1	RUBY, CANDICE A MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79069	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
55879	Fee-for-Service	1750916367	1750916367	1	1	ROGERS, LAUREN S CCC-SLP	5/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	745 E LOCUST AVE	STE. 110	FRESNO	CA	93720	3000	10	06019	36.84055248	-119.7718605	Fresno County
55952	Fee-for-Service	1013103688	1013103688	1	1	REIMER, KRISTIN PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
55993	Fee-for-Service	1588082093	1588082093	1	1	ROTHENBERG, KARA A MD	9/1/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	139187	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
56000	Fee-for-Service	1417480534	1417480534	1	1	ROOSTAN, MOHAMMAD MD	7/14/2020	208M00000X	NA	Other	026	PHYSICIANS	159854	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
56007	Fee-for-Service	1023126547	1023126547	1	1	RUVALCABA, JUAN C MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82685	08	Family Practice	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
56020	Fee-for-Service	1740643766	1740643766	1	1	RAHNAMA, RUYAN MD	8/29/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
56026	Fee-for-Service	1184802530	1184802530	1	1	RUBAL, LAUREN A MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98939	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
56036	Fee-for-Service	1962482513	1962482513	1	5	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	77 CADILLAC DRIVE	SUITE 240	SACRAMENTO	CA	95825	8363	34	06067	38.572551	-121.4181585	Sacramento County
56044	Fee-for-Service	1528308665	1528308665	1	1	ROBBIN, MARIAN M LMFT	3/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
56067	Fee-for-Service	1962495986	1962495986	1	2	REGENTS/UCDPBG/PED NEONA	5/1/1999	2080N0001X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
56080	Fee-for-Service	1760591564	1760591564	1	1	RAHEJA, ASHOK K MD INC	1/31/1990	207R00000X	NA	Other	026	PHYSICIANS	36879	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3621 E MARTIN LUTHER	KING JR BLVD STE 10	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
56096	Fee-for-Service	1578121653	1578121653	1	1	ROLLING HILLS CARE CENTER	5/17/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	2108 STILLMAN STREET	None	SELMA	CA	93662	3026	10	06019	36.57250949	-119.6127495	Fresno County
56114	Fee-for-Service	1942311311	1942311311	1	1	RIVERA, MARCELO R MD,INC	5/31/1981	193400000X	NA	Other	026	PHYSICIANS	39240	41	Internal Medicine	0	In state provider	None	1516 MAIN ST	STE 104	RAMONA	CA	92065	5242	37	06073	33.03747003	-116.8767366	San Diego County
56127	Fee-for-Service	1578551073	1578551073	1	1	REICH, IRWIN M MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54857	05	Anesthesiology	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
56135	Fee-for-Service	1407904451	1407904451	1	1	RUBY, CANDICE A MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79069	68	Hematology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
56155	Fee-for-Service	1992237622	1992237622	1	1	RAVINDRAN, USHAANTHY MD	9/11/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	169435	None	None	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
56156	Fee-for-Service	1821669300	1821669300	1	1	ROBERTO ROIZENBLATT MD, PROF	1/4/2023	261Q00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ESSIONAL CORPORATION	3828 SCHAUFELE AVE	STE 360	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
56185	Fee-for-Service	1306238563	1306238563	1	1	RM ELITE REHAB GROUP, INC.	7/27/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1251 POMONA RD.	SUITE 108	CORONA	CA	92882	7157	33	06065	33.88284937	-117.5871947	Riverside County
56221	Fee-for-Service	1831352095	1831352095	1	1	RAHIMI NAINI, SOHRAB MD	4/15/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	168362	None	None	0	In state provider	None	440 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3321	54	06107	36.06961683	-119.0266846	Tulare County
56228	Fee-for-Service	1316981954	1316981954	1	1	ROGACHEFSKY, RICHARD A MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	89005	46	Hand Surgery	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 408	LOS ANGELES	CA	90017	3905	19	06037	34.05270508	-118.2641005	Los Angeles County
56232	Fee-for-Service	1699398560	1699398560	1	1	RIDGECREST REGIONAL HOSPITAL	6/6/2024	3416L0300X	NA	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	350 E RIDGECREST BLVD	107	RIDGECREST	CA	93555	3928	15	06029	35.62252049	-117.6644025	Kern County
56291	Fee-for-Service	1780919985	1780919985	1	1	RAO, KAVITA K MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141053	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56324	Fee-for-Service	1710158142	1710158142	1	2	RHEE, EDWARD MD	1/11/2022	207L00000X	NA	Other	026	PHYSICIANS	116518	None	None	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
56337	Fee-for-Service	1104249408	1104249408	1	1	ROYAL HAVEN, LLC	6/9/2015	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9806 GERALD AVENUE	None	NORTHRIDGE	CA	91343	1710	19	06037	34.24859444	-118.4948294	Los Angeles County
56355	Fee-for-Service	1962495986	1962495986	1	2	REGENTS/UCDPBG/PED NEONA	11/14/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
56410	Fee-for-Service	1134548522	1134548522	1	1	RAE, JOSHUA M MD	12/8/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	139731	25	Physical Medicine and Rehabilitation	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
56422	Fee-for-Service	1407904451	1407904451	1	1	RUBY, CANDICE A MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79069	78	Neoplastic Diseases/Oncology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
56515	Fee-for-Service	1447307467	1447307467	1	1	REEDER, TILDEN MD	5/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	36969	36	Psychiatry	0	In state provider	None	15431 ANACAPA RD	STE D	VICTORVILLE	CA	92392	2458	36	06071	34.50544107	-117.3250832	San Bernardino County
56516	Fee-for-Service	1316981954	1316981954	1	1	ROGACHEFSKY, RICHARD A MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	89005	20	Orthopedic Surgery	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 408	LOS ANGELES	CA	90017	3905	19	06037	34.05270508	-118.2641005	Los Angeles County
56533	Fee-for-Service	1912967241	1912967241	1	1	RIVARD, DONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	25 HACKETT BLVD.	MC 208	ALBENY	NY	12208	3499	00	None	42.646437	-73.7797545	Albany
56541	Fee-for-Service	1649363334	1649363334	1	1	READER, MARK E DO	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8888	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	390 PEARSON DR	None	PORTERVILLE	CA	93257	3368	54	06107	36.07297342	-119.0275758	Tulare County
56547	Fee-for-Service	1679964837	1679964837	1	1	RSCR CALIFORNIA, INC	11/5/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2918 E GREENHEDGE AVE	None	ANAHEIM	CA	92806	3804	30	06059	33.84235556	-117.8660934	Orange County
56560	Fee-for-Service	1346806478	1346806478	1	1	RUBALCAVA, SANDRA	5/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
56607	Fee-for-Service	1023366762	1023366762	1	1	ROLLINS, JASMINE E LCSW	9/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
56637	Fee-for-Service	1437208345	1437208345	1	1	REITEN, PATRICK J	9/30/1996	208600000X	NA	General Surgery	026	PHYSICIANS	60737	01	General Practice	0	In state provider	None	227 W JANSS RD	STE 330	THOUSAND OAKS	CA	91360	1871	56	06111	34.20611691	-118.883861	Ventura County
56704	Fee-for-Service	1942399589	1942399589	1	1	ROSIN, MELISSA J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77805	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	STE 700	ORANGE	CA	92868	4212	30	06059	33.78034779	-117.8655767	Orange County
56747	Fee-for-Service	1528137791	1528137791	1	1	REYES, ADORACION A	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51639	01	General Practice	0	In state provider	None	1350 CHESTNUT AVE	None	LONG BEACH	CA	90813	2945	19	06037	33.78356343	-118.1963157	Los Angeles County
56785	Fee-for-Service	1811007578	1811007578	1	1	RALEY'S	10/25/1984	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1842 FORT JONES ST	None	YREKA	CA	96097	9531	47	06093	41.70142155	-122.6460067	Siskiyou County
56792	Fee-for-Service	1063564227	1063564227	1	1	RHEE-WOROBEC, CATHERINE H PH	6/11/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
56820	Fee-for-Service	1538425350	1538425350	1	1	ROBINSON, KELLY LMFT	8/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
56829	Fee-for-Service	1649363334	1649363334	1	1	READER, MARK E DO	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8888	04	Otology, Laryngology, Rhinology	0	In state provider	None	390 PEARSON DR	None	PORTERVILLE	CA	93257	3368	54	06107	36.07297342	-119.0275758	Tulare County
56881	Fee-for-Service	1639194061	1639194061	1	1	ROMERO, JOSE D MD	3/1/2000	207L00000X	NA	Other	026	PHYSICIANS	45126	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
56949	Fee-for-Service	1548334154	1548334154	1	1	REDDY GAYATRI P MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55880	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
56967	Fee-for-Service	1710200027	1710200027	1	1	RALPHS GROCERY COMPANY	4/19/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #650	19081 GOLDENWEST ST	None	HUNTINGTON BEACH	CA	92648	2151	30	06059	33.68533427	-118.0062792	Orange County
57018	Fee-for-Service	1265753339	1265753339	1	1	RUFF, JEFFRY C DO	9/2/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	19971	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
57028	Fee-for-Service	1831208826	1831208826	1	1	REGENTS OF THE UNIVERSITY OF	2/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
57033	Fee-for-Service	1639187768	1639187768	1	1	REDI-MED SUPPLY, INC	2/20/2001	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1958 N ROSE AVE	None	OXNARD	CA	93036	5051	56	06111	34.21960406	-119.1581945	Ventura County
57057	Fee-for-Service	1396027751	1396027751	1	1	RAWDIN, BROOKE E PHD	4/21/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
57066	Fee-for-Service	1164450938	1164450938	1	1	RESNICK, DONALD L MD	2/28/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18577	30	Radiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
57126	Fee-for-Service	1689062838	1689062838	1	1	RIVERSIDE CARE INC	11/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4301 CAROLINE COURT	None	RIVERSIDE	CA	92506	2902	33	06065	33.95027593	-117.399882	Riverside County
57133	Fee-for-Service	1972739571	1972739571	1	1	RAMPURE, MADHUMATI K MD	12/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106969	41	Internal Medicine	0	In state provider	None	3466 MT DIABLO BLVD	STE C-100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
57201	Fee-for-Service	1295289544	1295289544	1	1	ROLTSCH, IAN	8/4/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	79440 CORPORATE CENTER D	None	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
57203	Fee-for-Service	1144395559	1144395559	1	1	REYES, BENIGNO JR MD	5/10/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51387	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5015 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3116	19	06037	34.02129255	-118.1613094	Los Angeles County
57238	Fee-for-Service	1548334154	1548334154	1	1	REDDY GAYATRI P MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55880	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
57262	Fee-for-Service	1134279946	1134279946	1	1	RODRIGUEZ, NELSON A MD	11/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50589	08	Family Practice	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
57288	Fee-for-Service	1083088314	1083088314	1	1	RIGGINS, ELIZABETH M PT	12/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
57297	Fee-for-Service	1053304113	1053304113	1	1	REGENTS/UCDPBG/IM CARDIO	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
57304	Fee-for-Service	1821743766	1821743766	1	1	RMD GOALS INC	1/23/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1325 YOSEMITE CIRCLE	None	OAKLEY	CA	94561	5205	07	06013	37.98233378	-121.6837439	Contra Costa County
57321	Fee-for-Service	1811991169	1811991169	1	1	ROJEK, LOREN CPO	9/19/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	16520 HARBOR BLVD	SUITE G	FOUNTAIN VALLEY	CA	92708	1360	30	06059	33.7234142	-117.919744	Orange County
57326	Fee-for-Service	1306918131	1306918131	1	1	ROTHBARD, MINDY MD	8/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66880	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
57332	Fee-for-Service	1730386442	1730386442	1	1	RUCKER, SHANNON S LMFT	2/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
57421	Fee-for-Service	1720254527	1720254527	1	1	RICH, CYNTHIA L PSYD	5/3/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	104 MIRASOL CT.	None	MONTEREY	CA	93940	7617	27	06053	36.57094501	-121.7773111	Monterey County
57425	Fee-for-Service	1356929442	1356929442	1	1	RAV PREMERA CARE LLC	6/4/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	864 N FORD AVENUE	None	FULLERTON	CA	92832	1261	30	06059	33.87950252	-117.9307591	Orange County
57472	Fee-for-Service	1346465515	1346465515	1	1	ROSEWOOD FAMILY COUNSELING C	5/9/2022	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ENTER, A PROFESSIONAL CO	288 W 9TH ST	None	UPLAND	CA	91786	5949	36	06071	34.0960435	-117.6548445	San Bernardino County
57475	Fee-for-Service	1891777538	1891777538	1	1	RAMSAMOOJ, RAJENDRA MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81168	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
57499	Fee-for-Service	1467491001	1467491001	1	1	ROBINSON, JAMES M MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78333	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
57516	Fee-for-Service	1194121681	1194121681	1	1	RESOLUTIONCARE, PC	4/5/2016	174400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1875 S GRANT ST	None	SAN MATEO	CA	94402	2666	41	06081	37.55313	-122.302172	San Mateo County
57550	Fee-for-Service	1578519203	1578519203	1	1	RIFKIN, DENA E MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109186	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DRIVE	8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
57608	Fee-for-Service	1255738910	1255738910	1	1	ROBELO, ALBERT MD	3/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156419	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
57609	Fee-for-Service	1811991169	1811991169	1	1	ROJEK, LOREN CPO	9/19/2006	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	16520 HARBOR BLVD	SUITE G	FOUNTAIN VALLEY	CA	92708	1360	30	06059	33.7234142	-117.919744	Orange County
57653	Fee-for-Service	1912263336	1912263336	2	1	RIVELLO, GEORGE DPM	3/26/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	501 LOCUST ST	None	LONE PINE	CA	93545	8044	14	06027	36.60839814	-118.0579394	Inyo County
57673	Fee-for-Service	1306834270	1306834270	1	2	RICHARD ROSENBLUM DO	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
57704	Fee-for-Service	1467873927	1467873927	2	1	RESTORE HEALTH CORP	4/27/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12666 BROOKHURST ST	STE 110	GARDEN GROVE	CA	92840	4866	30	06059	33.77880618	-117.95819	Orange County
57753	Fee-for-Service	1265725725	1265725725	1	1	REDWOOD SLEEP AND	4/12/2016	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PULMONARY CARE INC	202 WEST WILLOW STREET	STE 103	VISALIA	CA	93291	6238	54	06107	36.3283683	-119.29356	Tulare County
57760	Fee-for-Service	1346465515	1346465515	1	1	ROSEWOOD FAMILY COUNSELING C	5/9/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ENTER, A PROFESSIONAL CO	288 W 9TH ST	None	UPLAND	CA	91786	5949	36	06071	34.0960435	-117.6548445	San Bernardino County
57769	Fee-for-Service	1386047660	1386047660	1	1	RAKHESH GUTTIKONDA MEDICAL I	11/18/2024	2086S0122X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	655 EUCLID AVE	SUITE 200	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
57807	Fee-for-Service	1477525376	1477525376	1	1	ROUMANAS, ATHAN MD	4/10/2019	208G00000X	NA	General Surgery	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
57809	Fee-for-Service	1629670500	1629670500	1	1	RICHARDS, ELISA LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
57852	Fee-for-Service	1740351543	1740351543	1	1	RUNYAN, STEPHANIE D DO	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12443	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
57895	Fee-for-Service	1962859793	1962859793	1	1	RIO BRAVO ONCOLOGY INC	9/23/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4500 MORNING DR	STE 105	BAKERSFIELD	CA	93306	7276	15	06029	35.39343836	-118.9166214	Kern County
57929	Fee-for-Service	1306998760	1306998760	1	1	REE, DANIEL MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72681	14	Neurological Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
57945	Fee-for-Service	1265743819	1265743819	1	1	ROCKFORD ADKINS	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	375 DIXMYTH AVE	None	CINCINNATI	OH	45220	2475	00	None	39.14076839	-84.52169161	Hamilton County
57970	Fee-for-Service	1396348892	1396348892	1	1	RMG HOSPICE CARE, INC	1/31/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6410 VAN NUYS BLVD	SUITE 205	VAN NUYS	CA	91401	6634	19	06037	34.187085	-118.4487115	Los Angeles County
57989	Fee-for-Service	1750377925	1750377925	1	1	RAJANAYAGAM, RASA MD	5/20/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40893	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
58004	Fee-for-Service	1235206087	1235206087	1	6	REDWOODS RURAL HEALTH CT	5/6/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 W COAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11704433	-123.8133408	Humboldt County
58072	Fee-for-Service	1851487672	1851487672	1	1	RICHMOND, ALEC C MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108534	41	Internal Medicine	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
58087	Fee-for-Service	1710194857	1710194857	1	1	ROSEVILLE CITY ELEM SD	2/16/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1000 DARLING WY	None	ROSEVILLE	CA	95678	4341	31	06061	38.73661752	-121.2802228	Placer County
58109	Fee-for-Service	1558456517	1558456517	1	1	REYTER, ILYA MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79982	07	Dermatology	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
58136	Fee-for-Service	1417547118	1417547118	1	2	ROBERT A. TAYLOR, MD, INC.	8/16/2021	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2403 CASTILLO ST	STE 206	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
58151	Fee-for-Service	1992751648	1992751648	1	1	RONALD D JENKINS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
58162	Fee-for-Service	1851777650	1851777650	1	1	RODRIGUEZ, CRISTELA LMFT	1/29/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
58164	Fee-for-Service	1609929397	1609929397	1	1	REDDY, DEEPA K MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102780	08	Family Practice	0	In state provider	None	2950 N SYCAMORE DR	STE 300	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
58175	Fee-for-Service	1134141286	1134141286	1	1	ROTHSTEIN, RONALD J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64138	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
58196	Fee-for-Service	1861134728	1861134728	1	1	REID, ANGELA LMFT	1/30/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	650 ALAMO PINTADO RD	103	SOLVANG	CA	93463	2266	42	06083	34.600536	-120.128554	Santa Barbara County
58201	Fee-for-Service	1992876759	1992876759	1	1	ROWHANI, NAGHMEH MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92037	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
58239	Fee-for-Service	1265540892	1265540892	1	1	RICHARDSON, BRIAN C	7/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	61066	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
58261	Fee-for-Service	1396348892	1396348892	1	1	RMG HOSPICE CARE, INC	1/31/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6410 VAN NUYS BLVD	SUITE 205	VAN NUYS	CA	91401	6634	19	06037	34.187085	-118.4487115	Los Angeles County
58266	Fee-for-Service	1780647735	1780647735	1	1	RIES, JEFFREY D DO	2/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	5138	None	None	0	In state provider	None	1175 E ARROW HWY	STE J	UPLAND	CA	91786	5525	36	06071	34.09981647	-117.636003	San Bernardino County
58290	Fee-for-Service	1235206087	1235206087	1	6	REDWOODS RURAL HEALTH CT	5/6/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 W COAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11704433	-123.8133408	Humboldt County
58348	Fee-for-Service	1346425121	1346425121	1	1	RECASENS, MARTA A MD APMC	3/17/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	CIATES	1111 N BRAND BLVD	STE 320	GLENDALE	CA	91202	3070	19	06037	34.1622	-118.2550855	Los Angeles County
58356	Fee-for-Service	1851487672	1851487672	1	1	RICHMOND, ALEC C MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
58374	Fee-for-Service	1366969404	1366969404	1	1	ROBINSON, ALEXANDRA M PHD	8/18/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1819 CLIFF DR	F	SANTA BARBARA	CA	93109	1650	42	06083	34.40137954	-119.7214154	Santa Barbara County
58434	Fee-for-Service	1538101456	1538101456	1	1	REDDY, GAUTHAM P MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82217	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
58510	Fee-for-Service	1518056191	1518056191	1	1	RESENDEZ, ELPIDIO JR MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78284	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
58521	Fee-for-Service	1265734636	1265734636	1	1	RIVER FOUNTAINS OF LODI	11/30/2010	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATOR	311 W TURNER	None	LODI	CA	95240	0517	39	06077	38.14571949	-121.2772635	San Joaquin County
58582	Fee-for-Service	1861528804	1861528804	1	1	RSCR CALIFORNIA, INC	2/27/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OLIVE STREET NORTH HOME	2034 N OLIVE ST	None	SANTA ANA	CA	92706	3513	30	06059	33.7640322	-117.8774382	Orange County
58645	Fee-for-Service	1790313773	1790313773	1	1	RODRIGUEZ, DONNA C LMFT	4/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25A W 25TH AVE	None	SAN MATEO	CA	94403	2576	41	06081	37.54402781	-122.3062667	San Mateo County
58750	Fee-for-Service	1578846473	1578846473	1	1	ROSEN, JAY W PHD	11/3/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3907 WARING ROAD	SUITE 2	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
58769	Fee-for-Service	1588685044	1588685044	1	1	RICHARDSON, WILLIAM P OD	9/5/1973	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	536 AUBURN RAVINE RD	None	AUBURN	CA	95603	3954	31	06061	38.90907336	-121.0744713	Placer County
58804	Fee-for-Service	1003253071	1003253071	1	1	RAHIM, BASIT MD	8/7/2019	2084V0102X	NA	Neurology	026	PHYSICIANS	148046	13	Neurology (M.D. only)	0	In state provider	None	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
58826	Fee-for-Service	1649419268	1649419268	1	1	RALEYS	6/4/2009	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	157 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2304	49	06097	38.24976583	-122.6269795	Sonoma County
58869	Fee-for-Service	1063401826	1063401826	1	2	REGENTS/UCDPBG/IM ALL/RH	5/1/1999	207KA0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
58882	Fee-for-Service	1346265949	1346265949	1	1	RALPHS GROCERY CO	6/4/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #64	14919 WHITTIER BLVD	None	WHITTIER	CA	90605	1793	19	06037	33.9492523	-118.0076084	Los Angeles County
59024	Fee-for-Service	1831354356	1831354356	1	1	RANGANATHAN, RAGHUVEER MD	10/8/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	169292	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
59026	Fee-for-Service	1174546055	1174546055	1	1	RUSSELL, JAMES W MD	5/6/1990	207L00000X	NA	Other	026	PHYSICIANS	54346	05	Anesthesiology	0	In state provider	None	10572 CALLE LEE	STE 122	LOS ALAMITOS	CA	90720	8528	30	06059	33.80890075	-118.0573006	Orange County
59060	Fee-for-Service	1518925577	1518925577	1	1	RIMAWI, LAMA I MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56102	40	Pediatrics	0	In state provider	None	910 MARSHALL STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.4876781	-122.2249265	San Mateo County
59088	Fee-for-Service	1578902003	1578902003	1	1	RODY, DEAN A LCSW	1/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59105	Fee-for-Service	1730237686	1730237686	1	1	RASSMAN, SEAN O MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92176	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
59112	Fee-for-Service	1336452333	1336452333	1	1	RIVERA, RACHELLE N MD	3/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
59122	Fee-for-Service	1811567142	1811567142	1	1	RAMIREZ, MIRTHA A CNP	10/11/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	SUITE 210	SANTA CLARITA	CA	91355	4497	19	06037	34.41257644	-118.5597683	Los Angeles County
59158	Fee-for-Service	1063401826	1063401826	1	2	REGENTS/UCDPBG/IM ALL/RH	12/12/2022	207KA0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
59229	Fee-for-Service	1043306129	1043306129	1	1	RANGAN, CYRUS MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61820	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
59293	Fee-for-Service	1447303607	1447303607	1	1	RAWLINS-NOVICKI, SAUNDRA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
59407	Fee-for-Service	1952819096	1952819096	1	1	ROUTLEDGE, ERIN N	6/9/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
59413	Fee-for-Service	1023042397	1023042397	1	1	RODARTE, ALEXANDER MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	32737	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
59439	Fee-for-Service	1245233709	1245233709	1	1	RESENDEZ, ELPIDIO JR MD	3/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78284	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
59453	Fee-for-Service	1912949942	1912949942	1	1	RICHARDS, JOANNE R MD	3/1/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1304 ELLA ST	STE A	SAN LUIS OBISPO	CA	93401	4165	40	06079	35.27704692	-120.6496857	San Luis Obispo County
59540	Fee-for-Service	1346669769	1346669769	1	1	RUPE, ERIC MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	139165	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
59563	Fee-for-Service	1922326305	1922326305	1	1	ROBERTS, ALLISON M MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140765	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
59570	Fee-for-Service	1467491183	1467491183	1	1	RUIZ, DAVID E MD	2/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88490	41	Internal Medicine	0	In state provider	None	3605 HOSPITAL ROAD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
59583	Fee-for-Service	1477696078	1477696078	1	1	ROBINSON, NINA C DPM	3/10/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3712 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1733	19	06037	34.0243965	-118.1933222	Los Angeles County
59614	Fee-for-Service	1477610491	1477610491	1	1	ROSS, MARTIN V PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3807 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90010	3104	19	06037	34.06171655	-118.3095032	Los Angeles County
59617	Fee-for-Service	1730234352	1730234352	1	1	REQUENA, MARIANO LMFT	11/16/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22 W. MICHELTORENA ST	D	SANTA BARBARA	CA	93101	6522	42	06083	34.4255722	-119.7090178	Santa Barbara County
59624	Fee-for-Service	1720311400	1720311400	1	1	RIETKERK, WILLIAM E MD	7/28/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	141249	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
59628	Fee-for-Service	1356330203	1356330203	1	3	REGENTS/UCDPBG/NEUROLOGY	9/17/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
59631	Fee-for-Service	1992720593	1992720593	1	1	RALPHS GROCERY COMPANY	12/13/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #683	306 S TWIN OAKS VALLEY R	None	SAN MARCOS	CA	92078	4333	37	06073	33.12998363	-117.1650008	San Diego County
59657	Fee-for-Service	1154693307	1154693307	1	1	ROHUN MEDICAL CORPORATION	11/15/2013	193400000X	NA	Other	026	PHYSICIANS	61869	None	None	0	In state provider	None	3300 E SOUTH ST	STE 206	LAKEWOOD	CA	90805	4590	19	06037	33.86018093	-118.1537163	Los Angeles County
59692	Fee-for-Service	1225592090	1225592090	1	1	RODRIGUEZ ROBLES, NEYSHIA M	10/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	D	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
59744	Fee-for-Service	1174761308	1174761308	1	1	RAO, MOHAN MD INC	10/6/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	62446	45	Nephrology (Renal-Kidney)	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
59759	Fee-for-Service	1821690306	1821690306	1	1	RELIACARE HOME HEALTH INC	8/11/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 147	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
59764	Fee-for-Service	1124269006	1124269006	1	2	ROBINSON, ADRIENE M LCSW	7/15/2020	364SP0809X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	5005 LA MART DR.	100 B3	RIVERSIDE	CA	92507	5991	33	06065	33.959493	-117.3322255	Riverside County
59810	Fee-for-Service	1053395731	1053395731	1	1	RASOULI, REZA MD	4/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85426	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
59845	Fee-for-Service	1225195571	1225195571	1	1	RALPHS GROCERY COMPANY	8/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #299	6300 IRVINE BLVD	None	IRVINE	CA	92620	2102	30	06059	33.69920001	-117.7393832	Orange County
59853	Fee-for-Service	1023158730	1023158730	1	1	ROBINSON, ANSTELLA D MD	6/30/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62964	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
59868	Fee-for-Service	1194505271	1194505271	1	1	RELIABLE MED-TRANS LLC	3/14/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3332 HEIGHTS DR	200	CAMERON PARK	CA	95682	7771	09	06017	38.66079902	-120.9810419	El Dorado County
59883	Fee-for-Service	1073706982	1073706982	1	1	RIEDMAN, NORMA J PHD	1/29/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
59903	Fee-for-Service	1639668247	1639668247	1	1	RODRIGUEZ, ALLEN R MD	12/3/2019	390200000X	NA	Other	026	PHYSICIANS	163327	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
59905	Fee-for-Service	1831151612	1831151612	1	1	REMINGTON, RODNEY C MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77177	18	Ophthalmology	0	In state provider	None	1360 E HERNDON AVE	STE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
59919	Fee-for-Service	1356330203	1356330203	1	3	REGENTS/UCDPBG/NEUROLOGY	1/1/1992	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
59941	Fee-for-Service	1619938164	1619938164	1	1	ROBERT LANE	6/28/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
59945	Fee-for-Service	1295231504	1295231504	1	1	RACHANA MILLER	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
59965	Fee-for-Service	1649344243	1649344243	1	1	RUMORE, GREGORY MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46433	22	Pathology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
59977	Fee-for-Service	1497936777	1497936777	1	1	REDDING PORT X RAY SRVS	1/1/1979	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	2468 BIRCHWOOD CIR	None	REDDING	CA	96002	3748	45	06089	40.54336119	-122.3250125	Shasta County
59989	Fee-for-Service	1114019973	1114019973	1	1	RADIOLOGY DISC OF ENCINO INC	9/21/2015	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	16661 VENTURA BLVD	SUITE 100	ENCINO	CA	91436	1922	19	06037	34.15820737	-118.496492	Los Angeles County
60002	Fee-for-Service	1336274414	1336274414	1	1	RADIOLOGY ASSOC OF SLO	1/1/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	FRENCH HOSP	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
60016	Fee-for-Service	1497757686	1497757686	1	1	RUDERMAN, JEFFREY P MD	1/22/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67920	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1613 S AZUSA AVE	None	HACIENDA HEIGHTS	CA	91745	3832	19	06037	33.99329659	-117.9316917	Los Angeles County
60030	Fee-for-Service	1174761308	1174761308	1	1	RAO, MOHAN MD INC	10/6/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	62446	41	Internal Medicine	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
60033	Fee-for-Service	1043371479	1043371479	1	1	RAO, UMA P MD	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77005	41	Internal Medicine	0	In state provider	None	18743 PIONEER BLVD	STE 203	ARTESIA	CA	90701	5662	19	06037	33.86025	-118.0821565	Los Angeles County
60056	Fee-for-Service	1821044694	1821044694	1	1	ROWLAND-SMITH, ROBERT A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	31395	05	Anesthesiology	0	In state provider	MEDICAL CORPORATION	400 W MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
60088	Fee-for-Service	1972562072	1972562072	1	1	ROBINSON, JOSEPH A MD	5/8/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79067	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
60140	Fee-for-Service	1497281042	1497281042	1	1	REDDY, NAVYA A MD	4/19/2021	207R00000X	NA	Other	026	PHYSICIANS	162283	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
60142	Fee-for-Service	1023158730	1023158730	1	1	ROBINSON, ANSTELLA D MD	6/30/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62964	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
60144	Fee-for-Service	1639466857	1639466857	1	1	ROBINSON, JESSE F	9/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
60205	Fee-for-Service	1356330203	1356330203	1	3	REGENTS/UCDPBG/NEUROLOGY	7/9/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60231	Fee-for-Service	1548440902	1548440902	1	1	REEVES, RYAN R	1/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108745	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
60239	Fee-for-Service	1952855843	1952855843	1	1	RISE PACIFIC PHYSICAL THERAP	2/3/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y AND SPORTS MEDICINE	501 MARIN ST	SUITE 205	THOUSAND OAKS	CA	91360	4260	56	06111	34.18371146	-118.8824904	Ventura County
60309	Fee-for-Service	1659364677	1659364677	1	3	REGENTS/UCDPBG/ANESTHESI	10/23/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60339	Fee-for-Service	1316099112	1316099112	1	1	RELLAN, BINDOO	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64456	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1720 EL CAMINO REAL	STE 120	BURLINGAME	CA	94010	3225	41	06081	37.59341466	-122.381361	San Mateo County
60425	Fee-for-Service	1467541722	1467541722	1	1	RAMIREZ, PAOLA L MD	6/11/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102598	40	Pediatrics	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
60427	Fee-for-Service	1235243999	1235243999	1	1	RHO, JONG M MD	9/18/2019	2084N0402X	NA	Neurology	026	PHYSICIANS	64857	79	Neurology-Child	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
60499	Fee-for-Service	1376524371	1376524371	1	1	RASAK, JON C MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76839	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1770	19	06037	34.0696407	-118.3836988	Los Angeles County
60525	Fee-for-Service	1164415238	1164415238	1	2	REGENTS OF THE UNIV OF CA	8/4/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60572	Fee-for-Service	1801873328	1801873328	1	1	RAKOFF, ALAN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
60599	Fee-for-Service	1659364677	1659364677	1	3	REGENTS/UCDPBG/ANESTHESI	4/11/2022	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60617	Fee-for-Service	1164841938	1164841938	1	1	ROSENBERG, GRAEME MD	9/28/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	138999	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
60641	Fee-for-Service	1568782100	1568782100	1	1	REES, ADAM S MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129544	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
60643	Fee-for-Service	1649740937	1649740937	1	1	REMEDIUM HOME HEALTH CARE	2/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	601 S GLENOAKS BLVD	STE 410	BURBANK	CA	91502	1474	19	06037	34.17930759	-118.3011138	Los Angeles County
60679	Fee-for-Service	1407855240	1407855240	1	16	ROCKY MOUNTAIN HOLDINGS, LLC	7/2/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	801 AIRLINE DRIVE	HANGAR 8-1	WACO	TX	76705	0000	00	None	31.63714853	-97.07972823	McLennan County
60705	Fee-for-Service	1639699598	1639699598	1	1	RUSSELL, ALBERTO MD	10/26/2020	207R00000X	NA	Other	026	PHYSICIANS	158093	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
60716	Fee-for-Service	1265907786	1265907786	1	1	ROTHFELD, ERIKA PT	3/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29992 HUNTER RD	SUITE 106	MURRIETA	CA	92563	4765	33	06065	33.56887078	-117.1376697	Riverside County
60737	Fee-for-Service	1659403004	1659403004	1	1	RAO, ARCHANA B MD	1/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73795	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60749	Fee-for-Service	1730193491	1730193491	1	1	ROSENBLATE, ROBIN L MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83459	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
60750	Fee-for-Service	1649741547	1649741547	1	1	RACE MEDICAL TRANSPORT INC.	1/27/2019	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2471 MAIN ST	23	CHULA VISTA	CA	91911	4657	37	06073	32.59477854	-117.0804645	San Diego County
60755	Fee-for-Service	1407876824	1407876824	1	1	REDDY, LAKSHMI K MD	8/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94295	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
60786	Fee-for-Service	1962644997	1962644997	1	2	RASYIDI, ERNEST MD	1/29/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106902	-	NOT APPLICABLE	0	In state provider	None	4000 BIRCH ST	SUITE 112A	NEWPORT BEACH	CA	92660	2211	30	06059	33.66463772	-117.8698289	Orange County
60800	Fee-for-Service	1316365133	1316365133	1	1	ROGERS, ALBERT J MD	6/22/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	137617	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60812	Fee-for-Service	1164415238	1164415238	1	2	REGENTS OF THE UNIV OF CA	12/30/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60859	Fee-for-Service	1750558961	1750558961	1	1	RINKENBERGER, AMALIA MFT	2/11/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	STE 209	ENCINO	CA	91436	2985	19	06037	34.15524484	-118.4756687	Los Angeles County
60879	Fee-for-Service	1346688199	1346688199	1	1	RICHINA, SARAH F MD	6/19/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147161	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
60887	Fee-for-Service	1659364677	1659364677	1	3	REGENTS/UCDPBG/ANESTHESI	4/7/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
60889	Fee-for-Service	1528413572	1528413572	1	1	RIDER, ERIC A MD	10/19/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	151753	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60931	Fee-for-Service	1912444688	1912444688	1	1	RUIZ, JENNIE L NP	1/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
60946	Fee-for-Service	1154368116	1154368116	1	1	RIVERSIDE HEALTHCARE SYS	5/1/1997	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE COMMUNITY HOSP	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
60979	Fee-for-Service	1548323769	1548323769	1	1	RHO, JAMES I MD	11/26/2019	208VP0014X	NA	Other	026	PHYSICIANS	80002	05	Anesthesiology	0	In state provider	None	9327 FAIRWAY VIEW PLACE	STE 210	RANCHO CUCAMONGA	CA	91730	0970	36	06071	34.084008	-117.5600535	San Bernardino County
60987	Fee-for-Service	1225121049	1225121049	1	1	RUSSO, JOIE D APMC	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	8335	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 ETIWANDA AVE	SUITE 315	TARZANA	CA	91356	6129	19	06037	34.17046451	-118.5308463	Los Angeles County
60989	Fee-for-Service	1801912928	1801912928	1	1	REYES, CAROLYN MD	9/10/2017	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69577	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
61025	Fee-for-Service	1659403004	1659403004	1	1	RAO, ARCHANA B MD	1/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73795	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61040	Fee-for-Service	1841396876	1841396876	1	1	REED, KIMBERLEE M MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60628	02	General Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
61047	Fee-for-Service	1780208199	1780208199	1	1	ROOTED VITALITY HEALTH COLLA	10/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	BORATIVE A PSYCHOLOGICAL	516 W SHAW AVE	200 OFFICE #13	FRESNO	CA	93704	2515	10	06019	36.80857947	-119.8019619	Fresno County
61072	Fee-for-Service	1356330203	1356330203	1	1	REGENTS/UCDPBG/NEUROLOGY	1/4/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61094	Fee-for-Service	1477834869	1477834869	1	1	REEVES, AMY K CCC-SLP	3/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3722 KATELLA AVE	STE C	LOS ALAMITOS	CA	90720	3102	30	06059	33.8029617	-118.0678946	Orange County
61101	Fee-for-Service	1164415238	1164415238	1	2	REGENTS OF THE UNIV OF CA	5/1/1999	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
61113	Fee-for-Service	1831286426	1831286426	1	1	RAESE, JOACHIM D MD	2/11/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	33990	36	Psychiatry	0	In state provider	None	25485 MEDICAL CENTER DR	STE 204	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
61132	Fee-for-Service	1316039449	1316039449	1	1	RUSSELL, DEBORAH L	11/13/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6591 COLLINS DR	STE E8	MOORPARK	CA	93021	1492	56	06111	34.2944564	-118.8424453	Ventura County
61155	Fee-for-Service	1699908640	1699908640	1	1	RASH, DOMINIQUE L MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116999	78	Neoplastic Diseases/Oncology	0	In state provider	None	299 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.75367411	-117.1660185	San Diego County
61174	Fee-for-Service	1659364677	1659364677	1	3	REGENTS/UCDPBG/ANESTHESI	1/1/1992	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
61194	Fee-for-Service	1548220585	1548220585	1	1	RAO, PRATIBHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
61216	Fee-for-Service	1306309182	1306309182	1	2	ROMERO, NATANAE	8/15/2023	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1370 BREA BLVD	105	FULLERTON	CA	92835	4132	30	06059	33.88482917	-117.9236469	Orange County
61268	Fee-for-Service	1407855240	1407855240	1	13	ROCKY MOUNTAIN HOLDINGS, LLC	7/26/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	150 E. TYSON ROAD	None	QUARTZSITE	AZ	85359	9999	00	None	33.6894693	-114.2095289	La Paz County
61331	Fee-for-Service	1164433652	1164433652	2	1	RIVER OAK PHARMACY	11/26/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1080 W F ST	STE D	OAKDALE	CA	95361	3677	50	06099	37.76163127	-120.8589407	Stanislaus County
61359	Fee-for-Service	1356330203	1356330203	1	1	REGENTS/UCDPBG/NEUROLOGY	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61383	Fee-for-Service	1548485642	1548485642	1	1	REINS, MARY G LMFT	8/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	115 LIBERTY ST	STE 1	PETALUMA	CA	94952	2320	49	06097	38.23380158	-122.6433482	Sonoma County
61387	Fee-for-Service	1710292594	1710292594	1	2	RUBERG, JOSHUA L PHD	8/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2801 CAMINO DEL RIO S	STE 211	SAN DIEGO	CA	92108	3860	37	06073	32.7699957	-117.1344758	San Diego County
61415	Fee-for-Service	1972739233	1972739233	1	1	RAMASWAMY, KRISHNA A MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129441	01	General Practice	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
61418	Fee-for-Service	1073274833	1073274833	1	1	RODRIGUEZ, RACHEL E PT	1/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1222 W COLONY RD	STE 130	RIPON	CA	95366	9480	39	06077	37.75395862	-121.136171	San Joaquin County
61442	Fee-for-Service	1699908640	1699908640	1	1	RASH, DOMINIQUE L MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116999	30	Radiology	0	In state provider	None	299 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.75367411	-117.1660185	San Diego County
61483	Fee-for-Service	1366520991	1366520991	1	1	ROOZROKH, HOOTAN C MD	3/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83949	02	General Surgery	0	In state provider	None	14850 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2011	43	06085	37.25269771	-121.9527964	Santa Clara County
61502	Fee-for-Service	1790183770	1790183770	1	1	ROETCISOENDER, WANETTA LCSW	8/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41765 12TH STREET WEST	SUITE D	PALMDALE	CA	93551	1422	19	06037	34.641891	-118.1513675	Los Angeles County
61508	Fee-for-Service	1235206087	1235206087	1	2	REDWOODS RURAL HEALTH CT	4/1/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	95 CENTER STREET	None	RIO DELL	CA	95562	1323	12	06023	40.5019947	-124.1047016	Humboldt County
61514	Fee-for-Service	1194923417	1194923417	1	1	ROSENGREEN, MARTIN A MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111925	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
61515	Fee-for-Service	1457370074	1457370074	1	1	RUSSO, FREDERICK M MD	10/31/1984	207R00000X	NA	Other	026	PHYSICIANS	41689	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
61524	Fee-for-Service	1730506882	1730506882	1	1	RUSTAMOVA, PARVINE S MD	12/27/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
61529	Fee-for-Service	1164558706	1164558706	1	1	RICHARD L HOFFMAN M D, A PR	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28338	None	None	0	In state provider	OFESSIONAL CORPORATION	201 S ALVARADO ST	828	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
61573	Fee-for-Service	1013002450	1013002450	1	1	RITTER, RICHARD J MD	3/20/1975	174400000X	NA	Other	026	PHYSICIANS	12514	20	Orthopedic Surgery	0	In state provider	None	710 N EUCLID	SUITE 208	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
61574	Fee-for-Service	1578558896	1578558896	1	1	RUSSELL, GAIL A MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89255	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 MISSION BLVD	SUITE 2800	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
61597	Fee-for-Service	1437651130	1437651130	1	1	RETINA INSTITUTE OF CALIFORN	3/31/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4344 CONVOY ST	C2	SAN DIEGO	CA	92111	3737	37	06073	32.81949721	-117.1550284	San Diego County
61601	Fee-for-Service	1669488698	1669488698	1	1	RICHMAN, PETER S	7/31/1986	208600000X	NA	General Surgery	026	PHYSICIANS	58960	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
61607	Fee-for-Service	1902073802	1902073802	1	1	RAPTIS, LISA S MD	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122558	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
61636	Fee-for-Service	1104999275	1104999275	1	1	REYES, TANYA LMFT	5/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	965 E YOSEMITE AVE	SUITE 1B	MANTECA	CA	95336	5958	39	06077	37.79749432	-121.2033865	San Joaquin County
61637	Fee-for-Service	1689722662	1689722662	1	1	RAIGOSA, HENRY C MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
61642	Fee-for-Service	1962644997	1962644997	1	1	RASYIDI, ERNEST MD	6/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106902	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
61645	Fee-for-Service	1356330203	1356330203	1	1	REGENTS/UCDPBG/NEUROLOGY	9/29/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61650	Fee-for-Service	1609044296	1609044296	1	1	RIVERA, NICOLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 E 21ST ST	None	SIOUX FALLS	SD	57105	1016	00	None	43.534251	-96.7157055	Minnehaha County
61657	Fee-for-Service	1326276304	1326276304	1	1	RODRIGUEZ-PALACIOS,	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	106582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GUADALUPE M MD	329 W 8TH ST	None	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
61663	Fee-for-Service	1164405528	1164405528	1	1	RIKER, DAVID R MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53916	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
61672	Fee-for-Service	1578547576	1578547576	1	1	REINER, STEVEN C MD	7/31/1990	207P00000X	NA	Other	026	PHYSICIANS	27015	01	General Practice	0	In state provider	None	1113 ALTA AVE	STE 120	UPLAND	CA	91786	2803	36	06071	34.10824455	-117.6322743	San Bernardino County
61734	Fee-for-Service	1821599358	1821599358	1	1	RODRIGUEZ, JILL S OD	3/26/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15330 AMAR ROAD	SUITE A	LA PUENTE	CA	91744	2001	19	06037	34.03714077	-117.9509701	Los Angeles County
61787	Fee-for-Service	1003980350	1003980350	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF II LLC	2757 TELEGRAPH AVE	None	OAKLAND	CA	94612	1733	01	06001	37.8168713	-122.2677574	Alameda County
61796	Fee-for-Service	1235206087	1235206087	1	2	REDWOODS RURAL HEALTH CT	4/1/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	95 CENTER STREET	None	RIO DELL	CA	95562	1323	12	06023	40.5019947	-124.1047016	Humboldt County
61874	Fee-for-Service	1598915134	1598915134	1	1	REAGAN, DENISE LMFT	10/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	515 OCEAN AVE	SUITE E	LOMPOC	CA	93436	6926	42	06083	34.63896348	-120.4520478	Santa Barbara County
61884	Fee-for-Service	1437651130	1437651130	1	1	RETINA INSTITUTE OF CALIFORN	3/31/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4344 CONVOY ST	C2	SAN DIEGO	CA	92111	3737	37	06073	32.81949721	-117.1550284	San Diego County
61918	Fee-for-Service	1487684825	1487684825	1	1	RESNICK, JEFFREY I MD	5/26/1987	2086S0122X	NA	General Surgery	026	PHYSICIANS	60190	24	Plastic Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
61928	Fee-for-Service	1689722662	1689722662	1	1	RAIGOSA, HENRY C MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71900	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
61935	Fee-for-Service	1356330203	1356330203	1	1	REGENTS/UCDPBG/NEUROLOGY	5/27/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61953	Fee-for-Service	1588869341	1588869341	1	1	ROYBAL, DONNA J MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105225	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
61960	Fee-for-Service	1578547576	1578547576	1	1	REINER, STEVEN C MD	7/31/1990	207P00000X	NA	Other	026	PHYSICIANS	27015	08	Family Practice	0	In state provider	None	1113 ALTA AVE	STE 120	UPLAND	CA	91786	2803	36	06071	34.10824455	-117.6322743	San Bernardino County
61966	Fee-for-Service	1578645057	1578645057	1	1	REDDY,SUNIL A MD	10/1/2000	207RX0202X	NA	Oncology	026	PHYSICIANS	61643	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62004	Fee-for-Service	1437754652	1437754652	1	1	RIGHTLER, KAREN CNP	3/17/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 218	ANAHEIM	CA	92801	5619	30	06059	33.83743497	-117.9590498	Orange County
62015	Fee-for-Service	1982768875	1982768875	1	1	RHODORA FIORE GEN PRT	8/11/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	R&F HOME MED EQUIP & SUP	1076 HORIZON DRIVE	SUITE 4	FAIRFIELD	CA	94533	8200	48	06095	38.2738198	-122.0123055	Solano County
62020	Fee-for-Service	1619236437	1619236437	1	1	RIVERA, JUDITH P	6/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
62054	Fee-for-Service	1578622171	1578622171	1	1	RICHIE, BRADLEY A MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61615	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
62104	Fee-for-Service	1144727868	1144727868	1	1	RAI, NAVDEEP S MD	7/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163895	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
62105	Fee-for-Service	1861406274	1861406274	1	1	RANDALL ROTTMAN MD	2/14/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1190 BOOKCLIFF AVE	UNIT 102	GRAND JCT	CO	81501	8159	00	None	39.08824351	-108.5528025	Mesa County
62182	Fee-for-Service	1912248782	1912248782	1	1	RAINCROSS WOMENS MEDICAL GRP	10/31/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6767 BROCKTON AVE	None	RIVERSIDE	CA	92506	3023	33	06065	33.950448	-117.396769	Riverside County
62184	Fee-for-Service	1861411142	1861411142	1	1	RAZ, SHLOMO MD	2/8/2015	208800000X	NA	Other	026	PHYSICIANS	30633	34	Urology and Urological Surgery	0	In state provider	None	924 WESTWOOD BLVD	STE 520	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
62205	Fee-for-Service	1487684825	1487684825	1	1	RESNICK, JEFFREY I MD	5/26/1987	2086S0122X	NA	General Surgery	026	PHYSICIANS	60190	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
62209	Fee-for-Service	1790364917	1790364917	1	1	RAJAPURAM, NIKHIL MD	7/2/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
62220	Fee-for-Service	1316992043	1316992043	1	1	RAI, ANUP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13943 N 91ST AVE	STE H101	PEORIA	AZ	85381	3689	00	None	33.610455	-112.253868	Maricopa County
62237	Fee-for-Service	1225141328	1225141328	1	1	RAZACK, NASSER MD	11/7/2023	2085R0204X	NA	Other	026	PHYSICIANS	190509	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
62250	Fee-for-Service	1710484472	1710484472	1	1	RUSSELL, MICHAEL D MD	4/20/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185250	None	None	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
62304	Fee-for-Service	1265014161	1265014161	1	1	RICHARDS, DEBBIE M LCSW	5/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
62333	Fee-for-Service	1023268182	1023268182	1	1	RASHEED, MOYRA N MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117406	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94549	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
62418	Fee-for-Service	1073670329	1073670329	1	1	RALPHS GROCERY COMPANY	12/18/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #279	4700 ADMIRALTY WAY	None	MARINA DEL REY	CA	90292	6905	19	06037	33.97863547	-118.4392419	Los Angeles County
62448	Fee-for-Service	1861585911	1861585911	1	1	REYES, FRANK E MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143272	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
62450	Fee-for-Service	1073559241	1073559241	1	1	RAFIZAD, AMIR B MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81189	05	Anesthesiology	0	In state provider	None	455 S MAIN STREET	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
62454	Fee-for-Service	1376212613	1376212613	1	1	RAO HEALTHCARE INC	8/25/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1050 LINDEN AVENUE, 2ND	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
62499	Fee-for-Service	1598946790	1598946790	1	1	RO, CYNTHIA H MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100348	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
62513	Fee-for-Service	1952564064	1952564064	1	1	ROIZENBLATT, ROBERTO MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109738	18	Ophthalmology	0	In state provider	None	2715 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
62515	Fee-for-Service	1265950547	1265950547	1	1	RAMOS, SASHA LMFT	3/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
62548	Fee-for-Service	1346236205	1346236205	1	1	RUBIN, JACK E MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60194	41	Internal Medicine	0	In state provider	None	575 E HARDY ST	STE 322	INGLEWOOD	CA	90301	4053	19	06037	33.94909392	-118.3477665	Los Angeles County
62553	Fee-for-Service	1154364438	1154364438	1	1	REYES DAVID MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	52992	66	Emergency Medicine (Urgent Care)	0	In state provider	ASSOC EMERG PHYS INC	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
62560	Fee-for-Service	1871573428	1871573428	1	1	REGENTS OF THE UNIV CA	1/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
62604	Fee-for-Service	1992984561	1992984561	1	1	RAMIREZ, SHANNAN C LMFT	8/24/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
62617	Fee-for-Service	1568758472	1568758472	1	1	ROONEY, KATHLEEN A	3/9/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	123510	None	None	0	In state provider	None	2277 FAIR OAKS BLVD	STE 355	SACRAMENTO	CA	95825	5595	34	06067	38.575404	-121.4121195	Sacramento County
62699	Fee-for-Service	1255775706	1255775706	1	1	RABIN, RICHARD L MD	2/28/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	138709	18	Ophthalmology	0	In state provider	None	1844 SAN MIGUEL DR	STE 303	WALNUT CREEK	CA	94596	4963	07	06013	37.89504879	-122.0529911	Contra Costa County
62700	Fee-for-Service	1972998045	1972998045	1	1	REDDY, AVANISH S MD	8/31/2022	207L00000X	NA	Other	026	PHYSICIANS	180537	None	None	0	In state provider	None	5530 BIRDCAGE ST	STE 145	CITRUS HEIGHTS	CA	95610	7690	34	06067	38.667744	-121.273758	Sacramento County
62744	Fee-for-Service	1265459747	1265459747	1	1	RAJU, CECILIA C OD	9/8/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15446 S WESTERN AVE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
62748	Fee-for-Service	1255565867	1255565867	1	1	RYAN, SHANNON LMFT	11/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44076	-	NOT APPLICABLE	0	In state provider	None	540 MIDDLE RINCON RD	None	SANTA ROSA	CA	95409	3107	49	06097	38.471364	-122.6695725	Sonoma County
62757	Fee-for-Service	1114961075	1114961075	1	1	RICE, NELSON T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 NICHOLASVILLE RD	None	LEXINGTON	KY	40503	1431	00	None	38.01867682	-84.51400197	Fayette County
62760	Fee-for-Service	1144275694	1144275694	1	1	ROBERT L DAVIDSON	12/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3525 E LOUISE DR	STE 100	MERIDIAN	ID	83642	6303	00	None	43.601931	-116.349894	Ada County
62763	Fee-for-Service	1720876154	1720876154	1	1	RADICAL AND TENDER CARE COMP	4/30/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
62784	Fee-for-Service	1669707600	1669707600	1	1	RODRIGUEZ, OKAIRY M LMSW	3/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1310 STEWART DR	508	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
62792	Fee-for-Service	1639334071	1639334071	1	1	RUNFOLA, CRISTIN D PHD	1/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62838	Fee-for-Service	1346236205	1346236205	1	1	RUBIN, JACK E MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60194	45	Nephrology (Renal-Kidney)	0	In state provider	None	575 E HARDY ST	STE 322	INGLEWOOD	CA	90301	4053	19	06037	33.94909392	-118.3477665	Los Angeles County
62845	Fee-for-Service	1083642342	1083642342	1	1	ROSE, DEMIAN D MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84681	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
62874	Fee-for-Service	1083800767	1083800767	1	1	RANA, JAMAL S MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103942	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	280 W MCCARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
62878	Fee-for-Service	1194431833	1194431833	1	1	RICH, JAMAICA R DOULA	2/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
62901	Fee-for-Service	1093820425	1093820425	1	1	RAVAL, USHA	12/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42057	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
62943	Fee-for-Service	1356051999	1356051999	1	1	RUBIO, BRIAN J PT	12/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
62966	Fee-for-Service	1295789477	1295789477	1	1	RAMOS, TRYNA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76353	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
62984	Fee-for-Service	1164484259	1164484259	1	1	REIS, GAYLE A OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CALIF CATARACT CENTER	627 E FLORIDA AVE	None	HEMET	CA	92543	4326	33	06065	33.74754249	-116.965368	Riverside County
62997	Fee-for-Service	1619025681	1619025681	1	1	RICHARDS, SCOTT B MD	9/1/1997	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50363	36	Psychiatry	0	In state provider	None	6367 ALVARADO CT	STE 305	SAN DIEGO	CA	92120	4916	37	06073	32.77665968	-117.0614306	San Diego County
62999	Fee-for-Service	1124542238	1124542238	1	1	RAMIREZ, BLANCA E LCSW	1/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
63019	Fee-for-Service	1437308541	1437308541	1	1	ROBERTS, YOLANDA Y LCSW	1/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1035 SAN PABLO AVE	SUITE 8 OFFICE 6	ALBANY	CA	94706	2277	01	06001	37.88531142	-122.2973343	Alameda County
63025	Fee-for-Service	1427236744	1427236744	1	1	ROSENTHAL, DAVID N MD	11/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81545	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
63037	Fee-for-Service	1891235727	1891235727	1	1	RAPP, GEORGE A MD INC	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123361	30	Radiology	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
63055	Fee-for-Service	1760057160	1760057160	1	1	RESPECTED HEALTHCARE SERVICE	6/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	8932 RESEDA BLVD	STE 107	NORTHRIDGE	CA	91324	3931	19	06037	34.232877	-118.5360545	Los Angeles County
63056	Fee-for-Service	1134148273	1134148273	1	1	RALPHS GROCERY COMPANY	2/13/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #160	49908 JEFFERSON ST	None	INDIO	CA	92201	9720	33	06065	33.686694	-116.2685905	Riverside County
63067	Fee-for-Service	1902557473	1902557473	1	1	RAMIREZ, ADRIAN K CRNA	1/12/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
63078	Fee-for-Service	1144330804	1144330804	1	1	RALEYS	11/13/1992	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3935 PARK DR	STE B	EL DORADO HILLS	CA	95762	4579	09	06017	38.65565873	-121.0700801	El Dorado County
63116	Fee-for-Service	1225288806	1225288806	1	1	RODRIGUEZ, ERICA D	1/6/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
63134	Fee-for-Service	1780167288	1780167288	1	1	ROSENBLATT, MELANIE J AU	5/30/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 5TH STREET	SUITE 250	SAN FRANCISCO	CA	94103	2919	38	06075	37.78207387	-122.405581	San Francisco County
63146	Fee-for-Service	1700045408	1700045408	1	1	RAJAN, RAJANI S MD	11/16/2010	390200000X	NA	Other	026	PHYSICIANS	103808	36	Psychiatry	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
63147	Fee-for-Service	1568526986	1568526986	1	1	RATH, STEPHANIE J LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
63151	Fee-for-Service	1861940835	1861940835	1	1	RAMIREZ, KAYLA L LCSW	10/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
63164	Fee-for-Service	1609244912	1609244912	1	1	RIVERA, NANCY LCSW	5/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
63188	Fee-for-Service	1518982115	1518982115	1	1	RALPHS GROCERY COMPANY	3/8/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #054	101 OLD GROVE RD	None	OCEANSIDE	CA	92057	1216	37	06073	33.22985238	-117.3066252	San Diego County
63204	Fee-for-Service	1407039563	1407039563	1	1	RUSTEM, SALIAR T MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102100	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
63294	Fee-for-Service	1245312289	1245312289	1	1	ROBINSON, MARIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W ST MARYS RD	None	TUCSON	AZ	85742	0000	00	None	32.228199	-111.0000825	Pima County
63307	Fee-for-Service	1992482434	1992482434	1	1	RATAJAC, MICHAEL PT	11/8/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
63321	Fee-for-Service	1427381391	1427381391	1	1	RAMIREZ, ELSA H NP	8/29/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
63344	Fee-for-Service	1750506739	1750506739	1	1	ROEMER, KURT R MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	40479	34	Urology and Urological Surgery	0	In state provider	None	534 E MAPLE ST	None	STOCKTON	CA	95204	6112	39	06077	37.96948196	-121.28765	San Joaquin County
63350	Fee-for-Service	1528449972	1528449972	1	1	RAIRDON, CHRIS LCSW	7/26/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
63411	Fee-for-Service	1104151711	1104151711	1	1	RAFII, ANDREA C	5/2/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
63424	Fee-for-Service	1851582266	1851582266	1	1	RYAN, SUSAN M	3/28/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	104 MARGARET LANE	#A	GRASS VALLEY	CA	95645	5261	29	06057	39.22982781	-121.046717	Nevada County
63431	Fee-for-Service	1083672000	1083672000	1	1	RYAN, CHARLES J MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83236	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63447	Fee-for-Service	1861417172	1861417172	1	1	ROJAS, CARLOS J MD	2/28/1983	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	40006	08	Family Practice	0	In state provider	None	2035 BONITA AVE	None	LA VERNE	CA	91750	4442	19	06037	34.10181432	-117.7708168	Los Angeles County
63461	Fee-for-Service	1285804708	1285804708	1	1	RUIZ-RIOS, ELENA D MD	1/8/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97254	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	3RD FL	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
63488	Fee-for-Service	1124106919	1124106919	1	1	REISMAN, MARK S MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54329	01	General Practice	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
63512	Fee-for-Service	1427323740	1427323740	1	1	RYAN, LINDSAY W MD	8/11/2017	207R00000X	NA	Other	026	PHYSICIANS	128393	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
63580	Fee-for-Service	1871117168	1871117168	1	1	RAUCH, KATHERINE M LMFT	4/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
63591	Fee-for-Service	1679150932	1679150932	1	1	ROBERTSON, ELIZABETH A MD	6/21/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186846	40	Pediatrics	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
63596	Fee-for-Service	1255769857	1255769857	1	1	ROWE, AIMEE L MD	7/30/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163302	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63655	Fee-for-Service	1003980590	1003980590	1	1	RAMAN, SRILATA MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89921	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
63713	Fee-for-Service	1154309862	1154309862	1	1	RESH, WILLIAM F MD	12/3/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	34661	07	Dermatology	0	In state provider	None	1625 E MAIN ST	None	EL CAJON	CA	92021	5211	37	06073	32.80969963	-116.9203429	San Diego County
63718	Fee-for-Service	1083672000	1083672000	1	1	RYAN, CHARLES J MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83236	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63722	Fee-for-Service	1417417643	1417417643	1	1	ROLNICK, KEVIN I MD	3/3/2023	207P00000X	NA	Other	026	PHYSICIANS	179545	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
63749	Fee-for-Service	1821053349	1821053349	1	1	RUBENSON, DAVID S MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	27729	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
63776	Fee-for-Service	1851468755	1851468755	1	1	ROTH, KATHRYN D DO	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7990	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
63796	Fee-for-Service	1497774210	1497774210	1	1	RODRIGUEZ, LARISSA V MD	5/1/2000	208800000X	NA	Other	026	PHYSICIANS	54911	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
63818	Fee-for-Service	1851463939	1851463939	1	1	ROMINES, KAREN A DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9121 FOLSOM BLVD	STE G	SACRAMENTO	CA	95826	2473	34	06067	38.559906	-121.3624125	Sacramento County
63825	Fee-for-Service	1326082165	1326082165	1	1	RANSON, NICOLA M LCSW	12/31/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2210 ENCINITAS BLVD STE	None	ENCINITAS	CA	92024	4376	37	06073	33.0379322	-117.2403774	San Diego County
63869	Fee-for-Service	1366519282	1366519282	1	1	REED, PHILLIP C MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	37419	05	Anesthesiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
63926	Fee-for-Service	1306229380	1306229380	1	1	RODRIGUEZ, JENNIFER M LMFT	4/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
63984	Fee-for-Service	1083236368	1083236368	1	1	ROGERS, CHASE N DO	8/14/2024	207L00000X	NA	Other	026	PHYSICIANS	20497	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
63986	Fee-for-Service	1396087425	1396087425	1	1	ROSENBAUM, JOSHUA I MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159679	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
63997	Fee-for-Service	1154309862	1154309862	1	1	RESH, WILLIAM F MD	12/3/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	34661	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1625 E MAIN ST	None	EL CAJON	CA	92021	5211	37	06073	32.80969963	-116.9203429	San Diego County
64002	Fee-for-Service	1669551891	1669551891	1	1	REY, MA MILDRED R MD	6/11/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39331	40	Pediatrics	0	In state provider	None	16415 COLORADO AVE	STE 308	PARAMOUNT	CA	90723	5035	19	06037	33.8853075	-118.1614695	Los Angeles County
64027	Fee-for-Service	1457924805	1457924805	1	1	ROLLE-RODA, MICHELLE M OT	10/18/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
64036	Fee-for-Service	1063971273	1063971273	1	1	ROSS, YUAN DO	1/31/2025	282N00000X	NA	Hospitals	026	PHYSICIANS	21536	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
64056	Fee-for-Service	1720344344	1720344344	1	1	READ, AMELIA K MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126436	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
64079	Fee-for-Service	1144578451	1144578451	1	1	ROBERTSON, KATHERINE S MD	3/6/2025	207R00000X	NA	Other	026	PHYSICIANS	152334	13	Neurology (M.D. only)	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
64083	Fee-for-Service	1346243375	1346243375	1	1	ROBERT WOOD JOHNSON UNIVERSI	5/7/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL, INC	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
64135	Fee-for-Service	1467291872	1467291872	1	1	RED CARPET LIVING, LLC	6/16/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
64151	Fee-for-Service	1912295445	1912295445	1	1	ROMERO, FABIAN A MD	1/26/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	162848	None	None	0	In state provider	None	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
64167	Fee-for-Service	1245785880	1245785880	1	1	ROGUS, SARAH F CRNA	6/25/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
64173	Fee-for-Service	1811024649	1811024649	1	1	RSCR CALIFORNIA, INC	7/30/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3252 FLORINDA ST	None	POMONA	CA	91767	1016	19	06037	34.10708442	-117.7556146	Los Angeles County
64186	Fee-for-Service	1225130677	1225130677	1	1	REGENTS OF THE UNIVERSITY OF	11/1/1998	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64223	Fee-for-Service	1891085940	1891085940	1	1	ROBERT A RUEF M.D	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
64229	Fee-for-Service	1427338359	1427338359	2	1	ROSE PHARMACY SF LLC	7/1/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12540 MCCANN DRIVE	None	SANTA FE SPRINGS	CA	90670	3337	19	06037	33.94677551	-118.0648305	Los Angeles County
64235	Fee-for-Service	1346583309	1346583309	1	1	RAMOS, ARLENE M LMFT	2/20/2023	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
64299	Fee-for-Service	1841547874	1841547874	1	1	RAI, ABHISHEK MD	7/1/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157870	36	Psychiatry	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
64308	Fee-for-Service	1558302612	1558302612	1	1	ROBERTS, MOLLY	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53951	08	Family Practice	0	In state provider	None	1350 S ELISEO DRIVE	#120	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
64321	Fee-for-Service	1982125696	1982125696	1	1	RICHMOND, GAYLEAH	6/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
64338	Fee-for-Service	1326404849	1326404849	1	1	ROYTER, VLADIMIR MD A	2/10/2016	193400000X	NA	Other	026	PHYSICIANS	109062	13	Neurology (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	125 MALL DR	STE 209B	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
64368	Fee-for-Service	1346243375	1346243375	1	1	ROBERT WOOD JOHNSON UNIVERSI	5/7/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TY HOSPITAL, INC	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
64381	Fee-for-Service	1790854644	1790854644	2	1	RX CONSULTANTS GRP, INC	10/9/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 S BRISTOL ST	STE 100	SANTA ANA	CA	92704	5718	30	06059	33.711876	-117.885371	Orange County
64389	Fee-for-Service	1235289257	1235289257	1	1	RAY, KATHY L LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
64438	Fee-for-Service	1467078253	1467078253	1	1	RAYAMAJHI, SACHINDRA	10/22/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
64474	Fee-for-Service	1225130677	1225130677	1	1	REGENTS OF THE UNIVERSITY OF	11/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64481	Fee-for-Service	1457445918	1457445918	1	1	RENIE, WILLIAM A MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	89074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
64498	Fee-for-Service	1902879505	1902879505	1	1	REICHMAN, ROBERT T MD	2/8/2015	208G00000X	NA	General Surgery	026	PHYSICIANS	51599	33	Thoracic Surgery	0	In state provider	None	488 E VALLEY PKWY	STE 211	ESCONDIDO	CA	92025	3370	37	06073	33.12523814	-117.0769715	San Diego County
64574	Fee-for-Service	1972595882	1972595882	1	1	RODNICK, JEFFREY M MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58325	30	Radiology	0	In state provider	None	2985 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28953746	-118.7439291	Ventura County
64578	Fee-for-Service	1780110809	1780110809	1	1	REICHELDERFER, SCOTT N MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	158956	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
64659	Fee-for-Service	1841507761	1841507761	1	1	RITZER, DORA A LMFT	7/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3616 MACDONALD AVE	STE B	RICHMOND	CA	94805	2101	07	06013	37.93390548	-122.3347749	Contra Costa County
64687	Fee-for-Service	1871988089	1871988089	1	1	REISS, DANIEL MD	9/30/2019	208M00000X	NA	Other	026	PHYSICIANS	147464	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64688	Fee-for-Service	1861765471	1861765471	1	1	ROBINSON, MICHAEL MD	6/10/2019	390200000X	NA	Other	026	PHYSICIANS	134108	02	General Surgery	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
64701	Fee-for-Service	1376601617	1376601617	1	1	RODRIGUEZ-FINSTON, MONICA M	2/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
64713	Fee-for-Service	1932317245	1932317245	1	1	ROSS, CARMEL T LMFT	1/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20200 REDWOOD RD	SUITE #6	CASTRO VALLEY	CA	94546	4312	01	06001	37.698075	-122.0739205	Alameda County
64717	Fee-for-Service	1790847747	1790847747	1	1	RAYMOND, ZINZI DO	10/14/2021	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	11621	-	NOT APPLICABLE	0	In state provider	None	1225 TRAVIS BLVD.	UNIT H	FAIRFIELD	CA	94533	4892	48	06095	38.25816997	-122.0477259	Solano County
64727	Fee-for-Service	1538110861	1538110861	1	1	RAUSCH PHYSICAL THERAPY, INC	2/18/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	30100 TOWN CENTER DR	SUITE YZ	LAGUNA NIGUEL	CA	92677	2064	30	06059	33.52590079	-117.7139676	Orange County
64752	Fee-for-Service	1154450989	1154450989	1	1	RODRIGUEZ, GINA L MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43050	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
64761	Fee-for-Service	1033529615	1033529615	1	1	RIEDERER, MICHELLE L MD	7/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148711	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64773	Fee-for-Service	1841348711	1841348711	1	1	REZVANPOUR, ATAOLAH MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36429	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
64778	Fee-for-Service	1831659960	1831659960	1	1	RULL, LOANN	4/9/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33495 FOLLMAN WAY	None	LAKE ELSINORE	CA	92530	6103	33	06065	33.63007709	-117.3441332	Riverside County
64788	Fee-for-Service	1902879505	1902879505	1	1	REICHMAN, ROBERT T MD	2/8/2015	208G00000X	NA	General Surgery	026	PHYSICIANS	51599	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	488 E VALLEY PKWY	STE 211	ESCONDIDO	CA	92025	3370	37	06073	33.12523814	-117.0769715	San Diego County
64793	Fee-for-Service	1235112988	1235112988	1	1	ROBERTS, BRIAN MD	1/1/1982	207PE0004X	NA	Other	026	PHYSICIANS	45388	08	Family Practice	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
64801	Fee-for-Service	1962732271	1962732271	1	1	RO, ANGELA MD	1/7/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171882	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
64809	Fee-for-Service	1912086059	1912086059	1	1	RABENS, RICHARD MD	6/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23247	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
64836	Fee-for-Service	1669891420	1669891420	1	1	RABELLO, MEGHAN E	7/2/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
64850	Fee-for-Service	1871089441	1871089441	1	1	RAO, SHOAIB I MD	7/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
64854	Fee-for-Service	1467690297	1467690297	1	1	ROSENTHAL, BENNET R MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43589	40	Pediatrics	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
64862	Fee-for-Service	1972595882	1972595882	1	1	RODNICK, JEFFREY M MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58325	41	Internal Medicine	0	In state provider	None	2985 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28953746	-118.7439291	Ventura County
64891	Fee-for-Service	1730495987	1730495987	1	1	RICHARDS, STEPHANIE M LMFT	7/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ATES	901 DOVER DRIVE	SUITE 239	NEWPORT BEACH	CA	92660	5515	30	06059	33.62418668	-117.9053624	Orange County
64949	Fee-for-Service	1316526551	1316526551	1	1	RIVARD, SAGE	8/17/2024	207P00000X	NA	Other	026	PHYSICIANS	20966	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
64976	Fee-for-Service	1659326874	1659326874	1	1	RINEHART, JOSEPH B MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101987	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
65003	Fee-for-Service	1962952382	1962952382	1	1	RYAN, CHRISTINE LCSW	9/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
65021	Fee-for-Service	1447273446	1447273446	1	1	REESE, WILLIAM A PHD	6/10/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
65060	Fee-for-Service	1831659960	1831659960	1	1	RULL, LOANN	4/10/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33495 FOLLMAN WAY	None	LAKE ELSINORE	CA	92530	6103	33	06065	33.63007709	-117.3441332	Riverside County
65066	Fee-for-Service	1700498664	1700498664	1	1	ROBSON, JULIA	2/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
65082	Fee-for-Service	1114530524	1114530524	1	1	RMD SERVICES INCORPORATED	2/15/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3515 FARM BUREAU CT	None	CONCORD	CA	94519	1707	07	06013	37.98215417	-122.0130851	Contra Costa County
65093	Fee-for-Service	1598913980	1598913980	1	1	ROCHON, PAUL J MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
65097	Fee-for-Service	1285807693	1285807693	1	1	RO, THOMAS K MD	8/20/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	91769	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
65124	Fee-for-Service	1164602710	1164602710	1	1	REZAEE, SHAHIN	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95694	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
65147	Fee-for-Service	1255627030	1255627030	1	1	RUSSELL, MEREDITH R NP	8/15/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
65196	Fee-for-Service	1053925404	1053925404	1	1	RYDQUIST, ALISON LMFT	12/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
65202	Fee-for-Service	1669608071	1669608071	1	1	ROVER, ELLIOT S	9/30/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4650 PALM AVE	None	SAN DIEGO	CA	92154	8404	37	06073	32.5839467	-117.0337851	San Diego County
65220	Fee-for-Service	1245255843	1245255843	1	1	RALPH'S GROCERY COMPANY	1/18/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #702	14440 BURBANK BLVD	None	SHERMAN OAKS	CA	91401	4823	19	06037	34.17208054	-118.447101	Los Angeles County
65277	Fee-for-Service	1114005766	1114005766	1	1	RHIM, JEAN C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54023	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
65283	Fee-for-Service	1760098990	1760098990	1	1	ROQUE, BRIANA OT	6/24/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	957 FAULKNERROAD	105	SANTA PAULA	CA	93060	9129	56	06111	34.33481551	-119.0867489	Ventura County
65325	Fee-for-Service	1497725402	1497725402	1	1	ROISMAN, JEFFREY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40506	40	Pediatrics	0	In state provider	None	222 GREEN VALLEY RD	None	FREEDOM	CA	95019	3136	44	06087	36.93777813	-121.7711905	Santa Cruz County
65331	Fee-for-Service	1295814333	1295814333	1	1	RUSSELL, THOMAS J MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67839	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
65340	Fee-for-Service	1083926703	1083926703	1	1	RAJAH, REVATHY P MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118949	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
65349	Fee-for-Service	1811481666	1811481666	1	1	RICHARDS-MAYNARD, MARIAH L L	7/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
65354	Fee-for-Service	1043293004	1043293004	1	1	RICHARD, MATTHEW G MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
65380	Fee-for-Service	1316969165	1316969165	1	1	RASMUSSEN, THOMAS MD	8/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	31136	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
65387	Fee-for-Service	1003920943	1003920943	1	1	RIVERSIDE NEIGHBORHOOD	3/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
65403	Fee-for-Service	1265762033	1265762033	1	1	ROBERTS, KENDALL R MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66977	40	Pediatrics	0	In state provider	None	6699 ALVARADO RD	STE 2204	SAN DIEGO	CA	92120	5253	37	06073	32.77665383	-117.0540279	San Diego County
65408	Fee-for-Service	1861558108	1861558108	1	1	ROCCUCCI, ELIZABETH J LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
65419	Fee-for-Service	1437508520	1437508520	1	1	RAYIKANTI, BENJAMIN MD	7/14/2020	207L00000X	NA	Other	026	PHYSICIANS	154996	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
65454	Fee-for-Service	1215465877	1215465877	1	1	RASHID, SARAH A DO MD	9/10/2018	207R00000X	NA	Other	026	PHYSICIANS	15612	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
65465	Fee-for-Service	1578611281	1578611281	1	1	READER, MICHELLE M PT	2/16/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 MORTON	B	PORTERVILLE	CA	93257	1940	54	06107	36.07332205	-119.0428201	Tulare County
65488	Fee-for-Service	1083200844	1083200844	1	1	REIB, LARRY D	1/29/2021	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4811 CHIPPENDALE DR	SUITE 208	SACRAMENTO	CA	95841	2555	34	06067	38.663046	-121.352472	Sacramento County
65495	Fee-for-Service	1104659150	1104659150	1	1	RISTOVIC, VANJA MD	3/27/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
65532	Fee-for-Service	1225232499	1225232499	1	1	RAMOS, MIGUEL A	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
65593	Fee-for-Service	1518084383	1518084383	1	1	ROH, HELLEN H DO	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9410	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
65605	Fee-for-Service	1144213166	1144213166	1	1	REGENTS/UCDPBG/PED CARDI	5/1/1983	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
65616	Fee-for-Service	1588811822	1588811822	1	1	ROBERT B. NEVES, M.D., INC.	4/7/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	N RAMON VALLEY	2305 CAMINO RAMON	SUITE 202	SAN RAMON	CA	94583	1396	07	06013	37.77544224	-121.9657563	Contra Costa County
65638	Fee-for-Service	1013979780	1013979780	1	1	RECINE, CARL A MD	7/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87933	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
65641	Fee-for-Service	1861760563	1861760563	1	1	ROSE, LAURENCE LMFT	1/22/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16430 VENTURA BLVD	307	ENCINO	CA	91436	2115	19	06037	34.15736278	-118.4911768	Los Angeles County
65643	Fee-for-Service	1447275045	1447275045	1	1	RALPHS GROCERY COMPANY	5/14/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE#664	1776 S VICTORIA AVE	None	VENTURA	CA	93003	6592	56	06111	34.25834074	-119.2090176	Ventura County
65646	Fee-for-Service	1922095827	1922095827	1	1	ROBERT DURNFORD	2/9/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5633 N LIDGERWOOD ST	None	SPOKANE	WA	99208	1224	00	None	47.709423	-117.406944	Spokane County
65666	Fee-for-Service	1316969165	1316969165	1	1	RASMUSSEN, THOMAS MD	8/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	31136	36	Psychiatry	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
65674	Fee-for-Service	1003920943	1003920943	1	1	RIVERSIDE NEIGHBORHOOD	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
65676	Fee-for-Service	1780957761	1780957761	1	2	REASONER, STEPHEN L MFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
65701	Fee-for-Service	1154789477	1154789477	1	1	REIMANN, BRITTANY K LMFT	9/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
65704	Fee-for-Service	1174526677	1174526677	1	1	RENZO M CATALDO MD	2/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 N 2ND ST	STE 118	SCOTTSDALE	AZ	85251	0000	00	None	33.491178	-111.92427	Maricopa County
65713	Fee-for-Service	1568664597	1568664597	1	1	RACUSIN, ADAM W MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129320	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO ROAD	SUITE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
65727	Fee-for-Service	1942482187	1942482187	1	1	RICHARDS, DOUGLAS A	5/1/1995	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9930 TALBERT AVE	2ND FLOOR	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
65771	Fee-for-Service	1841633591	1841633591	1	1	RAMSEY, ALLISON MD	5/20/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	142175	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
65815	Fee-for-Service	1669775698	1669775698	1	1	RATSIU, JOANA M MD	5/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102456	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92359	2804	36	06071	34.049547	-117.264078	San Bernardino County
65842	Fee-for-Service	1104591288	1104591288	1	1	RUELAS, CRISTINA M OT	5/31/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
65849	Fee-for-Service	1861855686	1861855686	1	1	REDDY, SHRAVANI MD	8/2/2023	207R00000X	NA	Other	026	PHYSICIANS	162069	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
65853	Fee-for-Service	1780957761	1780957761	1	1	REASONER, STEPHEN L MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84804	-	NOT APPLICABLE	0	In state provider	None	15307 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.2319353	-118.4656916	Los Angeles County
65857	Fee-for-Service	1992789861	1992789861	1	1	RAO, NARASIMHA R MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40464	41	Internal Medicine	0	In state provider	None	1180 N INDIAN CANYON DR	STE W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
65963	Fee-for-Service	1003920943	1003920943	1	1	RIVERSIDE NEIGHBORHOOD	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
65977	Fee-for-Service	1235592932	1235592932	1	1	RUCH, KATY L MD	10/15/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	150765	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
65978	Fee-for-Service	1891290029	1891290029	1	1	RABEI, RANA MD	6/25/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	167043	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
66000	Fee-for-Service	1912987934	1912987934	1	1	RAKOCZY, KARA S MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82171	41	Internal Medicine	0	In state provider	None	3010 COLBY ST	#221	BERKELEY	CA	94705	2056	01	06001	37.85492078	-122.2576101	Alameda County
66011	Fee-for-Service	1588612634	1588612634	1	1	RIVAS, HOMERO MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53953	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66037	Fee-for-Service	1437388147	1437388147	1	1	REINSTADLER, AMY M MD	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109147	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
66049	Fee-for-Service	1508015116	1508015116	1	1	ROBINSON, ATHENA PHD	10/29/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66060	Fee-for-Service	1841633591	1841633591	1	1	RAMSEY, ALLISON MD	5/20/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	142175	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
66069	Fee-for-Service	1023546637	1023546637	1	1	RUIZ, ANGELICA LMFT	7/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
66119	Fee-for-Service	1699758003	1699758003	2	1	REEDLEY COMMUNITY HOSPITAL	12/12/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	810 E D STREET	None	LEMOORE	CA	93245	9545	16	06031	36.30069303	-119.7694815	Kings County
66123	Fee-for-Service	1871174391	1871174391	1	1	RANGEL ROSALES, ENANYELI MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
66144	Fee-for-Service	1992789861	1992789861	1	1	RAO, NARASIMHA R MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40464	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1180 N INDIAN CANYON DR	STE W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
66171	Fee-for-Service	1265752810	1265752810	1	1	ROSS, KENNETH G MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124793	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
66192	Fee-for-Service	1033278304	1033278304	1	1	RHEE, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
66223	Fee-for-Service	1861099400	1861099400	1	1	ROLLINS, CHRISTINA J CCC-SLP	1/5/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CAMARILLO RANCH ROAD	SUITE 209	CAMARILLO	CA	93012	5903	56	06111	34.220943	-119.0186825	Ventura County
66242	Fee-for-Service	1316626492	1316626492	1	1	RESILIENCE INTEGRATIVE	3/25/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ESS	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
66251	Fee-for-Service	1003920943	1003920943	1	1	RIVERSIDE NEIGHBORHOOD	1/16/1997	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
66266	Fee-for-Service	1194911982	1194911982	1	1	RAMEZANI, AMIR PHD	9/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
66269	Fee-for-Service	1952489569	1952489569	1	1	RAZAVI, SUSAN C MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50519	05	Anesthesiology	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
66289	Fee-for-Service	1700832508	1700832508	1	1	RAWLINGS, RICHARD DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 N MESA DR	None	MESA	AZ	85201	5914	00	None	33.424767	-111.8219445	Maricopa County
66304	Fee-for-Service	1184206427	1184206427	1	1	RAMOS, RUTH A MD	11/9/2024	207P00000X	NA	Other	026	PHYSICIANS	183992	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
66359	Fee-for-Service	1619535234	1619535234	1	1	RECOVERY INNOVATIONS INC	9/7/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	47915 OASIS ST	STE C	INDIO	CA	92201	6950	33	06065	33.701508	-116.220908	Riverside County
66382	Fee-for-Service	1912217837	1912217837	1	1	RISARD, FREDERICK	6/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
66398	Fee-for-Service	1104882984	1104882984	1	1	ROBERSON, FLOYD MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	47778	05	Anesthesiology	0	In state provider	None	320 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
66402	Fee-for-Service	1134142979	1134142979	1	1	ROBERT R GREENLEE MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
66409	Fee-for-Service	1699758003	1699758003	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	810 E D STREET	None	LEMOORE	CA	93245	9545	16	06031	36.30069303	-119.7694815	Kings County
66413	Fee-for-Service	1871174391	1871174391	1	1	RANGEL ROSALES, ENANYELI MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
66464	Fee-for-Service	1194803858	1194803858	1	1	RAIMUNDO, ROGER JOHN MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71548	01	General Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
66479	Fee-for-Service	1609975416	1609975416	1	1	ROGGEVEEN, MARK J MD	11/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	0000	00	None	47.44115887	-122.2138846	King County
66482	Fee-for-Service	1396002382	1396002382	1	1	RAFFETTO, KATHERINE A NP	8/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
66514	Fee-for-Service	1942488895	1942488895	1	1	ROSE M LO VERME	11/1/2008	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	28329 VISTA DEL RIO DR	None	VALENCIA	CA	91353	3079	19	06037	34.45283166	-118.5638726	Los Angeles County
66522	Fee-for-Service	1790971711	1790971711	1	1	RAWDAN, RABAB M MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108872	08	Family Practice	0	In state provider	None	1645 PINE ST	None	REDDING	CA	96001	1018	45	06089	40.58295477	-122.3888377	Shasta County
66529	Fee-for-Service	1316626492	1316626492	1	1	RESILIENCE INTEGRATIVE	3/25/2024	261QM1300X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ESS	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
66553	Fee-for-Service	1528452117	1528452117	1	1	ROMANO-KELLY, RUSSELL MD	6/14/2021	207L00000X	NA	Other	026	PHYSICIANS	148433	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
66574	Fee-for-Service	1932138534	1932138534	1	1	RAY, LINDA M NP	8/21/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66587	Fee-for-Service	1922050525	1922050525	1	1	ROTH, RAUL FERNANDO MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56414	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	50 ALESSANDRO PL	STE 200	PASADENA	CA	91105	4002	19	06037	34.13101049	-118.151532	Los Angeles County
66600	Fee-for-Service	1427276211	1427276211	1	1	RIPPLINGER, MATTHEW C MD	4/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
66611	Fee-for-Service	1376525840	1376525840	1	2	RICHARD P CARR PHYSICAL THER	11/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	500 E CALAVERAS BLVD	SUITE 112	MILPITAS	CA	95035	7703	43	06085	37.43274015	-121.8967534	Santa Clara County
66698	Fee-for-Service	1699758003	1699758003	2	1	REEDLEY COMMUNITY HOSPITAL	12/18/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	810 E D STREET	None	LEMOORE	CA	93245	9545	16	06031	36.30069303	-119.7694815	Kings County
66732	Fee-for-Service	1881915155	1881915155	1	1	RBR MANAGEMENT LLC	7/12/2018	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	None	91 CORPORATE PARK DR	SUITE 120	HENDERSON	NV	89074	8713	00	None	36.03645893	-115.035814	Clark County
66759	Fee-for-Service	1740598523	1740598523	1	1	RASLAN,OSAMA ANWAR AHMED MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141158	42	Nuclear Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
66779	Fee-for-Service	1114456936	1114456936	1	1	REYES-MONCADA, JASMIN D MD	10/18/2023	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	174709	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
66802	Fee-for-Service	1942488895	1942488895	1	1	ROSE M LO VERME	11/1/2008	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	28329 VISTA DEL RIO DR	None	VALENCIA	CA	91353	3079	19	06037	34.45283166	-118.5638726	Los Angeles County
66806	Fee-for-Service	1295793859	1295793859	1	1	ROSALES, CARLOS A MD	12/4/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	30215	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2888 LONG BEACH BLVD	STE 165	LONG BEACH	CA	90806	1561	19	06037	33.809706	-118.189343	Los Angeles County
66812	Fee-for-Service	1568932549	1568932549	1	1	ROOP, BABITA RCP	12/30/2018	2279G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
66840	Fee-for-Service	1588710487	1588710487	1	1	RECKSON, MARK W MD	2/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	75490	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
66845	Fee-for-Service	1659763480	1659763480	2	1	RLZ HEALTHCARE GROUP LLC	10/10/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12302 RAMBLER AVE	None	BAKERSFIELD	CA	93312	5663	15	06029	35.40670845	-119.138931	Kern County
66861	Fee-for-Service	1013968171	1013968171	1	1	RIGLER, MARK L MD	8/20/1994	207L00000X	NA	Other	026	PHYSICIANS	53267	01	General Practice	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
66864	Fee-for-Service	1689616369	1689616369	1	1	RAPETTI, EDWARD MD	6/30/1988	207P00000X	NA	Other	026	PHYSICIANS	42129	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10445 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7323	19	06037	34.259094	-118.5023365	Los Angeles County
66869	Fee-for-Service	1043656077	1043656077	1	1	ROSS, COREE A LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
66937	Fee-for-Service	1235315953	1235315953	1	1	ROHSKOTHEN, ELIZABETH M LMFT	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
66961	Fee-for-Service	1740660778	1740660778	1	1	RAGHEB, MINA G	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154727	41	Internal Medicine	0	In state provider	None	2 WEST FERN STREET	None	REDLANDS	CA	92373	9021	36	06071	34.05016907	-117.1793443	San Bernardino County
66982	Fee-for-Service	1801425012	1801425012	1	1	ROBERSON, ASHLEE M	6/19/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176522	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
66983	Fee-for-Service	1699758003	1699758003	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	810 E D STREET	None	LEMOORE	CA	93245	9545	16	06031	36.30069303	-119.7694815	Kings County
67030	Fee-for-Service	1932694841	1932694841	1	1	REDDY, SHREYA MD	10/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174151	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67048	Fee-for-Service	1740598523	1740598523	1	1	RASLAN,OSAMA ANWAR AHMED MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141158	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
67065	Fee-for-Service	1114978616	1114978616	1	1	REYNOLDS JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 ST CLAIR BLDG 7	STE 17	HUNTSVILLE	AL	35801	0000	00	None	34.72176748	-86.5872675	Madison County
67067	Fee-for-Service	1598782203	1598782203	1	1	REISFELD, DEBORAH A LMFT	9/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
67068	Fee-for-Service	1386759199	1386759199	1	1	RAJAN, JAYANT V MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121593	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67110	Fee-for-Service	1538459961	1538459961	1	1	RANA, SHRADDHA MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127393	33	Thoracic Surgery	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
67113	Fee-for-Service	1740493311	1740493311	1	1	RODRIGUEZ, JUANITA C LCSW	8/28/2018	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	440 N MOUNTAIN AVE	SUITE 201J	UPLAND	CA	91786	7274	36	06071	34.09896749	-117.6700715	San Bernardino County
67180	Fee-for-Service	1649571720	1649571720	1	1	ROLPH, KELLIE K NP	11/2/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
67221	Fee-for-Service	1073502654	1073502654	1	1	REDER, C S MD INC	1/11/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	VALLEY EYE INSTITUTE MED	1680 E HERNDON AVE	STE 101	FRESNO	CA	93720	3305	10	06019	36.83756052	-119.7571005	Fresno County
67256	Fee-for-Service	1649222340	1649222340	1	2	RAO, APARNA R MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54275	40	Pediatrics	0	In state provider	None	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
67298	Fee-for-Service	1609889278	1609889278	1	1	REALMOTO, ROBERT P MD	1/31/1983	207R00000X	NA	Other	026	PHYSICIANS	50744	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
67300	Fee-for-Service	1851650469	1851650469	1	1	RUSSELL, ALECIA N DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
67301	Fee-for-Service	1174662555	1174662555	1	1	REGENTS OF THE UNIVERSITY	1/1/1982	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
67337	Fee-for-Service	1922560010	1922560010	1	1	RYBKA, DENYS MD	9/25/2023	208M00000X	NA	Other	026	PHYSICIANS	179457	None	None	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
67343	Fee-for-Service	1497844088	1497844088	1	1	RABINOWITZ, SANUEL C MD	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	45651	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
67355	Fee-for-Service	1386759199	1386759199	1	1	RAJAN, JAYANT V MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121593	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67368	Fee-for-Service	1326182361	1326182361	1	1	RICHARDSON, AQUILA	12/5/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
67406	Fee-for-Service	1760878995	1760878995	1	1	RODRIGUEZ ARAIZA, GLADYS M	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147390	41	Internal Medicine	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67433	Fee-for-Service	1003831603	1003831603	1	1	RALPHS GROCERY COMPANY	6/21/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #136	2661 GREEN RIVER RD	None	CORONA	CA	92882	7428	33	06065	33.87058838	-117.622429	Riverside County
67473	Fee-for-Service	1467585984	1467585984	1	1	READLE, BETTY L LMFT	6/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1212 HIGH ST	SUITE 3	AUBURN	CA	95603	5015	31	06061	38.89542596	-121.0739549	Placer County
67488	Fee-for-Service	1891299756	1891299756	1	1	RIDOUT, NICHOLAS P MD	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
67512	Fee-for-Service	1700840345	1700840345	1	1	REDDY, NITHIN C MD	12/13/2007	204D00000X	NA	Other	026	PHYSICIANS	83846	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
67561	Fee-for-Service	1477532273	1477532273	1	1	REGAN, MAUREEN M MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61154	41	Internal Medicine	0	In state provider	None	690 GUZZI LANE STE C	None	SONORA	CA	95370	5292	55	06109	37.97649546	-120.3719077	Tuolumne County
67562	Fee-for-Service	1710649710	1710649710	1	1	RH COMMUNITY BUILDERS LP.	4/17/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1804 OLIVE AVE	None	FRESNO	CA	93728	2619	10	06019	36.75748931	-119.8324108	Fresno County
67565	Fee-for-Service	1427303999	1427303999	1	1	REICHERT, ELIZABETH L PHD	10/2/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
67613	Fee-for-Service	1003943838	1003943838	1	1	RSCR CALIFORNIA, INC	10/5/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1361 N BRIAN AVE	None	AZUSA	CA	91702	1802	19	06037	34.14565616	-117.9161736	Los Angeles County
67624	Fee-for-Service	1487851523	1487851523	1	1	RATHWELL, JENNIFER Z	5/4/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
67668	Fee-for-Service	1518205863	1518205863	1	1	REGENTS OF THE UNIVERSITY OF	7/25/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	S MEDICAL CENTER	2315 STOCKTON BLVD	RM 1P175	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
67672	Fee-for-Service	1679566764	1679566764	1	2	REGENTS/UCDPBG/PM&R	9/30/2024	208100000X	NA	Physical Medicine and Rehabilitation	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
67729	Fee-for-Service	1437110400	1437110400	1	1	ROSENBERG, ROBERT D MD	4/30/1988	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43166	36	Psychiatry	0	In state provider	None	16660 PARAMOUNT BLVD	STE 309	PARAMOUNT	CA	90723	5459	19	06037	33.882723	-118.1599535	Los Angeles County
67756	Fee-for-Service	1477751584	1477751584	1	1	RICHARD W RITTENHOUSE, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
67778	Fee-for-Service	1982916375	1982916375	1	1	ROBERTS, KATHERINE D MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112985	40	Pediatrics	0	In state provider	None	777 CORPORATE DRIVE	SUITE 250	LADERA RANCH	CA	92694	2137	30	06059	33.557436	-117.6293075	Orange County
67784	Fee-for-Service	1518102060	1518102060	1	1	ROA, ROBERT B MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
67792	Fee-for-Service	1467213207	1467213207	1	1	RESILIENCE RISING BEHAVIORAL	1/6/2025	163WA0400X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HEALTH, LLC	12362 BEACH BOULEVARD	STE 30-31	STANTON	CA	90680	3935	30	06059	33.78298855	-117.9927453	Orange County
67839	Fee-for-Service	1518094812	1518094812	1	1	RSCR CALIFORNIA, INC	8/2/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	321 E 11TH ST	None	AZUSA	CA	91702	2100	19	06037	34.14083552	-117.90414	Los Angeles County
67851	Fee-for-Service	1558755512	1558755512	1	1	REPPART, CHRISTIE L LCSW	2/17/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
67896	Fee-for-Service	1679598270	1679598270	1	1	RALPHS GROCERY COMPANY	5/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #178	6290 E PACIFIC COAST HWY	None	LONG BEACH	CA	90803	4801	19	06037	33.76143892	-118.1142348	Los Angeles County
67897	Fee-for-Service	1083065379	1083065379	1	1	RODRIGUEZ, RICHARD A CCC-SP	9/11/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
67904	Fee-for-Service	1821086182	1821086182	1	1	ROHILLA, ARIF M MD	2/10/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	149413	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E205	PALM SPRINGS	CA	92262	4402	33	06065	33.839505	-116.5455735	Riverside County
67961	Fee-for-Service	1679566764	1679566764	1	2	REGENTS/UCDPBG/PM&R	6/3/2020	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
67968	Fee-for-Service	1427336759	1427336759	1	1	RASANIA, SAPNA S MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151914	83	Rheumatology	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
67969	Fee-for-Service	1114377140	1114377140	1	1	RANDHAWA, JASMEEN MD	2/4/2021	207R00000X	NA	Other	026	PHYSICIANS	159658	None	None	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
67982	Fee-for-Service	1790850808	1790850808	1	1	RODNEY-ZARRI, MARY	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
67994	Fee-for-Service	1902871494	1902871494	1	1	RAPPAPORT, AVIDAN MD	3/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	333 WEST HAMPDEN AVE	SUITE 600	ENGLEWOOD	CO	80110	2336	00	None	39.65335027	-104.9924183	Arapahoe County
68030	Fee-for-Service	1720046295	1720046295	1	1	RANDALL, JEFFREY B MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	68717	14	Neurological Surgery	0	In state provider	None	20055 LAKE CHABOT RD	STE 110	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
68043	Fee-for-Service	1265591903	1265591903	1	1	ROFMAN, JAKE W MD	2/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89226	08	Family Practice	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
68047	Fee-for-Service	1326063199	1326063199	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
68128	Fee-for-Service	1235496001	1235496001	1	1	RAJARATNAM, DAVID R MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127228	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
68136	Fee-for-Service	1376817684	1376817684	1	1	RIECKENBERG, CHAD B PT	6/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5533 W HILLSDALE AVE	SUITE 'A'	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
68139	Fee-for-Service	1659364677	1659364677	1	1	REGENTS/UCDPBG/ANESTHESI	4/11/2022	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
68141	Fee-for-Service	1770242943	1770242943	1	2	RISE ABOVE & BEYOND EMOTIONS	2/18/2022	172A00000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	N	905 PRAIRIE AVE	#B	INGLEWOOD	CA	90301	4136	19	06037	33.9523167	-118.3440211	Los Angeles County
68156	Fee-for-Service	1972964880	1972964880	1	1	RANSOHOFF, KATHERINE J MD	6/25/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	150430	07	Dermatology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
68159	Fee-for-Service	1497369227	1497369227	1	1	RIOS, JULIA PHD	1/17/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68185	Fee-for-Service	1699953380	1699953380	1	1	RIZKALLA, NICOLE A MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98426	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
68200	Fee-for-Service	1427244771	1427244771	1	2	RAKE, ALYSSA J MD	12/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90734	40	Pediatrics	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
68246	Fee-for-Service	1679566764	1679566764	1	2	REGENTS/UCDPBG/PM&R	5/1/1999	208100000X	NA	Physical Medicine and Rehabilitation	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
68249	Fee-for-Service	1720547888	1720547888	1	1	RAHIMIAN, RAMITA	1/24/2024	207L00000X	NA	Other	026	PHYSICIANS	182006	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
68253	Fee-for-Service	1144207002	1144207002	1	1	RHODES, SHANE D DPM	3/1/1998	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1560 E CHEVY CHASE DR	STE 330	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
68265	Fee-for-Service	1447224829	1447224829	1	1	ROSENTHAL, DAVID W MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53400	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
68282	Fee-for-Service	1376148882	1376148882	1	1	RUSCA, CASEY M PSYD	2/19/2024	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
68283	Fee-for-Service	1922048958	1922048958	1	1	RAMAN,KRISHNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21720 KINGLAND BLVD	None	KATY	TX	77450	0000	00	None	29.77505051	-95.7460995	Harris County
68334	Fee-for-Service	1326063199	1326063199	2	1	REEDLEY COMMUNITY HOSPITAL	9/27/2012	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
68360	Fee-for-Service	1497078752	1497078752	1	1	RAFIQUE, ASIM MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118312	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
68363	Fee-for-Service	1366528275	1366528275	1	1	REVESZ, THOMAS I MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52294	08	Family Practice	0	In state provider	None	5444 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3106	34	06067	38.661678	-121.337622	Sacramento County
68380	Fee-for-Service	1740357946	1740357946	1	1	ROBINSON, DAVID L MD	8/31/1995	2085R0204X	NA	Other	026	PHYSICIANS	69074	30	Radiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
68400	Fee-for-Service	1679918395	1679918395	1	2	REGENTS OF THE UNIVERSITY OF	6/17/2020	2251S0007X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	1250 16TH STREET	STE 2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
68413	Fee-for-Service	1225145626	1225145626	1	1	REZKALLA, MAHER A MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55000	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
68417	Fee-for-Service	1518200021	1518200021	1	1	RAGHAVAN, SIDDHARTH R MD	7/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152961	41	Internal Medicine	0	In state provider	None	1020 29TH ST	SUITE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
68428	Fee-for-Service	1659364677	1659364677	1	1	REGENTS/UCDPBG/ANESTHESI	5/1/1983	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
68442	Fee-for-Service	1437658333	1437658333	1	1	ROMERO, RITA LMFT	5/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
68447	Fee-for-Service	1023033032	1023033032	1	1	RAGLAND, JOHN D	5/12/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
68471	Fee-for-Service	1821596693	1821596693	1	1	RJHH ACTIVE HEARING INC	1/24/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	642 3RD AVE	UNIT G	CHULA VISTA	CA	91910	5727	37	06073	32.62949684	-117.0753169	San Diego County
68502	Fee-for-Service	1194487462	1194487462	1	1	REBURIANO, MARIE FE NP	4/12/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
68513	Fee-for-Service	1477948263	1477948263	1	1	RITCHIE, ANNE M MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147689	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68562	Fee-for-Service	1265020929	1265020929	1	1	RMJ MEDICAL INC.	2/22/2021	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8460 NUEVO AVENUE	7	FONTANA	CA	92335	3824	36	06071	34.10006903	-117.4369875	San Bernardino County
68605	Fee-for-Service	1306932462	1306932462	1	1	RIVERO, NIURKA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78521	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
68620	Fee-for-Service	1326063199	1326063199	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
68645	Fee-for-Service	1750993713	1750993713	1	1	RIZE HOSPICE	8/31/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9778 KATELLA AVE	STE 106	ANAHEIM	CA	92804	6446	30	06059	33.80288252	-117.9628155	Orange County
68654	Fee-for-Service	1831914951	1831914951	1	1	RESENDIZ, NATHALIE	3/14/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
68655	Fee-for-Service	1497078752	1497078752	1	1	RAFIQUE, ASIM MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118312	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
68668	Fee-for-Service	1952599128	1952599128	1	1	REBECA MOYES	11/1/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 ROUND VALLEY DR	None	PARK CITY	UT	84060	7552	00	None	40.68736413	-111.4675063	Summit County
68688	Fee-for-Service	1679918395	1679918395	1	2	REGENTS OF THE UNIVERSITY OF	10/29/2015	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP	1250 16TH STREET	STE 2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
68704	Fee-for-Service	1548756588	1548756588	1	1	REDDY, ARAVIND DO	8/30/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	188357	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
68715	Fee-for-Service	1407827371	1407827371	1	1	ROSPLOCK, THOMAS M DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHAPEL CHIROPRACTIC	724 E CHAPEL ST	None	SANTA MARIA	CA	93454	4524	42	06083	34.9542289	-120.4253959	Santa Barbara County
68716	Fee-for-Service	1659364677	1659364677	1	1	REGENTS/UCDPBG/ANESTHESI	2/28/2017	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
68722	Fee-for-Service	1689083438	1689083438	1	1	RENSEL, MICHELLE NP	6/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	07	06013	37.88758326	-122.1181419	Contra Costa County
68757	Fee-for-Service	1871936120	1871936120	1	1	RUNCIE, ELIZABETH A DO	8/8/2017	390200000X	NA	Other	026	PHYSICIANS	15574	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68759	Fee-for-Service	1821031477	1821031477	1	1	RICHARD LICHENSTEIN M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22 S GREENE ST	None	BALTIMORE	MD	21201	1544	00	None	39.28815298	-76.62364605	Baltimore city
68764	Fee-for-Service	1407831118	1407831118	1	1	RIVIERA NURSING &	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CONVALESCENT HOME INC	8203 TELEGRAPH RD	None	PICO RIVERA	CA	90660	4905	19	06037	33.96690494	-118.1153549	Los Angeles County
68831	Fee-for-Service	1659969962	1659969962	1	1	RAY, RITA D NP	6/14/2024	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	95 3RD ST	STE 293	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
68841	Fee-for-Service	1427039932	1427039932	1	1	RYU, JEFFREY Y MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2420 PROFESSIONAL COURT	SUITE 150	LAS VEGAS	NV	89128	0837	00	None	36.203769	-115.2550845	Clark County
68844	Fee-for-Service	1922150721	1922150721	1	1	RANGINWALA, MUHAMMAD MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88232	38	Geriatrics	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
68893	Fee-for-Service	1306932462	1306932462	1	1	RIVERO, NIURKA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78521	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
68906	Fee-for-Service	1649708397	1649708397	1	1	RIOS-STEED, GRETA E MD	7/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166356	None	None	0	In state provider	None	13925 INDIAN ST	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
68914	Fee-for-Service	1801028642	1801028642	2	1	REYES, TRINH T LCSW	8/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15399 EDGEMOOR ST	None	SAN LEANDRO	CA	94579	2009	01	06001	37.68191318	-122.1496838	Alameda County
68917	Fee-for-Service	1649950759	1649950759	1	1	RENFER, MARCY	2/26/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
68919	Fee-for-Service	1396717450	1396717450	1	1	ROSE, ROBERT M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	30267	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	414 N CAMDEN DR	STE 1100	BEVERLY HILLS	CA	90210	4517	19	06037	34.06880486	-118.4042308	Los Angeles County
68925	Fee-for-Service	1184656092	1184656092	1	1	RICCI, STEPHANIE T MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68435	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19582 BEACH BLVD	STE 206	HUNTINGTON BEACH	CA	92648	5950	30	06059	33.67831649	-117.9885198	Orange County
68932	Fee-for-Service	1750993713	1750993713	1	1	RIZE HOSPICE	8/31/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9778 KATELLA AVE	STE 106	ANAHEIM	CA	92804	6446	30	06059	33.80288252	-117.9628155	Orange County
68953	Fee-for-Service	1699717793	1699717793	1	1	RICHARD AUGUSTUS	7/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
68963	Fee-for-Service	1295015410	1295015410	1	1	RAJGARHIA, AYAN MD	2/1/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	192366	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
68983	Fee-for-Service	1801942156	1801942156	1	2	RINSKY, LAWRENCE A MD	1/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	23548	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
69005	Fee-for-Service	1659364677	1659364677	1	1	REGENTS/UCDPBG/ANESTHESI	2/8/2018	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
69034	Fee-for-Service	1184987034	1184987034	1	1	RASTAGAR, SULIMAN DO	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13447	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
69046	Fee-for-Service	1326156233	1326156233	1	1	ROBLES, DAVID T MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105427	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
69049	Fee-for-Service	1548349830	1548349830	1	1	REGENTS/UCDPBG/DAVIS MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOC	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
69073	Fee-for-Service	1912931395	1912931395	1	1	RUBIN, ZACHARY A MD	7/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96490	41	Internal Medicine	0	In state provider	None	200 MED PLAZA ST	#365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
69080	Fee-for-Service	1043593098	1043593098	1	1	ROOT, MATTHEW S DO	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12283	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
69089	Fee-for-Service	1609952118	1609952118	1	1	RAJA, SARALA MD	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72518	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
69096	Fee-for-Service	1063040384	1063040384	1	1	ROCHE, CHELSEA E NP	5/12/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
69114	Fee-for-Service	1720036312	1720036312	1	1	RUBIN, J P MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55160	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
69121	Fee-for-Service	1508857590	1508857590	1	1	RAMOSO, JOCELYN R MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139991	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
69135	Fee-for-Service	1922150721	1922150721	1	1	RANGINWALA, MUHAMMAD MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88232	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
69149	Fee-for-Service	1144250796	1144250796	1	1	ROSENFELD, MITCHEL E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE EMERGENCY GROUP INC	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
69154	Fee-for-Service	1457521049	1457521049	1	1	RICOKAAINOA, DIANN LCSW	8/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
69177	Fee-for-Service	1942559661	1942559661	1	1	RUBIO, ADRIANA LCSW	11/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
69205	Fee-for-Service	1396717450	1396717450	1	1	ROSE, ROBERT M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	30267	41	Internal Medicine	0	In state provider	None	414 N CAMDEN DR	STE 1100	BEVERLY HILLS	CA	90210	4517	19	06037	34.06880486	-118.4042308	Los Angeles County
69207	Fee-for-Service	1073751962	1073751962	1	1	RATHOD, ANKIT D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114382	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2210 E ILLINOIS AVE	STE 301	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
69234	Fee-for-Service	1891766911	1891766911	1	1	ROLL, JOHN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
69236	Fee-for-Service	1992818124	1992818124	1	1	ROSEMAN, MARGOT L MD	7/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49610	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
69237	Fee-for-Service	1043331820	1043331820	1	1	RINOIE, CHUGO DPM CORP	6/20/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	301 W HUNTINGTON DR	STE 300	ARCADIA	CA	91007	1527	19	06037	34.13481053	-118.0425638	Los Angeles County
69265	Fee-for-Service	1902160914	1902160914	1	1	RAO, SIRISHA A MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141626	05	Anesthesiology	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
69272	Fee-for-Service	1194796367	1194796367	1	1	ROBBINS, DANIEL C DO	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7917	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
69338	Fee-for-Service	1891872727	1891872727	1	1	RICHARDS, JANICE E MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56740	40	Pediatrics	0	In state provider	None	1235 OSOS ST	None	SAN LUIS OBISPO	CA	93401	3600	40	06079	35.27979518	-120.6596361	San Luis Obispo County
69355	Fee-for-Service	1124203583	1124203583	1	1	ROGERS, NICHOLAS A MD	1/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112189	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	530 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3723	19	06037	34.02866849	-118.2597481	Los Angeles County
69360	Fee-for-Service	1386862118	1386862118	1	1	REZNIKOVA-STEINWAY, SVETLANA	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	MD	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
69366	Fee-for-Service	1912931395	1912931395	1	1	RUBIN, ZACHARY A MD	7/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96490	77	Infectious Disease	0	In state provider	None	200 MED PLAZA ST	#365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
69376	Fee-for-Service	1245259647	1245259647	1	1	RODRIGUEZ, RUSSELL G MD	3/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84370	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
69383	Fee-for-Service	1386657187	1386657187	1	1	REYNALDO, DAVID A MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55774	01	General Practice	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5616	37	06073	32.63367609	-117.0769202	San Diego County
69425	Fee-for-Service	1740341239	1740341239	1	1	RIDDLE, EUGENE A PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
69460	Fee-for-Service	1730535824	1730535824	1	1	R2 MARKETING & CONSULTING LL	12/23/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	19800 MACARTHUR BLVD	SUITE 300	IRVINE	CA	92612	2421	30	06059	33.65468449	-117.8616578	Orange County
69463	Fee-for-Service	1447329883	1447329883	1	1	ROBINSON, MICHAEL J MD	10/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187582	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
69477	Fee-for-Service	1083762892	1083762892	1	1	RAVAL, NARENDRA MD	3/31/1990	207U00000X	NA	Other	026	PHYSICIANS	29727	22	Pathology (M.D. only)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
69478	Fee-for-Service	1447539572	1447539572	1	1	REYNOLDS,TOUSSAINT	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVENUE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
69506	Fee-for-Service	1275544710	1275544710	1	1	RANSOME, SUSAN S MD	3/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	77170	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
69520	Fee-for-Service	1639350846	1639350846	1	1	RUMBLE, NATALIE M MD	10/11/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	101373	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
69539	Fee-for-Service	1366121576	1366121576	1	1	RASMUSSEN, JESSE CPO	8/1/2023	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1530 SOUTH SINCLAIR ST	None	ANAHEIM	CA	92806	5933	30	06059	33.810246	-117.8800715	Orange County
69578	Fee-for-Service	1477964427	1477964427	1	1	ROLLE, PHAREZ D MD	6/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143415	36	Psychiatry	0	In state provider	None	1686 BARTON RD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
69626	Fee-for-Service	1457491904	1457491904	1	1	RANDALL DAVAULT	11/3/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1405 E KIRK ST	None	HUGO	OK	74743	3603	00	None	34.0116645	-95.4971505	Choctaw County
69640	Fee-for-Service	1518092204	1518092204	1	1	REED, ANNMARIE H LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44918	-	NOT APPLICABLE	0	In state provider	None	1625 WEST OLYMPIC BLVD	SUITE 600	LOS ANGELES	CA	90015	3809	19	06037	34.04957404	-118.2750068	Los Angeles County
69663	Fee-for-Service	1679819742	1679819742	1	1	REEDLEY COMMUNITY HOSPITAL	12/10/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3567 W MOUNT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43078218	-119.8620732	Fresno County
69672	Fee-for-Service	1386657187	1386657187	1	1	REYNALDO, DAVID A MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55774	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5616	37	06073	32.63367609	-117.0769202	San Diego County
69687	Fee-for-Service	1356334452	1356334452	1	2	REGENTS/UCDPBG/PED HEMOC	5/19/2023	2080P0207X	NA	Hematology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
69715	Fee-for-Service	1376110999	1376110999	1	1	RIVERBANK UNIFIED SCHOOL	1/1/2022	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	6715 7TH ST	None	RIVERBANK	CA	95367	2345	50	06099	37.7367511	-120.928921	Stanislaus County
69725	Fee-for-Service	1790095164	1790095164	1	1	RHODES, ANGELA C LMFT	7/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1274 CENTER COURT DR	STE 107	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
69731	Fee-for-Service	1932382447	1932382447	1	1	ROTMENSCH, SIEGFRIED MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102099	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
69744	Fee-for-Service	1366533226	1366533226	1	1	ROTHROCK, STEVEN G. MD	10/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9400 TURKEY LAKE RD	None	ORLANDO	FL	32819	8001	00	None	28.429236	-81.478692	Orange County
69764	Fee-for-Service	1083762892	1083762892	1	1	RAVAL, NARENDRA MD	3/31/1990	207U00000X	NA	Other	026	PHYSICIANS	29727	42	Nuclear Medicine	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
69796	Fee-for-Service	1326003823	1326003823	1	1	ROGERS, JOHN D MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	72728	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
69856	Fee-for-Service	1952301921	1952301921	1	1	RODRIGUEZ, ROLAND MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78464	02	General Surgery	0	In state provider	None	2521 G ST	None	BAKERSFIELD	CA	93301	2811	15	06029	35.382393	-119.0223575	Kern County
69901	Fee-for-Service	1396857561	1396857561	1	1	REICH, CRAIG A MD	8/15/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55133	08	Family Practice	0	In state provider	None	650 5TH ST	SUITE 311	SAN FRANCISCO	CA	94107	1542	38	06075	37.77575268	-122.3977845	San Francisco County
69916	Fee-for-Service	1881923704	1881923704	1	1	RAMANUJAM, SAHANA MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136930	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 270	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
69921	Fee-for-Service	1124023163	1124023163	1	1	RUGGIO, JOSEPH M MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	55288	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 410	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
69927	Fee-for-Service	1518942861	1518942861	1	1	ROSSIN, RICHARD DAVID MD	6/19/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63136	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
69953	Fee-for-Service	1679819742	1679819742	1	1	REEDLEY COMMUNITY HOSPITAL	5/8/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3567 W MOUNT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43078218	-119.8620732	Fresno County
69960	Fee-for-Service	1871591537	1871591537	1	1	RICHARD D DRAKE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2213 CHERRY ST	None	TOLEDO	OH	43608	2603	00	None	41.66854087	-83.54177085	Lucas County
69974	Fee-for-Service	1356334452	1356334452	1	2	REGENTS/UCDPBG/PED HEMOC	5/1/1999	2080P0207X	NA	Hematology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
69981	Fee-for-Service	1023003126	1023003126	1	1	RICH, PHILIP J MD	6/1/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	32089	30	Radiology	0	In state provider	UCLA, DEPT OF RADIO.SCIE	CENTER FOR HLTH SCIENCES	None	LOS ANGELES	CA	90024	0000	19	06037	0	0	None
69982	Fee-for-Service	1851377139	1851377139	1	1	RADHAKRISHNAN BALAKRISHNAN	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
70040	Fee-for-Service	1821014465	1821014465	1	1	RUSTON,ANDREW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
70043	Fee-for-Service	1720209786	1720209786	1	1	ROMINE, LORENE E MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87658	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
70045	Fee-for-Service	1336161835	1336161835	1	1	REITER, JOEL M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	17491	13	Neurology (M.D. only)	0	In state provider	None	1103 SONOMA AVE	None	SANTA ROSA	CA	95405	4805	49	06097	38.441214	-122.700591	Sonoma County
70064	Fee-for-Service	1700993557	1700993557	1	1	RAO, SANJAI MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88017	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
70071	Fee-for-Service	1578784146	1578784146	1	1	RECTOR, SARA LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 MARIN ST	114	THOUSAND OAKS	CA	91360	4260	56	06111	34.18371146	-118.8824904	Ventura County
70115	Fee-for-Service	1245289925	1245289925	1	1	RAPPOPORT, ARNOLD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29726	30	Radiology	0	In state provider	INC	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
70152	Fee-for-Service	1619058864	1619058864	1	1	RUBIN, HAYA R MD	8/29/2017	207R00000X	NA	Other	026	PHYSICIANS	58962	41	Internal Medicine	0	In state provider	None	6955 EL CAMINO REAL	STE 101	ATASCADERO	CA	93422	4216	40	06079	35.48656009	-120.6652493	San Luis Obispo County
70155	Fee-for-Service	1811381064	1811381064	1	1	RUMMANI, BENNY DO MD	6/21/2018	208M00000X	NA	Other	026	PHYSICIANS	15450	41	Internal Medicine	0	In state provider	None	2185 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
70170	Fee-for-Service	1578728077	1578728077	1	1	REGENTS/UCDMG/ENT	9/23/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GLASSROCK BLDG	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2002	34	06067	38.55204	-121.455387	Sacramento County
70179	Fee-for-Service	1477998870	1477998870	1	1	RUIZ, FERRIN K MD	11/14/2017	174400000X	NA	Other	026	PHYSICIANS	132956	41	Internal Medicine	0	In state provider	None	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
70225	Fee-for-Service	1396911772	1396911772	1	1	ROBINSON, TAMARA S MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130773	41	Internal Medicine	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
70241	Fee-for-Service	1679819742	1679819742	1	1	REEDLEY COMMUNITY HOSPITAL	5/8/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3567 W MOUNT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43078218	-119.8620732	Fresno County
70247	Fee-for-Service	1336101005	1336101005	1	1	RUSNACK, DOUGLAS W MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87907	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
70273	Fee-for-Service	1285828426	1285828426	1	1	ROBERTS, JAMES L LMFT	5/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
70308	Fee-for-Service	1760410690	1760410690	1	1	RUBIN, MARK J MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40239	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
70359	Fee-for-Service	1215317862	1215317862	1	1	REYES, VANESSA D MD	10/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145991	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
70386	Fee-for-Service	1871691345	1871691345	1	1	RIALTO FAMILY MEDICAL	1/12/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP INC	1786 N RIVERSIDE AVE	STE 1	RIALTO	CA	92376	8059	36	06071	34.132068	-117.3704665	San Bernardino County
70407	Fee-for-Service	1508555707	1508555707	1	1	RAMIREZ, ERIKA D BIRTH DOULA	5/3/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
70459	Fee-for-Service	1962482513	1962482513	1	1	REGENTS OF THE UNIVERSITY OF	3/23/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
70470	Fee-for-Service	1104890664	1104890664	1	1	ROSENBERG, PETER M MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85196	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	STE 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
70499	Fee-for-Service	1518030568	1518030568	1	9	RETINAL DIAGNOSTIC CENTER A	6/29/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	3301 EL CAMINO REAL	STE 101	ATHERTON	CA	94027	3803	41	06081	37.46631066	-122.2076453	San Mateo County
70555	Fee-for-Service	1750602629	1750602629	1	1	RYAN HASHEM	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 MALCOMX X BLVD	None	NEW YORK	NY	10037	1802	00	None	40.6181025	-74.1671055	Richmond County
70583	Fee-for-Service	1699091884	1699091884	1	1	REZVANI, BRIAN B MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135600	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
70586	Fee-for-Service	1811923436	1811923436	1	1	RESHI, RWOOF MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	45 10TH ST W	None	SAINT PAUL	MN	55102	1062	00	None	44.94882525	-93.10059843	Ramsey County
70698	Fee-for-Service	1144213232	1144213232	1	2	REGENTS/UCDPBG/FAM PRACT	5/1/1999	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
70720	Fee-for-Service	1982694436	1982694436	1	1	REDDY REDDY, VIKRAM K MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52488	41	Internal Medicine	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.741948	-121.848921	Butte County
70755	Fee-for-Service	1962482513	1962482513	1	1	REGENTS OF THE UNIVERSITY OF	2/12/2021	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
70758	Fee-for-Service	1104890664	1104890664	1	1	ROSENBERG, PETER M MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85196	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
70789	Fee-for-Service	1407871841	1407871841	1	1	REDDY, KARIMIREDDY J MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105541	22	Pathology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
70819	Fee-for-Service	1518030568	1518030568	1	8	RETINAL DIAGNOSTIC CENTER A	2/2/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	123 DI SALVO AVE	STE E	SAN JOSE	CA	95128	1717	43	06085	37.32628785	-121.9371289	Santa Clara County
70837	Fee-for-Service	1144229253	1144229253	1	1	RICHARDSON, HEATHER M MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132043	02	General Surgery	0	In state provider	None	120 S. SPALDING DRIVE	SUITE #205	BEVERLY HILLS	CA	90212	1841	19	06037	34.06625419	-118.4088854	Los Angeles County
70844	Fee-for-Service	1518030568	1518030568	1	5	RETINAL DIAGNOSTIC CENTER A	2/2/2015	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	235 O'CONNOR DRIVE	STE 4	SAN JOSE	CA	95128	1624	43	06085	37.324998	-121.9398865	Santa Clara County
70893	Fee-for-Service	1467589606	1467589606	1	1	RSCR CALIFORNIA, INC	8/19/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1408 DOUGLASS DR	None	POMONA	CA	91768	1317	19	06037	34.07339158	-117.7755686	Los Angeles County
70896	Fee-for-Service	1962820779	1962820779	1	1	RILEY, SHANNON MD	10/22/2020	2080P0203X	NA	Other	026	PHYSICIANS	168481	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
70942	Fee-for-Service	1649306986	1649306986	1	1	RES-CARE CALIFORNIA INC	4/26/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5208 LEQUEL WAY	None	CARMICHAEL	CA	95608	3087	34	06067	38.631645	-121.342338	Sacramento County
70952	Fee-for-Service	1548352388	1548352388	1	1	RILEY-HAGAN, MARGARET MD	1/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	49609	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
70962	Fee-for-Service	1649633199	1649633199	1	1	RYE, MEGAN K NP	8/3/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
70987	Fee-for-Service	1144213232	1144213232	1	2	REGENTS/UCDPBG/FAM PRACT	6/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
71024	Fee-for-Service	1881315240	1881315240	1	1	REZZO, CAMERYN P OD	11/2/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6767 N FRESNO ST	None	FRESNO	CA	93710	3709	10	06019	36.83686637	-119.7813437	Fresno County
71040	Fee-for-Service	1962482513	1962482513	1	1	REGENTS OF THE UNIVERSITY OF	3/31/2021	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
71058	Fee-for-Service	1093743239	1093743239	1	1	RYAN, ROBERT E III MD	1/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44628	40	Pediatrics	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
71064	Fee-for-Service	1336358233	1336358233	1	1	RAJKUMAR YARLAGADDA	9/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 W NORFOLK AVE	None	NORFOLK	NE	68701	4438	00	None	42.034779	-97.452981	Madison County
71151	Fee-for-Service	1659550150	1659550150	1	1	RAJU, MURALIDHARA R MD INC	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100400	14	Neurological Surgery	0	In state provider	None	11190 WARNER AVE	STE 305	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
71166	Fee-for-Service	1043664931	1043664931	1	1	ROSAS, ULYSSES S MD	8/1/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	150935	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
71186	Fee-for-Service	1912098872	1912098872	1	1	RODRIGUEZ, LEONEL L MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54600	08	Family Practice	0	In state provider	None	205 N 1ST ST	STE C	BLYTHE	CA	92225	1777	33	06065	33.613155	-114.595559	Riverside County
71219	Fee-for-Service	1932576584	1932576584	1	1	RUSKELL, LAUREN M NP	10/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
71262	Fee-for-Service	1043531643	1043531643	1	1	ROPER, GARY R MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141600	30	Radiology	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4871	49	06097	38.44224	-122.70195	Sonoma County
71303	Fee-for-Service	1023351772	1023351772	1	1	RUBIACO, GARY S MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138452	41	Internal Medicine	0	In state provider	None	4770 W HERNDON AVE	STE 111	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
71319	Fee-for-Service	1912168147	1912168147	1	1	RUS, HORIA R MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121346	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
71327	Fee-for-Service	1962482513	1962482513	1	1	REGENTS OF THE UNIVERSITY OF	12/31/1996	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	UC DAVIS MEDICAL GROUP	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
71378	Fee-for-Service	1508027772	1508027772	1	1	RYAN, KATHLEEN R MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136761	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
71386	Fee-for-Service	1992797377	1992797377	1	1	RIVERA-MORALES, ROBERTO MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	51519	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
71410	Fee-for-Service	1932123049	1932123049	1	1	REBER, HOWARD MD	1/5/1989	208600000X	NA	General Surgery	026	PHYSICIANS	37087	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
71439	Fee-for-Service	1235108226	1235108226	1	1	RYAN, BARBARA J MD	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	64579	None	None	0	In state provider	None	11370 ANDERSON STREET	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
71461	Fee-for-Service	1982150629	1982150629	1	1	ROCK, JORDAN AU	11/1/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
71465	Fee-for-Service	1790833788	1790833788	1	1	ROSENBLOOM, JOSEPH S MD	7/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55821	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
71473	Fee-for-Service	1871727149	1871727149	1	1	RIEGELS, NARDINE S MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107716	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
71489	Fee-for-Service	1407231210	1407231210	1	1	RIDGECREST REGIONAL HOSPITAL	11/19/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
71527	Fee-for-Service	1952443160	1952443160	1	1	RIZK, NORMAN MD	5/31/1983	207RC0200X	NA	Other	026	PHYSICIANS	36138	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
71561	Fee-for-Service	1346400546	1346400546	1	1	RAMACHANDRAN, SWETHA MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125444	83	Rheumatology	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
71609	Fee-for-Service	1093891509	1093891509	1	1	RIHAL, GURPREET K MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53753	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
71615	Fee-for-Service	1962482513	1962482513	1	1	REGENTS OF THE UNIVERSITY OF	5/23/2019	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
71642	Fee-for-Service	1942737002	1942737002	1	1	RANGARAJAN, SANDHYA MD	9/9/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	169247	40	Pediatrics	0	In state provider	None	901 CAMPUS DR.	None	DALY CITY	CA	94015	4900	41	06081	37.66535778	-122.4763793	San Mateo County
71650	Fee-for-Service	1972792570	1972792570	1	1	RAO, MADHURIMA MD	5/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53556	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
71732	Fee-for-Service	1255998373	1255998373	1	1	REFINED HOMECARE LLC	4/28/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	674 COUNTY SQUARE DR	#106-A	VENTURA	CA	93003	9028	56	06111	34.26954195	-119.2148249	Ventura County
71743	Fee-for-Service	1356984249	1356984249	1	1	RSCR CALIFORNIA INC	3/23/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6540 CHRISTINE CIRCLE	None	BUENA PARK	CA	90620	4511	30	06059	33.81144544	-118.0185904	Orange County
71750	Fee-for-Service	1922062355	1922062355	1	1	ROPPOLO, LYNN P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
71777	Fee-for-Service	1407231210	1407231210	1	1	RIDGECREST REGIONAL HOSPITAL	11/19/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
71784	Fee-for-Service	1902107915	1902107915	1	1	RAROQUE, SABRINA C MD	12/21/2018	174400000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
71786	Fee-for-Service	1699768879	1699768879	1	1	RAMONA REHABILITATION AND	6/1/1995	310400000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	POST ACUTE CARE INC	485 W JOHNSTON AVE	None	HEMET	CA	92543	7012	33	06065	33.73295787	-116.9752937	Riverside County
71863	Fee-for-Service	1992798912	1992798912	1	1	REGENTS/UCDPBG/OB REI	5/1/1983	207VE0102X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
71864	Fee-for-Service	1689241150	1689241150	1	1	REGIONAL IMAGING, PC	2/3/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6412 LAUREL AVE	None	MOUNTAIN MESA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
71868	Fee-for-Service	1366893117	1366893117	1	1	RICH, SANDEE A NP	10/18/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
71875	Fee-for-Service	1245751650	1245751650	1	1	RAMIREZ, JACQUELINE LCSW	5/30/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
71891	Fee-for-Service	1063494870	1063494870	1	1	ROBERT MATTHEW WEISS	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
71893	Fee-for-Service	1053479469	1053479469	1	1	REISER, PAUL J PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1141 DIVISION ST	None	NAPA	CA	94559	3333	28	06055	38.29513899	-122.2838868	Napa County
71900	Fee-for-Service	1093891509	1093891509	1	1	RIHAL, GURPREET K MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53753	10	Gastroenterology (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
71937	Fee-for-Service	1972792570	1972792570	1	1	RAO, MADHURIMA MD	5/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53556	08	Family Practice	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
71968	Fee-for-Service	1528102282	1528102282	1	1	REDDING RANCHERIA	1/1/1998	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1441 LIBERTY ST	None	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
71973	Fee-for-Service	1104957125	1104957125	1	1	RADE, STEPHANIE MD	7/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8673	41	Internal Medicine	0	In state provider	None	306 E PACIFIC COAST HWY	STE 102	LONG BEACH	CA	90806	6259	19	06037	33.78984347	-118.1885985	Los Angeles County
71982	Fee-for-Service	1376200675	1376200675	1	1	RIPARIP, CARISSA-ANN J CRNA	2/22/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
71992	Fee-for-Service	1427141803	1427141803	1	1	ROMAIN, JONATHAN E PHD	8/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
72003	Fee-for-Service	1265538060	1265538060	1	1	REPRODUCTIVE ASSOC MED	1/1/1989	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1045 ATLANTIC AVE	STE 508	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
72013	Fee-for-Service	1417390915	1417390915	1	1	RENEA HENDERSON	3/9/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
72016	Fee-for-Service	1093986788	1093986788	1	1	RODRIGUEZ, LEONARDO N MD	1/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
72037	Fee-for-Service	1316362882	1316362882	1	1	ROSS, KIMBERLY C MD	10/17/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	160316	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
72057	Fee-for-Service	1497797559	1497797559	1	1	RODRIGUEZ, ALVARO H MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41323	25	Physical Medicine and Rehabilitation	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
72061	Fee-for-Service	1285821330	1285821330	1	1	RAVITZ, ADRIAN B CO	5/8/2009	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 4TH AVE	#405	CHULA VISTA	CA	91910	4430	37	06073	32.63513513	-117.0820663	San Diego County
72066	Fee-for-Service	1689337818	1689337818	1	1	REACH PHYSICAL THERAPY NETWO	1/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 N TUSTIN AVE	407	SANTA ANA	CA	92705	3608	30	06059	33.752286	-117.8341735	Orange County
72173	Fee-for-Service	1841258951	1841258951	1	1	RAJANI, VINOD H MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62445	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
72229	Fee-for-Service	1598171852	1598171852	1	1	RAMIREZ, SANDRA LCSW	6/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
72251	Fee-for-Service	1205839768	1205839768	1	1	ROBERT-JAYSON COMMUNICATIONS	10/17/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 WILSON TERRACE	SUITE 270	GLENDALE	CA	91206	4078	19	06037	34.14960934	-118.2313491	Los Angeles County
72252	Fee-for-Service	1114919784	1114919784	1	1	RESNECK-SANNES, LARRY D MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25952	08	Family Practice	0	In state provider	None	5403 SCOTTS VALLEY DR	STE A	SCOTTS VALLEY	CA	95066	3451	44	06087	37.05890483	-122.0101155	Santa Cruz County
72293	Fee-for-Service	1942042064	1942042064	1	1	ROSS, JENNIFER L PT	9/24/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
72392	Fee-for-Service	1003980772	1003980772	1	1	REINER, MARC H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49887	36	Psychiatry	0	In state provider	None	2240 SHELTER ISLAND DR	SUITE 104	SAN DIEGO	CA	92106	3137	37	06073	32.71791933	-117.2227586	San Diego County
72425	Fee-for-Service	1861928921	1861928921	1	1	REDDY, LAYA MD	9/22/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	163652	None	None	0	In state provider	None	4136 BACHMAN PL	None	SAN DIEGO	CA	92103	2028	37	06073	32.75258794	-117.1632586	San Diego County
72463	Fee-for-Service	1164952339	1164952339	1	1	RAMOS SANTILLAN, VICENTE O M	10/1/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	D	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
72465	Fee-for-Service	1134455868	1134455868	1	1	REMEDY HEALTHCARE SERVICES	5/9/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	16689 FOOTHILL BLVD	SUITE 204	FONTANA	CA	92335	8412	36	06071	34.10658054	-117.4406715	San Bernardino County
72474	Fee-for-Service	1326494741	1326494741	1	1	RECOVERY INNOVATIONS, INC	9/7/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2500 NORTH PALM CANYON	A1-A4	PALM SPRINGS	CA	92264	1866	33	06065	33.85264176	-116.551965	Riverside County
72490	Fee-for-Service	1861579021	1861579021	1	1	RADELL, PAIGE D MD	3/7/2011	207N00000X	NA	Dermatology	026	PHYSICIANS	80594	07	Dermatology	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
72494	Fee-for-Service	1073719290	1073719290	1	1	RAKOFF, DAVID A MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89264	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
72507	Fee-for-Service	1528178399	1528178399	1	1	ROSEN, RONALD G MD	9/28/2018	208600000X	NA	General Surgery	026	PHYSICIANS	60316	02	General Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
72522	Fee-for-Service	1609389030	1609389030	1	1	RAINEY, AMANDA E NP	12/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72565	Fee-for-Service	1659019743	1659019743	1	1	RYAN, KIMBERLY D CLD	4/13/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
72569	Fee-for-Service	1902963879	1902963879	1	1	RADFORD, MEGAN L	9/21/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2530 PROFESSIONAL PKWY	None	SANTA MARIA	CA	93455	1602	42	06083	34.91417616	-120.4383527	Santa Barbara County
72577	Fee-for-Service	1396060844	1396060844	1	1	REPPLINGER, DANIEL J MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118701	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
72596	Fee-for-Service	1912402843	1912402843	1	1	RAVILLA, ANOOP MD	2/19/2020	111NR0200X	NA	Other	026	PHYSICIANS	163471	30	Radiology	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
72616	Fee-for-Service	1730574815	1730574815	1	1	REYES, KATHERINE M MD	12/30/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159452	15	Obstetrics (D.O. only)	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
72619	Fee-for-Service	1891012969	1891012969	1	1	RITCHIE, JULIE B MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126346	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
72639	Fee-for-Service	1033122833	1033122833	1	1	RIEDLER, SCOTT A MD	7/31/1985	2084N0400X	NA	Neurology	026	PHYSICIANS	51289	13	Neurology (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
72642	Fee-for-Service	1891763561	1891763561	1	1	RANCHO PHYSICAL THERAPY, INC	10/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
72658	Fee-for-Service	1356437339	1356437339	1	1	RODRIGUEZ- GOMEZ, GERARDO D	11/16/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	47771	None	None	0	In state provider	MD	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
72676	Fee-for-Service	1003980772	1003980772	1	1	REINER, MARC H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49887	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2240 SHELTER ISLAND DR	SUITE 104	SAN DIEGO	CA	92106	3137	37	06073	32.71791933	-117.2227586	San Diego County
72679	Fee-for-Service	1043603863	1043603863	1	1	RAUNIG, JEFFEREY MD	1/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147045	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
72685	Fee-for-Service	1679541320	1679541320	1	1	RANCHO PHYSICAL THERAPY, INC	10/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	31720 TEMECULA PKWY	STE 101	TEMECULA	CA	92592	5802	33	06065	33.4799323	-117.1033702	Riverside County
72686	Fee-for-Service	1275579195	1275579195	1	1	REGIONAL PAIN TREATMENT MEDI	6/24/2020	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CAL CENTER INC	295 IMPERIAL HWY	SUITE 100	FULLERTON	CA	92835	1020	30	06059	33.91748047	-117.9291825	Orange County
72705	Fee-for-Service	1649272337	1649272337	1	1	ROGER, DOUGLAS J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77670	20	Orthopedic Surgery	0	In state provider	None	1293 6TH ST	None	COACHELLA	CA	92236	1707	33	06065	33.67731363	-116.1789134	Riverside County
72718	Fee-for-Service	1891253613	1891253613	1	1	REVELES, ADRIAN MSW LCSW	8/30/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	411 10TH ST	None	SAN PEDRO	CA	90731	3213	19	06037	33.7351085	-118.2859605	Los Angeles County
72723	Fee-for-Service	1629257514	1629257514	1	1	RICARDO GUANZON	4/2/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
72728	Fee-for-Service	1144374653	1144374653	1	1	RUNNING RIVER HOME HEALTH	7/11/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	11110 ARTESIA BLVD	SUITE E	CERRITOS	CA	90703	2546	19	06037	33.87288133	-118.097193	Los Angeles County
72730	Fee-for-Service	1487693701	1487693701	1	1	REHFIELD, PATRICIA L DO	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10854	01	General Practice	0	In state provider	None	100 HOSPITAL DR	STE 1103	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
72735	Fee-for-Service	1558634485	1558634485	1	1	RHEE, LISA CP	8/7/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
72752	Fee-for-Service	1841683141	1841683141	1	1	RNPLUS HOME HEALTH INC	12/5/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22600 SAVI RANCH PARKWAY	SUITE A2	YORBA LINDA	CA	92287	4639	30	06059	33.87500251	-117.7425073	Orange County
72762	Fee-for-Service	1710201215	1710201215	1	1	REGALIA, KIRSTEN A MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125295	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72825	Fee-for-Service	1306442967	1306442967	1	1	RESTORATIVE HOME HEALTH	9/1/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	125 S LOUISE ST	STE 18	GLENDALE	CA	91205	1024	19	06037	34.14566113	-118.252704	Los Angeles County
72842	Fee-for-Service	1790795730	1790795730	1	1	ROMO-GRITZEWSKY, M MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76531	41	Internal Medicine	0	In state provider	None	1150 MAIN ST	STE 3	WATSONVILLE	CA	95076	3760	44	06087	36.9163164	-121.7698107	Santa Cruz County
72852	Fee-for-Service	1225248644	1225248644	1	1	RIVERSIDE CO REGIONAL	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
72874	Fee-for-Service	1417954926	1417954926	1	1	ROSS, DAVID M MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
72890	Fee-for-Service	1861522237	1861522237	1	1	REDDY, LALI L MD	9/16/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45989	None	None	0	In state provider	None	7853 EL CAJON	SUITE C	LA MESA	CA	91942	0621	37	06073	32.76863785	-117.0287642	San Diego County
72964	Fee-for-Service	1649565920	1649565920	1	1	RENNER, MORGAN E MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142841	18	Ophthalmology	0	In state provider	None	14501 MAGNOLIA ST	STE 103	WESTMINSTER	CA	92683	1307	30	06059	33.75188963	-117.9723601	Orange County
72976	Fee-for-Service	1295091635	1295091635	1	1	REGEV, AVIVA MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128035	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
73016	Fee-for-Service	1487693701	1487693701	1	1	REHFIELD, PATRICIA L DO	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10854	08	Family Practice	0	In state provider	None	100 HOSPITAL DR	STE 1103	VALLEJO	CA	94589	2577	48	06095	38.13100118	-122.2403008	Solano County
73036	Fee-for-Service	1659841484	1659841484	1	1	RUANO, AARON F PT	3/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3889 W STETSON AVE	SUITE 150	HEMET	CA	92545	9686	33	06065	33.72930152	-117.011988	Riverside County
73054	Fee-for-Service	1508881376	1508881376	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	250 W EL MONTE WAY	None	DINUBA	CA	93618	1554	54	06107	36.54587921	-119.3967215	Tulare County
73061	Fee-for-Service	1548365083	1548365083	1	1	REINKING, DEBRA A MD	11/1/2005	207L00000X	NA	Other	026	PHYSICIANS	43867	05	Anesthesiology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
73178	Fee-for-Service	1720091572	1720091572	1	1	ROTH, JULIE DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7989	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
73182	Fee-for-Service	1750312146	1750312146	1	1	RAHIMIAN, JEANNINE MD	6/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
73187	Fee-for-Service	1720775745	1720775745	1	1	RENDER, NICOLE CLAUDINE	8/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27754 CORTE DEL SOL	None	MORENO VALLEY	CA	92555	5933	33	06065	33.88855617	-117.1792496	Riverside County
73195	Fee-for-Service	1033228382	1033228382	1	1	REYES, ATMAN R MD	7/30/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	65293	-	NOT APPLICABLE	0	In state provider	None	1317 DEL NORTE RD	STE 200	CAMARILLO	CA	93010	8368	56	06111	34.22312217	-119.1046861	Ventura County
73197	Fee-for-Service	1144274911	1144274911	1	1	ROSS, RICHARD L MD	6/30/1978	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34130	08	Family Practice	0	In state provider	FAMILY PRACTICE CTR	1072 GAYLEY AVE	None	LOS ANGELES	CA	90024	3402	19	06037	34.06071361	-118.4468596	Los Angeles County
73221	Fee-for-Service	1245274125	1245274125	1	1	ROOHAN, JOHN A MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73104	08	Family Practice	0	In state provider	None	1250 N AVALON BLVD	None	WILMINGTON	CA	90744	2602	19	06037	33.78817201	-118.2630512	Los Angeles County
73237	Fee-for-Service	1215575550	1215575550	1	1	ROJAS, ELIZABETH LP	1/31/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
73296	Fee-for-Service	1992780142	1992780142	1	1	RAJAPPA, PRABHU MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89081	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
73324	Fee-for-Service	1174601678	1174601678	1	1	RABINOFF, MICHAEL DO	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7248	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
73334	Fee-for-Service	1467943399	1467943399	1	1	RAN, LYDIA MD	9/3/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	174707	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
73344	Fee-for-Service	1508881376	1508881376	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	250 W EL MONTE WAY	None	DINUBA	CA	93618	1554	54	06107	36.54587921	-119.3967215	Tulare County
73410	Fee-for-Service	1447202759	1447202759	1	1	RICHARD D SCHMIDT	6/22/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
73454	Fee-for-Service	1467724195	1467724195	1	1	RIDDAR, SARAH E CPO	7/18/2016	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	550 WASHINGTON ST	SUITE 400	SAN DIEGO	CA	92103	2213	37	06073	32.75003652	-117.1603431	San Diego County
73468	Fee-for-Service	1720091572	1720091572	1	1	ROTH, JULIE DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
73474	Fee-for-Service	1720775745	1720775745	1	1	RENDER, NICOLE CLAUDINE	8/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27754 CORTE DEL SOL	None	MORENO VALLEY	CA	92555	5933	33	06065	33.88855617	-117.1792496	Riverside County
73500	Fee-for-Service	1720092851	1720092851	1	1	RUHLAND, LINDA C LMFT	7/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25129 THE OLD RD	SUITE 202	SANTA CLARITA	CA	91381	2288	19	06037	34.3752041	-118.5639379	Los Angeles County
73566	Fee-for-Service	1477546406	1477546406	1	2	REGENTS/UCDPBG/RADIOLOGY	5/1/1999	2085R0202X	NA	Mammography/MRI Provider	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
73603	Fee-for-Service	1396727889	1396727889	1	1	RAMANNA, LALITHA MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	30015	42	Nuclear Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
73607	Fee-for-Service	1780008839	1780008839	1	1	RIVERSIDE COMMUNITY COLLEGE	6/4/2014	261QS1000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92506	1299	33	06065	33.970626	-117.3826755	Riverside County
73613	Fee-for-Service	1427055102	1427055102	1	1	ROSE, MARK R MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	48234	None	None	0	In state provider	None	1555 SHAW AVE	STE 101	CLOVIS	CA	93611	4096	10	06019	36.80870008	-119.687617	Fresno County
73623	Fee-for-Service	1275239758	1275239758	1	1	RAMIREZ, EVELYN NP	12/23/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
73631	Fee-for-Service	1508881376	1508881376	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	250 W EL MONTE WAY	None	DINUBA	CA	93618	1554	54	06107	36.54587921	-119.3967215	Tulare County
73633	Fee-for-Service	1407971914	1407971914	1	1	RAJASHEKARA, B M MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32460	24	Plastic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
73663	Fee-for-Service	1467452367	1467452367	1	1	ROSERO, RAMIRO R MD	7/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66094	08	Family Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
73677	Fee-for-Service	1962482513	1962482513	1	3	REGENTS OF THE UNIVERSITY OF	11/19/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1801 E MARCH LANE	C-330	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
73702	Fee-for-Service	1316172844	1316172844	1	1	RAWI, TAIB A DO	12/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10746	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
73810	Fee-for-Service	1386895068	1386895068	1	1	REGENTS/UCDPBG/COCC SERO	8/3/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3144 TUPPER HALL	SHIELDS AVE	DAVIS	CA	95616	8645	57	06113	38.536875	-121.772457	Yolo County
73819	Fee-for-Service	1144583667	1144583667	1	1	REACH PROJECT	12/31/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3385 MAIN STREET	SUITE B	OAKLEY	CA	94561	6017	07	06013	37.99777154	-121.7153655	Contra Costa County
73837	Fee-for-Service	1033615232	1033615232	1	1	RAMIREZ, GINA C MD	3/3/2023	390200000X	NA	Other	026	PHYSICIANS	179772	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
73839	Fee-for-Service	1922074624	1922074624	1	1	RANDY DAVIDSON M.D	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1311 N MILDRED RD	None	CORTEZ	CO	81321	2231	00	None	37.36196474	-108.5727346	Montezuma County
73841	Fee-for-Service	1245613348	1245613348	1	1	RAMASWAMY, NANDINIDEVI MD	2/13/2023	207R00000X	NA	Other	026	PHYSICIANS	153224	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
73853	Fee-for-Service	1477546406	1477546406	1	2	REGENTS/UCDPBG/RADIOLOGY	5/1/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
73855	Fee-for-Service	1447730635	1447730635	1	1	RIOS, JASMIN A PT	1/27/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 W ARROW HWY	130	SAN DIMAS	CA	91773	2330	19	06037	34.10677054	-117.8331379	Los Angeles County
73890	Fee-for-Service	1396727889	1396727889	1	1	RAMANNA, LALITHA MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	30015	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
73920	Fee-for-Service	1407971914	1407971914	1	1	RAJASHEKARA, B M MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32460	46	Hand Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
73964	Fee-for-Service	1962482513	1962482513	1	3	REGENTS OF THE UNIVERSITY OF	3/23/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1801 E MARCH LANE	C-330	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
73968	Fee-for-Service	1154379394	1154379394	1	1	REGENTS OF THE UNIVERSITY OF	4/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ROUP	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
73978	Fee-for-Service	1255573606	1255573606	1	1	RAHIMY, EHSAN MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114436	18	Ophthalmology	0	In state provider	None	301 INDUSTRIAL RD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
74017	Fee-for-Service	1831763531	1831763531	1	1	REID, ALEXIS LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 6TH ST	108	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
74040	Fee-for-Service	1184781536	1184781536	1	1	RYDZ, THOMAS J MD	12/31/1990	208600000X	NA	General Surgery	026	PHYSICIANS	71695	02	General Surgery	0	In state provider	None	2456 BUHNE ST	None	EUREKA	CA	95501	3207	12	06023	40.78590706	-124.139941	Humboldt County
74055	Fee-for-Service	1487855045	1487855045	1	1	RIVERSIDE-SAN BERNARDINO	4/23/2018	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	607 DONNA WAY	None	SAN JACINTO	CA	92583	5517	33	06065	33.78235445	-116.9370685	Riverside County
74091	Fee-for-Service	1437182805	1437182805	1	1	ROKHSAR, SEPEHR MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77643	78	Neoplastic Diseases/Oncology	0	In state provider	None	9090 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
74105	Fee-for-Service	1912139528	1912139528	1	1	ROHANINEJAD, MOHAMMADREZA MD	12/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108612	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
74117	Fee-for-Service	1467449603	1467449603	1	1	RAY PROPERTIES KIT CARSON	4/23/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	811 COURT ST	None	JACKSON	CA	95642	2131	03	06005	38.35290269	-120.7672088	Amador County
74156	Fee-for-Service	1841302080	1841302080	1	1	RUPESH PRASAD, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 N 12TH ST	None	MILWAUKEE	WI	53233	1305	00	None	43.042428	-87.92718546	Milwaukee County
74165	Fee-for-Service	1407002777	1407002777	1	1	RODRIGUEZ, REBECCA L MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135051	41	Internal Medicine	0	In state provider	None	1711 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	4901	19	06037	34.0127217	-118.466458	Los Angeles County
74210	Fee-for-Service	1558749572	1558749572	1	1	ROZNER, LEANNE LMFT	1/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
74253	Fee-for-Service	1962482513	1962482513	1	3	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1801 E MARCH LANE	C-330	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
74258	Fee-for-Service	1154379394	1154379394	1	1	REGENTS OF THE UNIVERSITY OF	4/5/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ROUP	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
74266	Fee-for-Service	1750469433	1750469433	1	1	REDDY, SAVITHA K MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79860	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
74313	Fee-for-Service	1336171545	1336171545	1	1	RICHMOND, MARK GLEN MD	5/22/1997	207P00000X	NA	Other	026	PHYSICIANS	54598	None	None	0	In state provider	None	11234 ANDERSON ST	STE A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
74326	Fee-for-Service	1164701975	1164701975	1	1	RAJI, CYRUS A MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123636	30	Radiology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74352	Fee-for-Service	1821113770	1821113770	1	1	RAVEN, KRISTA H LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49705	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
74368	Fee-for-Service	1750468476	1750468476	1	1	ROWLEY, ROBERT D	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37911	None	None	0	In state provider	None	27206 CALAROGA AVE	STE 207	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
74391	Fee-for-Service	1588679997	1588679997	1	1	ROYALTY RADIATION ONCOLO	8/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1910 ROYALTY DR	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
74405	Fee-for-Service	1649222365	1649222365	1	1	REMARK,RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 S 3RD STREET	None	MONTROSE	CO	81401	0000	00	None	38.480076	-107.868969	Montrose County
74407	Fee-for-Service	1619136561	1619136561	2	1	RICKS, GEORGE T MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	30710	01	General Practice	0	In state provider	None	25431 CABOT ROAD	SUITE 118	LAGUNA HILLS	CA	92653	5515	30	06059	33.59115448	-117.6744575	Orange County
74412	Fee-for-Service	1316996465	1316996465	1	1	ROCO, CARMELO L MD	11/27/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47770	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
74477	Fee-for-Service	1144548751	1144548751	1	1	ROJAS-MARTINEZ, JULIO C MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130294	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74481	Fee-for-Service	1861969172	1861969172	1	1	ROMANELLI, KEAN A LMFT	4/23/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132695	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
74491	Fee-for-Service	1447482062	1447482062	1	1	RUGGERI, WENDY E MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
74512	Fee-for-Service	1922158518	1922158518	1	1	RETREAT FOR CHILDREN	8/7/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8339 CYPRESS CT	None	DUBLIN	CA	94568	1247	01	06001	37.72473926	-121.927579	Alameda County
74514	Fee-for-Service	1750458675	1750458675	1	1	RAYMAN, MARK D.	4/29/1999	2085R0204X	NA	Other	026	PHYSICIANS	64513	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
74542	Fee-for-Service	1962482513	1962482513	1	3	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1801 E MARCH LANE	C-330	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
74579	Fee-for-Service	1790061000	1790061000	1	1	ROTH, SHAWN C	1/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
74582	Fee-for-Service	1538106497	1538106497	1	1	ROSENBERG, WILLIAM A MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2410 FIRE MESA STREET	180	LAS VEGAS	NV	89128	9017	00	None	36.20533596	-115.2575074	Clark County
74614	Fee-for-Service	1346822806	1346822806	1	1	RAMIREZ, ROSA A CCC-SLP	1/26/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
74620	Fee-for-Service	1790261014	1790261014	1	1	RMBB,LLC	5/31/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3269 D ST	None	HAYWARD	CA	94541	4585	01	06001	37.678888	-122.0482923	Alameda County
74661	Fee-for-Service	1821260084	1821260084	1	1	RUSSELL, MATTHEW S MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103049	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74664	Fee-for-Service	1508380411	1508380411	1	1	RUIZ, BELEM LMFT	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
74666	Fee-for-Service	1346201811	1346201811	1	1	RUSSO, GILBERTO C MD	12/5/2008	2086S0129X	NA	General Surgery	026	PHYSICIANS	63421	01	General Practice	0	In state provider	None	71777 SAN JACINTO	STE 101G	RANCHO MIRAGE	CA	92262	4457	33	06065	33.74394755	-116.4124572	Riverside County
74702	Fee-for-Service	1366050213	1366050213	1	1	REDWOOD COAST MONTESSORI	7/1/2020	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1611 PENINSULA DR	None	ARCATA	CA	95521	9658	12	06023	40.84460149	-124.1687331	Humboldt County
74735	Fee-for-Service	1043424419	1043424419	1	1	RANDERIA, SHYAM D MD	8/5/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	101775	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
74741	Fee-for-Service	1912267253	1912267253	1	1	RAHMAN, RAZI	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	186566	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
74765	Fee-for-Service	1295890473	1295890473	2	1	RTY PHARMACEUTICAL INC	6/24/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6465 BALBOA AVE	STE 101	SAN DIEGO	CA	92111	3124	37	06073	32.82020448	-117.172791	San Diego County
74791	Fee-for-Service	1518103472	1518103472	1	1	RAHMAN, MAISARA I MD	6/16/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105803	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204B	LOMA LINDA	CA	92354	3450	36	06071	34.04805253	-117.249534	San Bernardino County
74823	Fee-for-Service	1780673871	1780673871	1	1	RAVEN, MARIA C MD	8/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54727	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74830	Fee-for-Service	1659477487	1659477487	1	1	RISSER ORTHOPAEDIC GROUP	1/1/1979	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	A MEDICAL CORPORATION	2627 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16917853	-118.096371	Los Angeles County
74834	Fee-for-Service	1962482513	1962482513	1	8	REGENTS OF THE UNIVERSITY OF	8/8/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
74896	Fee-for-Service	1871547331	1871547331	1	1	ROSENTHAL, GUY MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87268	14	Neurological Surgery	0	In state provider	None	1001 POTRERO AVE	RM 4M39	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
74900	Fee-for-Service	1639257264	1639257264	1	1	RAJA, ROSHAN DO	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	7249	13	Neurology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
74914	Fee-for-Service	1881019545	1881019545	1	1	RELIANCE HOME HEALTH CARE	9/18/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	520 E WILSON AVE	SUITE 110	GLENDALE	CA	91206	4374	19	06037	34.14812361	-118.2491324	Los Angeles County
74948	Fee-for-Service	1437659992	1437659992	1	1	REDMAN, MICHELLE	12/11/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	490 S FARRELL DR	SUITE C208	PALM SPRINGS	CA	92262	7992	33	06065	33.81651	-116.5180015	Riverside County
74949	Fee-for-Service	1942460605	1942460605	1	1	RHEE, DIANE Y MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109550	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
74972	Fee-for-Service	1487644902	1487644902	1	1	RICHARD BLACK MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	455 TOLL GATE RD	None	WARWICK	RI	02886	2759	00	None	41.70484367	-71.47855402	Kent County
74991	Fee-for-Service	1053531343	1053531343	1	1	RAMOS BRACAMONTES, MARIA A C	8/1/2023	367A00000X	NA	Certified Nurse Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	NM	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
75037	Fee-for-Service	1235652983	1235652983	1	1	ROMINE, DANIELLE E	8/14/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3980 W FLORIDA AVE	STE 102	HEMET	CA	92545	5258	33	06065	33.74575495	-117.0140414	Riverside County
75087	Fee-for-Service	1861501926	1861501926	1	1	REINSTEIN, HOWARD J MD	12/4/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41612	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
75123	Fee-for-Service	1962482513	1962482513	1	8	REGENTS OF THE UNIVERSITY OF	11/7/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
75137	Fee-for-Service	1245277730	1245277730	1	1	RONGKAVILIT, CHOKECHAI MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140364	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
75174	Fee-for-Service	1982102661	1982102661	1	1	RISSMAN, KASEY D LPCC	6/30/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
75179	Fee-for-Service	1437202124	1437202124	1	1	RIVERSIDE-SAN BERNARDINO	6/9/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11555 1/2 POTRERO RD	None	BANNING	CA	92220	6946	33	06065	33.953571	-116.8290655	Riverside County
75180	Fee-for-Service	1225201148	1225201148	1	1	RODNEY GILLMAN JAY JR. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
75181	Fee-for-Service	1396767828	1396767828	1	1	ROSENBERG, STEVEN MD INC	2/15/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37233	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 LOMITA BLVD	STE 400	TORRANCE	CA	90505	4927	19	06037	33.81309744	-118.3448635	Los Angeles County
75182	Fee-for-Service	1164125936	1164125936	1	1	RICO, DESIREE G	3/30/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	19367 VICTORY BLVD	SUITE 14	TARZANA	CA	91335	6302	19	06037	34.18658599	-118.5557169	Los Angeles County
75183	Fee-for-Service	1245214766	1245214766	1	1	RECIO RESTREPO, MARIA V MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
75191	Fee-for-Service	1518125624	1518125624	1	1	ROSCA, DANA I MD	4/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118458	36	Psychiatry	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
75245	Fee-for-Service	1316993926	1316993926	1	1	RIEGEL, BYRON W MD INC	2/10/1978	207W00000X	NA	Ophthalmology	026	PHYSICIANS	12296	18	Ophthalmology	0	In state provider	None	2830 W MAIN ST	None	VISALIA	CA	93291	4331	54	06107	36.330093	-119.3222565	Tulare County
75250	Fee-for-Service	1730524737	1730524737	1	1	ROSHANZADEH, VISNA Z MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138362	41	Internal Medicine	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
75324	Fee-for-Service	1508308180	1508308180	1	1	RECOVERY INNOVATIONS, INC	10/10/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	170 WILKERSON AVE.	STE. A-D	PERRIS	CA	92570	2200	33	06065	33.78602543	-117.220127	Riverside County
75333	Fee-for-Service	1285207084	1285207084	1	1	RUIZ, RACHAEL LMFT	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
75354	Fee-for-Service	1336297316	1336297316	1	1	RABBI, MITCHELL M MD	9/30/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56002	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
75390	Fee-for-Service	1871865816	1871865816	1	1	RICHARDSON, LAURA A DO	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12435	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
75411	Fee-for-Service	1962482513	1962482513	1	8	REGENTS OF THE UNIVERSITY OF	8/8/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
75416	Fee-for-Service	1417111501	1417111501	1	1	ROSSOW, DAVID MD	8/29/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187446	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
75426	Fee-for-Service	1245277730	1245277730	1	1	RONGKAVILIT, CHOKECHAI MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140364	77	Infectious Disease	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
75437	Fee-for-Service	1982652905	1982652905	1	1	ROSENBLUM, LELAND H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72002	18	Ophthalmology	0	In state provider	None	798 CASS ST	STE 201	MONTEREY	CA	93940	2918	27	06053	36.59428586	-121.8953825	Monterey County
75447	Fee-for-Service	1487695730	1487695730	1	1	ROSE, BARRY M MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	38658	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
75451	Fee-for-Service	1912991605	1912991605	2	1	ROSSER, ROBERT J MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	22746	22	Pathology (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
75465	Fee-for-Service	1437202124	1437202124	1	1	RIVERSIDE-SAN BERNARDINO	2/1/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11555 1/2 POTRERO RD	None	BANNING	CA	92220	6946	33	06065	33.953571	-116.8290655	Riverside County
75470	Fee-for-Service	1245214766	1245214766	1	1	RECIO RESTREPO, MARIA V MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
75536	Fee-for-Service	1730524737	1730524737	1	1	ROSHANZADEH, VISNA Z MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138362	01	General Practice	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
75538	Fee-for-Service	1760541569	1760541569	1	23	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8616 LA TIJERA BLVD	404	LOS ANGELES	CA	92856	6526	19	06037	33.95943215	-118.3918599	Los Angeles County
75581	Fee-for-Service	1699727990	1699727990	1	1	RIFFEL, HUGO D	3/4/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30878	None	None	0	In state provider	None	440 S SOTO ST	STE 110	LOS ANGELES	CA	90033	4335	19	06037	34.03945087	-118.2124758	Los Angeles County
75589	Fee-for-Service	1699303008	1699303008	1	1	RYAN, MICHAEL	7/29/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	191514	07	Dermatology	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
75598	Fee-for-Service	1275809691	1275809691	1	1	RAM, REUBEN J MD	12/15/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132493	None	None	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
75612	Fee-for-Service	1659908721	1659908721	1	1	RANDLES, JULIANNE LPCC	6/21/2024	390200000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29995 TECHNOLOGY DR	101A	MURRIETA	CA	92563	2633	33	06065	33.56041691	-117.1370428	Riverside County
75629	Fee-for-Service	1588412431	1588412431	1	1	RYRA INCORPORATED	9/25/2024	364SC1501X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
75648	Fee-for-Service	1417970054	1417970054	1	1	ROWLAND, JACK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66240	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	332 SANTA FE DR	STE 150	ENCINITAS	CA	92024	5146	37	06073	33.039567	-117.2850165	San Diego County
75649	Fee-for-Service	1780891390	1780891390	1	1	ROCKLIN UNIFIED SCHOOL	1/4/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	2615 SIERRA MEADOWS DR	None	ROCKLIN	CA	95677	2126	31	06061	38.79183891	-121.2225706	Placer County
75655	Fee-for-Service	1235512799	1235512799	1	1	RUSSO, AUDREY	9/24/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5211 LOCUST AVENUE	None	LONG BEACH	CA	90805	6411	19	06037	33.850746	-118.189839	Los Angeles County
75698	Fee-for-Service	1962482513	1962482513	1	8	REGENTS OF THE UNIVERSITY OF	8/8/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
75709	Fee-for-Service	1790716447	1790716447	1	1	RADLEY AND COHEN AMC	9/20/2007	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	SYLMAR MEDICAL CENTER	14124 FOOTHILL BLVD	STE 100	SYLMAR	CA	91342	8051	19	06037	34.31598785	-118.4413895	Los Angeles County
75736	Fee-for-Service	1487695730	1487695730	1	1	ROSE, BARRY M MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	38658	01	General Practice	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
75781	Fee-for-Service	1952636730	1952636730	1	1	RYAN, ADAM T MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137488	30	Radiology	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
75825	Fee-for-Service	1760541569	1760541569	1	23	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	8616 LA TIJERA BLVD	404	LOS ANGELES	CA	92856	6526	19	06037	33.95943215	-118.3918599	Los Angeles County
75843	Fee-for-Service	1619169877	1619169877	1	1	RAMANN, RADHIKA A MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93446	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
75850	Fee-for-Service	1023321239	1023321239	1	1	RODRIGUEZ CASTRO, CARLOS E M	12/2/2021	207R00000X	NA	Other	026	PHYSICIANS	151021	None	None	0	In state provider	D	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
75930	Fee-for-Service	1215399233	1215399233	1	1	REDDY, VISHRUTH K MD	6/4/2021	2085R0001X	NA	Other	026	PHYSICIANS	172604	None	None	0	In state provider	None	27235 TOURNEY RD	1500	VALENCIA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
75946	Fee-for-Service	1235512799	1235512799	1	1	RUSSO, AUDREY	9/24/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5211 LOCUST AVENUE	None	LONG BEACH	CA	90805	6411	19	06037	33.850746	-118.189839	Los Angeles County
75950	Fee-for-Service	1346402039	1346402039	1	1	REVELS, SHASHONDA L MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140738	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	RM 64-128	LOS ANGELES	CA	90095	6003	19	06037	34.06373445	-118.443537	Los Angeles County
75967	Fee-for-Service	1962674762	1962674762	2	1	RECOVERCARE LLC	2/25/2010	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	RECOVERCARE LLC	4360 PINELL STREET	None	SACRAMENTO	CA	95838	2928	34	06067	38.64672	-121.418964	Sacramento County
75976	Fee-for-Service	1801806997	1801806997	1	1	RAHMAN, SHAFI UR MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50385	40	Pediatrics	0	In state provider	None	1121 W 4TH ST	STE B	MADERA	CA	93637	4474	20	06039	36.95568822	-120.0735751	Madera County
75994	Fee-for-Service	1598751745	1598751745	1	1	ROHART, PAUL MD	4/20/2022	207P00000X	NA	Other	026	PHYSICIANS	50212	None	None	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
75998	Fee-for-Service	1790716447	1790716447	1	1	RADLEY AND COHEN AMC	6/4/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SYLMAR MEDICAL CENTER	14124 FOOTHILL BLVD	STE 100	SYLMAR	CA	91342	8051	19	06037	34.31598785	-118.4413895	Los Angeles County
76001	Fee-for-Service	1639205438	1639205438	1	1	ROBBINS, WENDYE R MD	10/12/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80044	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
76040	Fee-for-Service	1316988116	1316988116	1	1	RAHMAN, JOSEPH E MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85354	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
76064	Fee-for-Service	1609168517	1609168517	1	1	ROCHON-DUCK, MICHAEL MD	6/4/2019	207R00000X	NA	Other	026	PHYSICIANS	123912	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76073	Fee-for-Service	1356429427	1356429427	1	1	RAMASWAMY, MOHAN R MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84614	42	Nuclear Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
76085	Fee-for-Service	1154765196	1154765196	1	1	RICCOBONI, STEVEN T MD	2/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133402	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
76086	Fee-for-Service	1164532032	1164532032	1	1	RONNINGEN, LELAND D MD	7/1/2000	208800000X	NA	Other	026	PHYSICIANS	85070	34	Urology and Urological Surgery	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
76113	Fee-for-Service	1386101335	1386101335	1	1	RELEVANT HOME HEALTH SERVICE	10/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	S LLC	12235 BEACH BLVD	SUITE 200C	STANTON	CA	90680	3959	30	06059	33.784425	-117.9930265	Orange County
76131	Fee-for-Service	1619169877	1619169877	1	1	RAMANN, RADHIKA A MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93446	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76164	Fee-for-Service	1831119056	1831119056	1	1	RICHARD C COX, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1303 N MAIN ST	None	CEDAR CITY	UT	84721	9746	00	None	37.699596	-113.0664465	Iron County
76175	Fee-for-Service	1558625806	1558625806	1	1	RAYJAY2011, LLC	1/16/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1740 W KATELLA AVE	STE M	ORANGE	CA	92867	3434	30	06059	33.80612228	-117.8711943	Orange County
76238	Fee-for-Service	1346402039	1346402039	1	1	REVELS, SHASHONDA L MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140738	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	RM 64-128	LOS ANGELES	CA	90095	6003	19	06037	34.06373445	-118.443537	Los Angeles County
76243	Fee-for-Service	1902291909	1902291909	1	1	RUMELD, ARIELA MD	12/4/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
76251	Fee-for-Service	1871369553	1871369553	1	1	RAPID RESPONSE URGENT CARE,	2/20/2025	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	17559 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	5720	19	06037	34.26489548	-118.517301	Los Angeles County
76258	Fee-for-Service	1811927965	1811927965	1	1	ROBERT E FOWLES, M.D.	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	54 NORTH 800 WEST	None	SALT LAKE CTY	UT	84116	0000	00	None	40.77072	-111.913834	Salt Lake County
76299	Fee-for-Service	1407935844	1407935844	1	1	RAMOS-PLATT, LEIGH K MD	8/2/2008	2084N0402X	NA	Neurology	026	PHYSICIANS	80955	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
76314	Fee-for-Service	1588121271	1588121271	1	1	RASMUSSEN, JOSHUA PT	7/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 N STATE COLLEGE BLVD	STE G	ANAHEIM	CA	92806	2932	30	06059	33.84270255	-117.8893257	Orange County
76343	Fee-for-Service	1578753562	1578753562	1	1	RAINS, CORINA E LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
76350	Fee-for-Service	1902125040	1902125040	1	1	RANDOLL, ERIN E LMFT	10/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93805	-	NOT APPLICABLE	0	In state provider	None	10201 MISSION GORGE RD	STE O	SANTEE	CA	92071	3027	37	06073	32.83844552	-116.9759925	San Diego County
76355	Fee-for-Service	1609168517	1609168517	1	1	ROCHON-DUCK, MICHAEL MD	6/4/2019	207R00000X	NA	Other	026	PHYSICIANS	123912	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76370	Fee-for-Service	1104963925	1104963925	1	1	RANSDELL, LAURA E LCSW	12/19/2012	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	56244 PAPAGO TRAIL	SUITE 5	YUCCA VALLEY	CA	92284	3285	36	06071	34.11972614	-116.4372902	San Bernardino County
76387	Fee-for-Service	1912029091	1912029091	1	2	RPP FAMILY AND ELDER CARE	7/2/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3975 JACKSON STREET	SUITE 203	RIVERSIDE	CA	92503	4001	33	06065	33.92729721	-117.4413503	Riverside County
76401	Fee-for-Service	1871515205	1871515205	1	1	ROOT, ROBERT A MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72730	36	Psychiatry	0	In state provider	None	2323 SACRAMENTO ST	None	SAN FRANCISCO	CA	94115	2328	38	06075	37.790109	-122.431555	San Francisco County
76426	Fee-for-Service	1912341066	1912341066	1	1	RICHARDSON, ANDREW G	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140648	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
76450	Fee-for-Service	1700867678	1700867678	1	1	REIMER, JERRY D MD	7/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81225	01	General Practice	0	In state provider	None	275 HERNDON AVE	None	CLOVIS	CA	93612	0000	10	06019	36.83772546	-119.7061946	Fresno County
76484	Fee-for-Service	1538304621	1538304621	1	1	RONEY HIBBERD, SUSAN M NP	2/24/2016	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
76499	Fee-for-Service	1679204325	1679204325	1	1	RIVERSIDE-SAN BERNARDINO COU	12/1/2022	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	C	53000 CAHUILLA ROAD	None	ANZA	CA	92539	9231	33	06065	33.54344233	-116.7356692	Riverside County
76507	Fee-for-Service	1912993973	1912993973	1	1	RODRIGUEZ, MARTHA L MD	8/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80070	08	Family Practice	0	In state provider	None	7340 FLORENCE AVE	STE 109	DOWNEY	CA	90240	3646	19	06037	33.9592158	-118.1413479	Los Angeles County
76535	Fee-for-Service	1871369553	1871369553	1	1	RAPID RESPONSE URGENT CARE,	2/20/2025	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	17559 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	5720	19	06037	34.26489548	-118.517301	Los Angeles County
76536	Fee-for-Service	1629061882	1629061882	1	4	REGENTS OF THE UNIV OF CA	2/1/2021	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
76560	Fee-for-Service	1285950444	1285950444	1	1	RASHIDI, BABAK MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138457	01	General Practice	0	In state provider	None	200 MUIR DRIVE	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
76568	Fee-for-Service	1841794633	1841794633	1	1	RIVERA, NANCY MD	5/2/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164381	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
76573	Fee-for-Service	1982938502	1982938502	1	1	RODRIGUEZ, GIBRHAM MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113926	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
76587	Fee-for-Service	1407935844	1407935844	1	1	RAMOS-PLATT, LEIGH K MD	8/2/2008	2084N0402X	NA	Neurology	026	PHYSICIANS	80955	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
76662	Fee-for-Service	1639246176	1639246176	1	1	RIOS, JAVIER R MD	9/14/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53521	None	None	0	In state provider	None	31946 MISSION TRAIL	STE A	LAKE ELSINORE	CA	92530	4539	33	06065	33.65640803	-117.2979656	Riverside County
76663	Fee-for-Service	1982964276	1982964276	1	1	REID, CHRISTOPHER M MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122947	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
76670	Fee-for-Service	1730801218	1730801218	1	1	RAMOS, WENDY A CNP	10/17/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
76750	Fee-for-Service	1467400135	1467400135	1	1	RONAY, THOMAS G MD	7/1/1998	207PE0004X	NA	Other	026	PHYSICIANS	62383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
76758	Fee-for-Service	1679835193	1679835193	1	2	REIDA, BRENDA L LPCC	6/26/2020	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
76780	Fee-for-Service	1750484754	1750484754	1	1	RILEY, JAMES E MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63461	08	Family Practice	0	In state provider	None	13350 BIG BASIN WAY	None	BOULDER CREEK	CA	95006	9237	44	06087	37.12492123	-122.1245364	Santa Cruz County
76788	Fee-for-Service	1679204325	1679204325	1	1	RIVERSIDE-SAN BERNARDINO COU	12/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	C	53000 CAHUILLA ROAD	None	ANZA	CA	92539	9231	33	06065	33.54344233	-116.7356692	Riverside County
76827	Fee-for-Service	1629061882	1629061882	1	4	REGENTS OF THE UNIV OF CA	2/1/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
76854	Fee-for-Service	1134612278	1134612278	1	1	RUBIN, ANDREA M A INC	1/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	531 E CHAPMAN AVE	STE D	ORANGE	CA	92866	1647	30	06059	33.78788653	-117.8480115	Orange County
76859	Fee-for-Service	1750312088	1750312088	1	1	RASHEED, KARIM MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43351	18	Ophthalmology	0	In state provider	None	1315 LAS TABLAS RD	None	TEMPLETON	CA	93465	9759	40	06079	35.55437455	-120.7225305	San Luis Obispo County
76919	Fee-for-Service	1669702379	1669702379	1	1	RICCI, SHANNON	12/17/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	24012 CALLE DE LA PLATA	SUITE 215	LAGUNA HILLS	CA	92653	7624	30	06059	33.61012113	-117.7115908	Orange County
76934	Fee-for-Service	1942970363	1942970363	1	1	ROSS, TRISTEN	2/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
76972	Fee-for-Service	1174611206	1174611206	1	1	REYES, NORMAN D MD	5/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	40111	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	333 UNIVERSITY AVE	SUITE 120	SACRAMENTO	CA	95825	6532	34	06067	38.570976	-121.416651	Sacramento County
76976	Fee-for-Service	1811246838	1811246838	1	1	RUGG, CANDICE M NP	12/12/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76994	Fee-for-Service	1023367216	1023367216	1	1	RIBEIRO CALDAS DOMINGUES,	6/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132160	36	Psychiatry	0	In state provider	ISABEL A MD	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
77021	Fee-for-Service	1669764486	1669764486	1	1	ROLNICK, JOSHUA A MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122275	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
77056	Fee-for-Service	1770901613	1770901613	1	2	RAGSDALE & CLAYTON	8/10/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CENTERS INC	3674 SUNNYSIDE DR	STE 2	RIVERSIDE	CA	92506	2403	33	06065	33.95450253	-117.3936375	Riverside County
77091	Fee-for-Service	1811465081	1811465081	1	1	RUIZ, DANAI Y LCSW	7/21/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5855 E NAPLES PLZ	215	LONG BEACH	CA	90803	5060	19	06037	33.75591002	-118.119711	Los Angeles County
77097	Fee-for-Service	1427046341	1427046341	1	1	RICAURTE, JUAN C MD	10/29/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	70169	41	Internal Medicine	0	In state provider	None	6255 W SUNSET BLVD	STE 2100	LOS ANGELES	CA	90028	7403	19	06037	34.09802749	-118.3255515	Los Angeles County
77123	Fee-for-Service	1790713394	1790713394	1	2	RIVERSIDE FAMILY	10/11/2023	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PHYSICIANS APMC	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
77169	Fee-for-Service	1427472463	1427472463	1	1	RESOLUTE HOSPITAL COMPANY	10/20/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	555 CREEKSIDE CROSSING	None	NEW BRAUNFELS	TX	78130	2594	00	None	29.71931256	-98.07120571	Comal County
77192	Fee-for-Service	1861812760	1861812760	1	1	REDDY, OPAL L MD	12/1/2020	207ZH0000X	NA	Other	026	PHYSICIANS	141144	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
77194	Fee-for-Service	1730165044	1730165044	1	1	RIM, PETER MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54885	83	Rheumatology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
77197	Fee-for-Service	1508803362	1508803362	1	1	RIES, MICHAEL D MD	3/31/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	50054	20	Orthopedic Surgery	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76351054	-122.4579681	San Francisco County
77256	Fee-for-Service	1043239189	1043239189	1	1	RALPHS GROCERY COMPANY	2/3/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RAPLHS STORE #196	2250 E CARSON ST	None	LONG BEACH	CA	90807	3044	19	06037	33.83241155	-118.1650095	Los Angeles County
77260	Fee-for-Service	1174611206	1174611206	1	1	REYES, NORMAN D MD	5/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	40111	02	General Surgery	0	In state provider	None	333 UNIVERSITY AVE	SUITE 120	SACRAMENTO	CA	95825	6532	34	06067	38.570976	-121.416651	Sacramento County
77265	Fee-for-Service	1487920963	1487920963	1	1	ROSENDALE, NICOLE L MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128038	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77332	Fee-for-Service	1720465511	1720465511	1	1	RAVINDRANATHAN, SHARMILA MD	7/31/2023	207R00000X	NA	Other	026	PHYSICIANS	178181	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
77367	Fee-for-Service	1962947630	1962947630	1	1	RYAN, NILES PT	9/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
77370	Fee-for-Service	1003637448	1003637448	1	1	REVITALIZE WELLNESS CENTER I	1/8/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NC	5170 N FLOYD AVE	None	FRESNO	CA	93723	9435	10	06019	36.810468	-119.995209	Fresno County
77396	Fee-for-Service	1558146563	1558146563	1	1	RUBAN, ANASTASIA LMFT	10/15/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
77412	Fee-for-Service	1790713394	1790713394	1	2	RIVERSIDE FAMILY	5/21/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PHYSICIANS APMC	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
77445	Fee-for-Service	1457767634	1457767634	1	1	RAGBIR-TOOLSIE, KRISTAL V MD	9/26/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	2116 CRAIG RD	None	EAU CLAIRE	WI	54701	6149	00	None	44.79642	-91.5191165	Eau Claire County
77450	Fee-for-Service	1609485127	1609485127	1	1	RADIN, RACHEL M PHD	11/5/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77451	Fee-for-Service	1275233975	1275233975	2	1	REID, BIANCA L	8/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
77453	Fee-for-Service	1427472463	1427472463	1	1	RESOLUTE HOSPITAL COMPANY	10/20/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	555 CREEKSIDE CROSSING	None	NEW BRAUNFELS	TX	78130	2594	00	None	29.71931256	-98.07120571	Comal County
77480	Fee-for-Service	1154610145	1154610145	1	1	ROY, REBECCA L MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140267	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
77538	Fee-for-Service	1609320597	1609320597	1	1	RIOS, JAMIE N LMFT	5/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
77577	Fee-for-Service	1700083359	1700083359	1	1	REEVES, SARAH S LMFT	6/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
77592	Fee-for-Service	1730253345	1730253345	1	1	RICHTER, RICHARD C MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51916	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
77630	Fee-for-Service	1497750640	1497750640	1	1	RAMANI, MANDY L MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72436	01	General Practice	0	In state provider	None	1346 FOOTHILL BLVD	STE 203	LA CANADA	CA	91011	2141	19	06037	34.20780552	-118.2076252	Los Angeles County
77647	Fee-for-Service	1700401627	1700401627	1	1	RX PHARMA INC	12/29/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18840 VENTURA BLVD	120	TARZANA	CA	91356	3301	19	06037	34.17204394	-118.5442921	Los Angeles County
77659	Fee-for-Service	1144586371	1144586371	1	1	RAO, SISHIR MD	10/26/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	166807	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
77663	Fee-for-Service	1952366163	1952366163	1	1	RYAN, SUSAN MAREE	7/19/1995	207L00000X	NA	Other	026	PHYSICIANS	76843	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
77691	Fee-for-Service	1659424885	1659424885	1	2	RIVERSIDE-SAN BERNARDINO	7/13/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	39100 CONTRERAS ROAD	SUITE C	ANZA	CA	92539	8724	33	06065	33.55389243	-116.6746342	Riverside County
77692	Fee-for-Service	1477546406	1477546406	1	1	REGENTS/UCDPBG/RADIOLOGY	5/1/1985	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
77698	Fee-for-Service	1790713394	1790713394	1	2	RIVERSIDE FAMILY	4/11/2022	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PHYSICIANS APMC	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
77778	Fee-for-Service	1447286489	1447286489	1	1	REDDY, SRAVANTHI R MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73740	30	Radiology	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
77820	Fee-for-Service	1427183508	1427183508	1	1	RADIOLOGY ASSOC OF SLO	7/1/1982	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1010 MURRAY ST	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.29101669	-120.6663647	San Luis Obispo County
77846	Fee-for-Service	1821193970	1821193970	1	1	RAPHAEL, DAVID A MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60734	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
77869	Fee-for-Service	1528787132	1528787132	1	1	ROZO, JOSE A NP	10/10/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77887	Fee-for-Service	1861508509	1861508509	1	1	RICHARDS, KRISTINE F LCSW	1/29/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8318 UNIVERSITY AVE	SUITE A-2	LA MESA	CA	91942	9358	37	06073	32.76790659	-117.0185664	San Diego County
77915	Fee-for-Service	1831304021	1831304021	1	1	RAO, VEENA A MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84524	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
77922	Fee-for-Service	1912928565	1912928565	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	1760 W 16TH ST	None	SAN BERNARDINO	CA	92411	1160	36	06071	34.12857759	-117.3252109	San Bernardino County
77951	Fee-for-Service	1245267285	1245267285	1	1	RUNDLE, KEITH V MD	7/24/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	79729	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
77954	Fee-for-Service	1780947499	1780947499	1	1	RODRIGUEZ, MARIA G MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133261	01	General Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
77969	Fee-for-Service	1831678689	1831678689	1	1	ROGALLA, STEPHAN MD	10/9/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77974	Fee-for-Service	1912979204	1912979204	1	1	RODRIGUEZ, FAUSTO J MD	9/28/2021	207ZP0105X	NA	Other	026	PHYSICIANS	173820	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
77980	Fee-for-Service	1659424885	1659424885	1	2	RIVERSIDE-SAN BERNARDINO	7/13/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	39100 CONTRERAS ROAD	SUITE C	ANZA	CA	92539	8724	33	06065	33.55389243	-116.6746342	Riverside County
77984	Fee-for-Service	1225013204	1225013204	1	1	ROHN, JAMES G JR MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	26733	30	Radiology	0	In state provider	None	10115 HIGHWAY 49	None	SONORA	CA	95370	9456	55	06109	38.00376433	-120.4266899	Tuolumne County
77985	Fee-for-Service	1790713394	1790713394	1	2	RIVERSIDE FAMILY	11/22/2016	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PHYSICIANS APMC	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
78054	Fee-for-Service	1124240874	1124240874	1	1	RAVIKUMAR, ASHA R MD	8/5/2009	207R00000X	NA	Other	026	PHYSICIANS	99469	45	Nephrology (Renal-Kidney)	0	In state provider	None	1801 W ROMNEYA DR	#207	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
78058	Fee-for-Service	1912042342	1912042342	1	1	RENAL CONSULTANTS MED GR	5/31/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
78074	Fee-for-Service	1952486615	1952486615	1	1	ROMANO, CARMELA G MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	5912	01	General Practice	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
78086	Fee-for-Service	1639433709	1639433709	1	1	RAJ, JANICE J PSYD	11/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
78088	Fee-for-Service	1881894715	1881894715	1	1	ROMANENKO, DMITRIY MD	12/21/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94512	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5831 FIRESTONE BLVD	STE E	SOUTH GATE	CA	90280	3718	19	06037	33.95077836	-118.1645843	Los Angeles County
78108	Fee-for-Service	1154356947	1154356947	1	1	RAO, JIANYU MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55745	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
78137	Fee-for-Service	1316452592	1316452592	1	1	RANDLEMAN, MICHAEL LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
78150	Fee-for-Service	1164910402	1164910402	1	1	ROMBOY, MAKAYLA MD	6/3/2024	207PP0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
78154	Fee-for-Service	1417222688	1417222688	1	1	ROYZMAN, MICHELLE L MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123058	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
78166	Fee-for-Service	1134313240	1134313240	1	1	RODRIGUEZ, DAVID MD INC	10/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79225	28	Proctology (colon and rectal)	0	In state provider	None	3939 J ST	STE 250	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
78180	Fee-for-Service	1487951224	1487951224	1	1	RINCON, KATHRYN D CCC-SLP	11/8/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	787 MUNRAS AVE	SUITE 101	MONTEREY	CA	93940	3128	27	06053	36.59424304	-121.8933177	Monterey County
78196	Fee-for-Service	1811150303	1811150303	1	1	ROSSETTI, CINDY MD	11/14/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
78204	Fee-for-Service	1184919524	1184919524	1	1	RAMKUMAR, HEMA L MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121980	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78269	Fee-for-Service	1447441530	1447441530	1	1	REHABCARE UNLIMITED PHYSICAL	2/2/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
78272	Fee-for-Service	1821436163	1821436163	1	1	RIDOUT, SAMUEL J MD	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148076	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
78302	Fee-for-Service	1679038434	1679038434	1	1	RIDGECREST REGIONAL HOSPITAL	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	105 E SYDNOR STREET	SUITES 100 AND 204	RIDGECREST	CA	93555	3130	15	06029	35.64096373	-117.6688699	Kern County
78336	Fee-for-Service	1043872872	1043872872	1	1	RICKETTS, EMILY PHD	9/11/2019	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
78366	Fee-for-Service	1477896686	1477896686	1	1	RENIK, MARGARET L MD	9/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125054	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
78374	Fee-for-Service	1881894715	1881894715	1	1	ROMANENKO, DMITRIY MD	12/21/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94512	02	General Surgery	0	In state provider	None	5831 FIRESTONE BLVD	STE E	SOUTH GATE	CA	90280	3718	19	06037	33.95077836	-118.1645843	Los Angeles County
78379	Fee-for-Service	1942572631	1942572631	1	1	REZAEI, PARI	4/27/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
78387	Fee-for-Service	1922552645	1922552645	1	1	ROZOVSKAYA, OLGA CRNA	8/28/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
78411	Fee-for-Service	1134283948	1134283948	1	1	RIDDLE, JOSEPH M PSYD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
78421	Fee-for-Service	1740744010	1740744010	1	1	REFFELL, SANDRINE C RCP	9/7/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
78433	Fee-for-Service	1053525188	1053525188	1	1	RAMESH, VIDYA K MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110935	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
78459	Fee-for-Service	1427078328	1427078328	1	1	RALEY'S	7/28/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4900 ELK GROVE BLVD	None	ELK GROVE	CA	95758	4188	34	06067	38.407644	-121.4486055	Sacramento County
78467	Fee-for-Service	1922494392	1922494392	1	1	ROBBINS, MICHAEL MD	12/4/2020	207P00000X	NA	Other	026	PHYSICIANS	169634	None	None	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
78494	Fee-for-Service	1699015750	1699015750	1	1	RADOSEVICH, JEANA T MD	1/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122342	None	None	0	In state provider	None	595 CENTER AVE	SUITE 300	MARTINEZ	CA	94553	4633	07	06013	37.99313048	-122.1189497	Contra Costa County
78553	Fee-for-Service	1447441530	1447441530	1	1	REHABCARE UNLIMITED PHYSICAL	1/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
78566	Fee-for-Service	1083921977	1083921977	1	1	RILEY, MICHELLE L LCSW	1/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RSHIP	3340 TULLY RD	SUITE D4	MODESTO	CA	95350	0852	50	06099	37.687248	-121.0124415	Stanislaus County
78588	Fee-for-Service	1679038434	1679038434	1	1	RIDGECREST REGIONAL HOSPITAL	11/6/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	105 E SYDNOR STREET	SUITES 100 AND 204	RIDGECREST	CA	93555	3130	15	06029	35.64096373	-117.6688699	Kern County
78604	Fee-for-Service	1164455572	1164455572	1	1	REIN, JODY A. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1801 16TH STREET	None	GREELEY	CO	80633	0000	00	None	40.41386551	-104.7097035	Weld County
78618	Fee-for-Service	1154459998	1154459998	1	1	RUBASHKIN, NICHOLAS A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94707	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
78701	Fee-for-Service	1023484433	1023484433	1	1	RUBIN, MOREEN PSYD	3/31/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
78703	Fee-for-Service	1770878324	1770878324	1	1	ROBINSON, SHANNON L DO	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13899	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
78708	Fee-for-Service	1053525188	1053525188	1	1	RAMESH, VIDYA K MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110935	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
78750	Fee-for-Service	1285356535	1285356535	1	1	REMIGIO, CLAUDETTE NP	2/28/2025	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
78774	Fee-for-Service	1164596490	1164596490	1	1	RAI CARE CENTERS OF NORTHERN	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA I LLC	3011 CERES AVE	SUITE 125	CHICO	CA	95973	9804	04	06007	39.77592447	-121.8384651	Butte County
78819	Fee-for-Service	1639413404	1639413404	1	1	ROBERTS, MARTHA A NP	3/1/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
78842	Fee-for-Service	1447441530	1447441530	1	1	REHABCARE UNLIMITED PHYSICAL	2/12/2024	225100000X	NA	Physical Therapist	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
78859	Fee-for-Service	1235185992	1235185992	1	1	ROSS, CATHRYN MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1144 SONOMA AVE	STE 113	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
78888	Fee-for-Service	1437338449	1437338449	1	1	RUZO, SHIRLEY R PHD	9/15/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
78905	Fee-for-Service	1780763474	1780763474	1	1	ROGERS, JOHN P LPCC	6/1/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
78937	Fee-for-Service	1467676353	1467676353	1	1	ROXAS, CZARINA J MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107056	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1328 TWENTY SECOND ST	None	SANTA MONICA	CA	90404	2091	19	06037	34.03122319	-118.4797185	Los Angeles County
78943	Fee-for-Service	1982031597	1982031597	1	1	REEVE, WENDY MD	2/26/2021	207R00000X	NA	Other	026	PHYSICIANS	170942	None	None	0	In state provider	None	2300 CALIFORNIA ST	103	SAN FRANCISCO	CA	94115	2753	38	06075	37.78910083	-122.4323944	San Francisco County
78948	Fee-for-Service	1760541569	1760541569	1	5	RETINA INSTITUTE OF CALIFORN	9/15/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
78956	Fee-for-Service	1891028866	1891028866	1	1	RAGAN, ERICA P PHD	11/17/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
78980	Fee-for-Service	1326343336	1326343336	1	1	RAMIREZ, ROXANNA	6/10/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
79021	Fee-for-Service	1194284257	1194284257	1	1	REINITZ, FELICIA S MD	4/24/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	181279	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
79053	Fee-for-Service	1164581765	1164581765	1	1	ROGEN, BRUCE I MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46341	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
79072	Fee-for-Service	1790718773	1790718773	1	1	RASHID, UZMA MD	7/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89333	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
79076	Fee-for-Service	1922065341	1922065341	1	1	ROBERT GOLDSZER	9/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 ALTON RD	None	MIAMI BEACH	FL	33140	2948	00	None	25.81334191	-80.139276	Miami-Dade County
79094	Fee-for-Service	1255375341	1255375341	1	1	RIVERA, LUIS M MD INC	1/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69601	05	Anesthesiology	0	In state provider	None	760 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	3923	37	06073	33.148926	-117.10188	San Diego County
79105	Fee-for-Service	1689470122	1689470122	1	1	RUSS L LEVITAN MD INC	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	10 SANTA ROSA ST	SUITE 201	SAN LUIS OBISPO	CA	93405	5826	40	06079	35.29325417	-120.667547	San Luis Obispo County
79142	Fee-for-Service	1457555864	1457555864	1	1	RUSSELL, MARK T MD	1/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109063	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
79143	Fee-for-Service	1336769058	1336769058	1	1	RAMANATHAN, MUTHUKUMAR MD	7/3/2023	207ZP0101X	NA	Other	026	PHYSICIANS	183953	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
79158	Fee-for-Service	1063731693	1063731693	1	1	RUSSELL, PATRICK M MD	1/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	832 WILLOW ST	None	RENO	NV	89434	9641	00	None	39.52468616	-119.8016173	Washoe County
79160	Fee-for-Service	1104280783	1104280783	1	1	RAHMAN, AADIL M DO	10/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
79164	Fee-for-Service	1972545952	1972545952	1	1	RANDAZZO, MARCO ROGER MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69186	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
79197	Fee-for-Service	1063408490	1063408490	1	1	REZAI, NINA MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63177	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
79200	Fee-for-Service	1760958342	1760958342	1	1	ROGUE VALLEY MEDICAL TRANSPO	11/22/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	RT, LLC.	200 W JACKSON ST	None	MEDFORD	OR	97501	2440	00	None	42.33110545	-122.880357	Jackson County
79205	Fee-for-Service	1518960061	1518960061	1	1	RIDER, KENNETH L PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4966 EL CAMINO REAL	STE 119	LOS ALTOS	CA	94022	1406	43	06085	37.397593	-122.1063372	Santa Clara County
79209	Fee-for-Service	1275904047	1275904047	1	1	RAJAEI, NILOUFAR NP	4/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
79216	Fee-for-Service	1629596515	1629596515	1	1	RODRIGUEZ, ARLENE LCSW	1/16/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
79227	Fee-for-Service	1558758763	1558758763	1	1	ROPER, JON B MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144528	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
79237	Fee-for-Service	1619364940	1619364940	1	1	RYBKIN, IVAN MD	8/29/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	143769	15	Obstetrics (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
79238	Fee-for-Service	1760541569	1760541569	1	5	RETINA INSTITUTE OF CALIFORN	9/15/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
79239	Fee-for-Service	1487682084	1487682084	1	1	RAZZOUK, ANEES	5/31/1985	208G00000X	NA	General Surgery	026	PHYSICIANS	50813	None	None	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
79301	Fee-for-Service	1477201564	1477201564	1	1	RAMIREZ, JEANETTE DO	8/15/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
79318	Fee-for-Service	1558651497	1558651497	1	1	RAKOW PENNER, REBECCA A MD	9/20/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	128755	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
79343	Fee-for-Service	1730379728	1730379728	1	1	RUPANI, RAVIN M MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92837	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	SUITE 207	ANAHEIM	CA	92801	2810	30	06059	33.84718298	-117.933758	Orange County
79345	Fee-for-Service	1588234447	1588234447	1	1	RESTORATIVE SPINE AND PAIN,	3/3/2023	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC.	1105 LAS TABLAS RD	STE D	TEMPLETON	CA	93465	9480	40	06079	35.55437047	-120.7191105	San Luis Obispo County
79364	Fee-for-Service	1326384579	1326384579	1	1	REEDLEY COMMUNITY HOSPITAL	6/11/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	337 E KINGS STREET	None	AVENAL	CA	93204	1630	16	06031	36.00253508	-120.1335979	Kings County
79366	Fee-for-Service	1629061882	1629061882	1	3	REGENTS OF THE UNIV OF CA	6/19/2012	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	77 CADILLAC DR	SUITE 101	SACRAMENTO	CA	95825	8337	34	06067	38.572551	-121.4181585	Sacramento County
79377	Fee-for-Service	1730299496	1730299496	1	1	RALEYS	10/7/1983	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	311 S. LOWER SACRAMENTO	None	LODI	CA	95242	3322	39	06077	38.1296925	-121.3068518	San Joaquin County
79378	Fee-for-Service	1538574736	1538574736	1	1	RAHMANIAN, SAMIRA MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144433	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
79401	Fee-for-Service	1013758184	1013758184	1	1	RAJ, MUHAMMAD MD	12/30/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
79440	Fee-for-Service	1265042949	1265042949	1	1	REYES, LISSETH K LMFT	10/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
79456	Fee-for-Service	1780211086	1780211086	1	1	RAHMAN, MEGAN DO	1/26/2024	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	21054	None	None	0	In state provider	None	17742 BEACH BLVD	STE 360	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
79460	Fee-for-Service	1215925292	1215925292	1	1	ROSETT, ROBERT C	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70990	08	Family Practice	0	In state provider	None	780 E ROMIE LN	STE C	SALINAS	CA	93901	4223	27	06053	36.65861498	-121.6403327	Monterey County
79463	Fee-for-Service	1407032501	1407032501	1	1	ROBISON, KERRIE L	7/1/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18687 MAIN ST	STE 102	GROVELAND	CA	95321	9432	55	06109	37.8384463	-120.2312997	Tuolumne County
79466	Fee-for-Service	1356304034	1356304034	1	1	REGENTS OF THE UNIVERSITY OF	10/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
79500	Fee-for-Service	1205320298	1205320298	1	1	ROSSI MEYER, MONICA K MD	6/23/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	184458	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
79516	Fee-for-Service	1730250648	1730250648	1	1	ROMIAS, BRIAN K MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66978	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
79523	Fee-for-Service	1619364940	1619364940	1	1	RYBKIN, IVAN MD	8/29/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	143769	09	Gynecology (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
79524	Fee-for-Service	1528096138	1528096138	1	1	RIEG, GUNTER K MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	72522	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
79531	Fee-for-Service	1417393745	1417393745	1	1	RODRIGUEZ, DULCE Y MD	12/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137237	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
79572	Fee-for-Service	1326669045	1326669045	1	1	ROSENBLATT, ANDREW S PHD	6/10/2022	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
79604	Fee-for-Service	1083788681	1083788681	1	1	RUSH, SHANNON M DPM	3/15/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
79630	Fee-for-Service	1588234447	1588234447	1	1	RESTORATIVE SPINE AND PAIN,	3/3/2023	208100000X	NA	Physical Medicine and Rehabilitation	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC.	1105 LAS TABLAS RD	STE D	TEMPLETON	CA	93465	9480	40	06079	35.55437047	-120.7191105	San Luis Obispo County
79634	Fee-for-Service	1194830828	1194830828	1	1	RAO, PRIYA MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120372	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
79649	Fee-for-Service	1326384579	1326384579	1	1	REEDLEY COMMUNITY HOSPITAL	12/10/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	337 E KINGS STREET	None	AVENAL	CA	93204	1630	16	06031	36.00253508	-120.1335979	Kings County
79654	Fee-for-Service	1629061882	1629061882	1	3	REGENTS OF THE UNIV OF CA	6/19/2012	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	77 CADILLAC DR	SUITE 101	SACRAMENTO	CA	95825	8337	34	06067	38.572551	-121.4181585	Sacramento County
79665	Fee-for-Service	1568849495	1568849495	1	1	REILLY, DAVID F MD	3/8/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	162735	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
79676	Fee-for-Service	1942241336	1942241336	1	1	RHODEMAN, THOMAS J JR MD	10/31/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	48141	30	Radiology	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
79680	Fee-for-Service	1285817809	1285817809	1	1	RUIZ, MAGDALENA NP	2/2/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
79723	Fee-for-Service	1912046012	1912046012	1	1	RANCHO RESEARCH INSTITUTE	2/1/1995	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	EDUCATION INSTITUTE, INC	7450 LEEDS ST	None	DOWNEY	CA	90242	3379	19	06037	33.9299776	-118.1599345	Los Angeles County
79808	Fee-for-Service	1912306416	1912306416	1	1	ROMAN, GERALDINE LMFT	3/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
79819	Fee-for-Service	1265926182	1265926182	1	1	RODRIGUEZ, CRYSTAL LCSW	7/29/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
79835	Fee-for-Service	1265559348	1265559348	1	1	ROMANO, RENEE L G	10/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
79838	Fee-for-Service	1831403575	1831403575	1	1	RACINES, JUDRYN M MD	11/24/2019	207R00000X	NA	Other	026	PHYSICIANS	158773	41	Internal Medicine	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
79856	Fee-for-Service	1841653755	1841653755	1	1	REISS, JONATHAN MD	6/17/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153696	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
79871	Fee-for-Service	1689777609	1689777609	1	1	ROY W GRAVES, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E KINCAID STREET	None	MOUNT VERNON	WA	98274	0000	00	None	48.41742639	-122.323873	Skagit County
79881	Fee-for-Service	1871610675	1871610675	1	1	RODRIGUEZ-UKES, KATHLEEN	5/28/2004	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 S KRAEMER BLVD	STE 228	PLACENTIA	CA	92870	6102	30	06059	33.87035522	-117.8630104	Orange County
79897	Fee-for-Service	1831560184	1831560184	1	1	ROYAL HOMEHEALTH CARE INC	10/15/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14328 VICTORY BLVD	SUITE 203	VAN NUYS	CA	91401	6510	19	06037	34.1866137	-118.4454117	Los Angeles County
79917	Fee-for-Service	1033388616	1033388616	1	1	RAO, SOUMYA G MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99911	83	Rheumatology	0	In state provider	None	3633 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4014	37	06073	32.77798059	-117.1163142	San Diego County
79940	Fee-for-Service	1326384579	1326384579	1	1	REEDLEY COMMUNITY HOSPITAL	6/11/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	337 E KINGS STREET	None	AVENAL	CA	93204	1630	16	06031	36.00253508	-120.1335979	Kings County
79949	Fee-for-Service	1922218676	1922218676	1	1	RODIL, SURESH J MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
79953	Fee-for-Service	1700314713	1700314713	1	1	REZVANI, RODD MD	4/20/2023	207L00000X	NA	Other	026	PHYSICIANS	178348	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
79979	Fee-for-Service	1700310414	1700310414	1	1	REDDI, SRIKANTH MD	5/3/2023	207R00000X	NA	Other	026	PHYSICIANS	161693	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
80009	Fee-for-Service	1881055853	1881055853	1	1	RAMIREZ-ONTIVEROS, JORGE A M	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
80036	Fee-for-Service	1720253941	1720253941	1	1	ROHATGI, RAJAT MD	11/20/2008	207RX0202X	NA	Oncology	026	PHYSICIANS	83993	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MIC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
80087	Fee-for-Service	1366984544	1366984544	1	1	RIVERA, CASSANDRA M CNM	6/13/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
80117	Fee-for-Service	1215389564	1215389564	1	1	REYNA, CAROLINE LMFT	1/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
80122	Fee-for-Service	1083633721	1083633721	1	1	ROBLES, LYDIA G LMFT	2/20/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16600 WOODRUFF AVE	STE 102	BELLFLOWER	CA	90706	4916	19	06037	33.88354622	-118.1173077	Los Angeles County
80147	Fee-for-Service	1124135108	1124135108	1	1	REBECCA LOREDO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
80190	Fee-for-Service	1609477090	1609477090	1	1	RIZO, CARLA LMFT	6/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	146883	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD STREET	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
80205	Fee-for-Service	1033388616	1033388616	1	1	RAO, SOUMYA G MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99911	41	Internal Medicine	0	In state provider	None	3633 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4014	37	06073	32.77798059	-117.1163142	San Diego County
80208	Fee-for-Service	1265718035	1265718035	1	1	ROSSI, BLAKE M	2/19/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
80224	Fee-for-Service	1356441190	1356441190	1	1	REINHART, MICHAEL A MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30413	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
80228	Fee-for-Service	1326384579	1326384579	1	1	REEDLEY COMMUNITY HOSPITAL	2/1/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	337 E KINGS STREET	None	AVENAL	CA	93204	1630	16	06031	36.00253508	-120.1335979	Kings County
80229	Fee-for-Service	1164817391	1164817391	1	1	RAM, SARMISTA S DO	9/11/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15673	08	Family Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
80325	Fee-for-Service	1720253941	1720253941	1	1	ROHATGI, RAJAT MD	11/20/2008	207RX0202X	NA	Oncology	026	PHYSICIANS	83993	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MIC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
80329	Fee-for-Service	1346266954	1346266954	1	2	REEKSTIN ENTERPRISES INC.	2/10/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1026 CHAPMAN	B & C	ORANGE	CA	92866	2149	30	06059	33.78782648	-117.8429265	Orange County
80343	Fee-for-Service	1588778815	1588778815	1	1	RAMSEYER, JOANNA K MD	12/31/1990	207P00000X	NA	Other	026	PHYSICIANS	43327	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	FAIRFIELD	CA	95240	5179	39	06077	38.12188356	-121.285872	San Joaquin County
80373	Fee-for-Service	1528081270	1528081270	1	1	REIDY, JOHN P MD	6/30/1992	207L00000X	NA	Other	026	PHYSICIANS	55546	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
80437	Fee-for-Service	1043413438	1043413438	1	1	RODRIGUEZ EBOLI AROZTEGUY,	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121485	14	Neurological Surgery	0	In state provider	MARIA P MD	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
80452	Fee-for-Service	1720304751	1720304751	1	1	RUSSELL, KYLA A	6/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
80467	Fee-for-Service	1932494226	1932494226	1	2	REYES HERNANDEZ, RAUL MD	10/31/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	127581	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
80488	Fee-for-Service	1619036183	1619036183	1	1	RIGSBY, RHODES L MD	1/1/1990	207R00000X	NA	Other	026	PHYSICIANS	64063	41	Internal Medicine	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
80490	Fee-for-Service	1396050829	1396050829	1	1	REDWOOD SURGERY CENTER LP	5/14/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	20998 REDWOOD RD	None	CASTRO VALLEY	CA	94546	5918	01	06001	37.69338464	-122.0737355	Alameda County
80493	Fee-for-Service	1083040992	1083040992	1	1	RUEZGA, SANDRA OD	9/19/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1026B WEST COVINA PKWY	None	WEST COVINA	CA	91790	8212	19	06037	34.06852268	-117.9314089	Los Angeles County
80516	Fee-for-Service	1720422934	1720422934	1	1	RICHMOND, SHANNON K NP	8/29/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95006341	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
80550	Fee-for-Service	1912042342	1912042342	1	2	RENAL CONSULTANTS MED GR	5/31/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	23928 LYONS AVE	STE 205	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
80613	Fee-for-Service	1881856300	1881856300	1	1	RIANNA C. LEAZER	2/15/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
80629	Fee-for-Service	1679796486	1679796486	1	1	RICHARD IAN GRAY M.D.	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
80674	Fee-for-Service	1558779884	1558779884	1	1	RAHMAN, FARAH S NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
80722	Fee-for-Service	1780800615	1780800615	1	1	RICE, KYLA M MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99647	08	Family Practice	0	In state provider	None	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	49	06097	38.479743	-122.729625	Sonoma County
80733	Fee-for-Service	1427386044	1427386044	1	1	RODRIGUEZ, ELAINE M OT	12/6/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12411 SLAUSON AVE	STE H	WHITTIER	CA	90606	2835	19	06037	33.96028839	-118.0529975	Los Angeles County
80772	Fee-for-Service	1598476608	1598476608	1	1	RASMUSSEN, MATTHEW PT	3/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
80826	Fee-for-Service	1033695879	1033695879	1	1	RABAH SAMI	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BROOKLYN	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
80870	Fee-for-Service	1750307757	1750307757	1	1	ROBERT J MORRISON M.D.	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 34TH ST	STE 400	AUSTIN	TX	78705	1922	00	None	30.30410411	-97.74771241	Travis County
80875	Fee-for-Service	1932494226	1932494226	1	1	REYES HERNANDEZ, RAUL MD	10/31/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	127581	-	NOT APPLICABLE	0	In state provider	None	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
80903	Fee-for-Service	1174056774	1174056774	1	1	RAYAN, NISMA CCC-SLP	2/26/2021	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
80964	Fee-for-Service	1487901112	1487901112	1	1	RAI, ANAND KUMAR MD	5/5/2020	207RC0200X	NA	Other	026	PHYSICIANS	153350	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
80966	Fee-for-Service	1760541569	1760541569	1	21	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	5400 BALBOA BLVD	222	ENCINO	CA	91316	1502	19	06037	34.169283	-118.501072	Los Angeles County
80967	Fee-for-Service	1821092297	1821092297	2	1	REGIONAL TOXICOLOGY SERVICES	1/15/2025	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	, LLC	2617 E. L ST	None	TACOMA	WA	98421	2205	00	None	47.23938779	-122.4167961	Pierce County
80982	Fee-for-Service	1548872351	1548872351	1	1	RAMIREZ, DAIMI Y PT	9/25/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
81008	Fee-for-Service	1225493356	1225493356	1	2	REEKESHRPATELMD INC	6/27/2018	193400000X	NA	Other	026	PHYSICIANS	126035	01	General Practice	0	In state provider	None	323 N PRAIRIE AVE	STE 417	INGLEWOOD	CA	90301	4506	19	06037	33.966333	-118.3439975	Los Angeles County
81015	Fee-for-Service	1104815067	1104815067	1	2	REGENTS/UCDPBG/PED IC	5/1/1999	2080P0203X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
81017	Fee-for-Service	1245487586	1245487586	1	1	RILEY, ALIDA D	11/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43700 17TH STREET WEST	SUITE 202	LANCASTER	CA	93534	4661	19	06037	34.677063	-118.161233	Los Angeles County
81043	Fee-for-Service	1710017165	1710017165	1	1	REID, ROBERTA H MFT	3/17/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43223	-	NOT APPLICABLE	0	In state provider	None	916 N MOUNTAIN AVENUE	A	UPLAND	CA	91786	3658	36	06071	34.105419	-117.670193	San Bernardino County
81079	Fee-for-Service	1679165484	1679165484	1	1	RA INVESTMENT CAPITAL,INC	10/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1080 LA CIENEGA BLVD	STE 105	LOS ANGELES	CA	90035	2686	19	06037	34.057206	-118.3761845	Los Angeles County
81092	Fee-for-Service	1104994060	1104994060	1	1	RYKEN, PATRICK W PT	4/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
81150	Fee-for-Service	1699934133	1699934133	1	1	RODRIGUEZ, SAMUEL T MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129751	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81152	Fee-for-Service	1013386580	1013386580	1	1	ROBBINS RIOS, LAURA	6/24/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
81168	Fee-for-Service	1952565780	1952565780	1	1	ROBERTSON, CATHERINE M MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87544	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
81204	Fee-for-Service	1326135328	1326135328	1	1	RAJASEKHAR, DAMODARA MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55917	40	Pediatrics	0	In state provider	A MEDICAL CORPORATION	18182 OUTER HIGHWAY 18	STE 103	APPLE VALLEY	CA	92307	2159	36	06071	34.54090019	-117.2676208	San Bernardino County
81228	Fee-for-Service	1861558918	1861558918	1	1	REZZADEH, RUDY R MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55967	41	Internal Medicine	0	In state provider	None	22900 VENTURA BLVD	STE 5704	WOODLAND HILLS	CA	91364	1204	19	06037	34.16502532	-118.626386	Los Angeles County
81231	Fee-for-Service	1609188333	1609188333	1	1	RASKIN, ERIN E LAC	8/3/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
81256	Fee-for-Service	1760541569	1760541569	1	21	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5400 BALBOA BLVD	222	ENCINO	CA	91316	1502	19	06037	34.169283	-118.501072	Los Angeles County
81310	Fee-for-Service	1861063463	1861063463	1	1	RICO, REGINA RN PNP	1/24/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	415 W ROUTE 66 STE 202	None	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
81318	Fee-for-Service	1477569655	1477569655	1	1	RUELAS, ANTONIO MD	7/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34343	08	Family Practice	0	In state provider	None	128 N 10TH ST	None	SANTA PAULA	CA	93060	2803	56	06111	34.35503975	-119.0605395	Ventura County
81333	Fee-for-Service	1871650127	1871650127	1	1	RALPHS GROCERY COMPANY	10/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #113	16225 SIERRA LAKES PKWY	None	FONTANA	CA	92336	1245	36	06071	34.13828174	-117.4502183	San Bernardino County
81360	Fee-for-Service	1386637346	1386637346	1	4	REGENTS/UCDPBG/PEDIATRIC	1/23/2023	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
81362	Fee-for-Service	1679174684	1679174684	1	1	ROSSI, MEREDITH W LMFT	11/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
81431	Fee-for-Service	1902466121	1902466121	1	1	REES, RYAN MD	4/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	187319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
81440	Fee-for-Service	1699934133	1699934133	1	1	RODRIGUEZ, SAMUEL T MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129751	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81462	Fee-for-Service	1992363956	1992363956	1	1	RAGHAVAN, RANJITA MD	7/28/2023	207P00000X	NA	Other	026	PHYSICIANS	184333	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
81475	Fee-for-Service	1275866121	1275866121	1	1	RAMIREZ, GLORIA LMFT	3/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
81503	Fee-for-Service	1801910138	1801910138	1	1	RATTI, JYOTHI MD	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106802	41	Internal Medicine	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
81514	Fee-for-Service	1861558918	1861558918	1	1	REZZADEH, RUDY R MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55967	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	22900 VENTURA BLVD	STE 5704	WOODLAND HILLS	CA	91364	1204	19	06037	34.16502532	-118.626386	Los Angeles County
81517	Fee-for-Service	1356334452	1356334452	1	1	REGENTS/UCDPBG/PED HEMOC	5/1/1983	2080P0207X	NA	Hematology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
81535	Fee-for-Service	1215226915	1215226915	1	1	REDDY, RADHIKA Z MD	12/4/2017	207RP1001X	NA	Pulmonology	026	PHYSICIANS	123736	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
81577	Fee-for-Service	1932580990	1932580990	1	1	ROSTOMIAN, ARA H MD	2/8/2019	207R00000X	NA	Other	026	PHYSICIANS	145935	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
81583	Fee-for-Service	1689296311	1689296311	1	1	REINHARDT, JANAE A LCSW	6/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
81594	Fee-for-Service	1780277251	1780277251	1	1	ROSENBLATT, TATIANA R MD	5/13/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
81600	Fee-for-Service	1588907604	1588907604	1	1	RIGUAL, DAVID A MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153835	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81609	Fee-for-Service	1356396501	1356396501	1	1	RABIZADEH, SUSAN M MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103599	07	Dermatology	0	In state provider	None	200 N ROBERTSON AVE	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.069509	-118.383743	Los Angeles County
81646	Fee-for-Service	1386637346	1386637346	1	4	REGENTS/UCDPBG/PEDIATRIC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
81708	Fee-for-Service	1477502425	1477502425	1	1	REILLY, LINDA MD	6/11/1998	2086S0129X	NA	General Surgery	026	PHYSICIANS	47462	02	General Surgery	0	In state provider	None	488 MOFFITT HOSPITAL	None	SAN FRANCISCO	CA	94143	0001	38	06075	0	0	None
81712	Fee-for-Service	1124003181	1124003181	1	1	ROBINSON, M LAURA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PROGESSIVE MEDICAL ASSOC	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
81728	Fee-for-Service	1740246669	1740246669	3	1	ROSA L RANGEL MD AND PEDRO	8/31/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ACEVES	3304 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239308	-124.1360417	Humboldt County
81733	Fee-for-Service	1144539305	1144539305	1	1	RUDELL, JOLENE C MD	8/15/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	135469	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
81744	Fee-for-Service	1902807654	1902807654	2	1	RIVERBANK REHABILITATION	7/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER, LLC	2649 TOPEKA ST	None	RIVERBANK	CA	95367	2248	50	06099	37.73702433	-120.9484667	Stanislaus County
81770	Fee-for-Service	1902159270	1902159270	1	1	ROBERTS, TRICIA M MD	12/8/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	134793	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
81785	Fee-for-Service	1861593840	1861593840	1	1	RITTER, MANFRED P MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72523	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
81794	Fee-for-Service	1518913029	1518913029	1	1	RHODES, LEILA MD INC	2/23/2010	207R00000X	NA	Other	026	PHYSICIANS	85877	41	Internal Medicine	0	In state provider	None	6525 LA JOLLA BLVD	None	LA JOLLA	CA	92037	6016	37	06073	32.82740592	-117.276931	San Diego County
81805	Fee-for-Service	1942449780	1942449780	1	1	RATHI, PRABODH D MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122987	41	Internal Medicine	0	In state provider	None	108 GREEN VALLEY ROAD	None	FREEDOM	CA	95019	3110	44	06087	36.93669269	-121.7720262	Santa Cruz County
81808	Fee-for-Service	1134358252	1134358252	1	1	ROGSTAD, DANIEL K MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136344	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
81822	Fee-for-Service	1215226915	1215226915	1	1	REDDY, RADHIKA Z MD	12/4/2017	207RP1001X	NA	Pulmonology	026	PHYSICIANS	123736	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
81837	Fee-for-Service	1477531119	1477531119	1	1	REYES, ADRIAN T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91226	05	Anesthesiology	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
81846	Fee-for-Service	1144883315	1144883315	1	1	REZK, ANDREW DO	12/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	23660	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	36	06071	34.109001	-117.4357835	San Bernardino County
81876	Fee-for-Service	1104187566	1104187566	1	1	RAJPAL, AMAN MD	10/5/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	178412	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81935	Fee-for-Service	1386637346	1386637346	1	4	REGENTS/UCDPBG/PEDIATRIC	3/19/2024	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
81967	Fee-for-Service	1235578444	1235578444	1	1	REEDLEY COMMUNITY HOSPITAL	1/16/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	54	06107	36.54592542	-119.39921	Tulare County
82029	Fee-for-Service	1598733271	1598733271	1	1	RANCHO PHYSICAL THERAPY, INC	12/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3142 VISTA WAY	STE 101	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
82034	Fee-for-Service	1861797953	1861797953	1	1	RIEKER, JEFFREY MD INC	6/28/2011	207L00000X	NA	Other	026	PHYSICIANS	44862	05	Anesthesiology	0	In state provider	None	10841 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	90730	3811	36	06071	34.10467596	-117.5661881	San Bernardino County
82095	Fee-for-Service	1154833200	1154833200	1	1	RIBEIRO, DR STEFIE O D PROF	5/29/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORP	46660 WASHINGTON ST	STE 3	LA QUINTA	CA	92253	2451	33	06065	33.709761	-116.2945925	Riverside County
82123	Fee-for-Service	1508854563	1508854563	1	1	RAHUL BHATIA MD	11/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
82148	Fee-for-Service	1639196579	1639196579	2	1	R NANDAN MD INC	9/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3650 SOUTH ST	STE 212	LAKEWOOD	CA	90712	1528	19	06037	33.86019847	-118.149255	Los Angeles County
82155	Fee-for-Service	1043412489	1043412489	1	1	ROE, RICHARD H MD	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95880	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	# 1620	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
82174	Fee-for-Service	1144317496	1144317496	1	1	RALEY'S	10/26/1981	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40041 HIGHWAY 49	None	OAKHURST	CA	93644	8965	20	06039	37.33120744	-119.6557926	Madera County
82249	Fee-for-Service	1982642179	1982642179	1	2	RICHARDSON, ROBERT A MD	4/18/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	34155	-	NOT APPLICABLE	0	In state provider	None	13333 PALMDALE RD	None	VICTORVILLE	CA	92392	9364	36	06071	34.503642	-117.3710025	San Bernardino County
82257	Fee-for-Service	1235578444	1235578444	1	1	REEDLEY COMMUNITY HOSPITAL	7/16/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	54	06107	36.54592542	-119.39921	Tulare County
82259	Fee-for-Service	1447693882	1447693882	1	1	RIZVI, BISHARAH S MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142914	41	Internal Medicine	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
82273	Fee-for-Service	1205974755	1205974755	1	1	REZAZADEH KALEBASTY, ARASH	2/4/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	167307	68	Hematology	0	In state provider	MD	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
82275	Fee-for-Service	1366726135	1366726135	1	1	RUZICS, ERVIN P MD INC	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51676	34	Urology and Urological Surgery	0	In state provider	None	1100 W STEWART DT	None	ORANGE	CA	92868	5600	30	06059	33.78236558	-117.8648414	Orange County
82333	Fee-for-Service	1518137629	1518137629	1	1	RAHMAN, SYED	8/14/2008	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3761 GEARY BLVD	None	SAN FRANCISCO	CA	94418	3405	38	06075	37.78112022	-122.4595496	San Francisco County
82340	Fee-for-Service	1649440744	1649440744	1	1	REDDY, SRIKANTH A MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99810	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 100	MISSION VIEJO	CA	92691	6389	30	06059	33.56286021	-117.6673449	Orange County
82365	Fee-for-Service	1295221125	1295221125	1	1	RUDOLPH, ALEXANDRIA NP	10/21/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
82373	Fee-for-Service	1952034787	1952034787	1	1	REYES, SARAH LCSW	7/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4241 JUTLAND DR	320	SAN DIEGO	CA	92117	3663	37	06073	32.82458459	-117.2275063	San Diego County
82377	Fee-for-Service	1972027506	1972027506	1	1	RUH-WALSH, JANELLE A	3/1/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33716 SURFSIDE DRIVE	None	DANA POINT	CA	92629	2152	30	06059	33.47344127	-117.683221	Orange County
82396	Fee-for-Service	1588913743	1588913743	1	1	RICE, ANDREA L	3/6/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
82397	Fee-for-Service	1396270252	1396270252	1	1	ROCHA RIVERA, GIOVANNA J LCS	8/26/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125075	-	NOT APPLICABLE	0	In state provider	W	600 W SANTA ANA BLVD	SUITE 107 108 109 110	SANTA ANA	CA	92701	4558	30	06059	33.74804119	-117.874111	Orange County
82414	Fee-for-Service	1679715510	1679715510	1	1	RICKS, CAMERON J MD	5/20/2009	207L00000X	NA	Other	026	PHYSICIANS	107033	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
82422	Fee-for-Service	1336579630	1336579630	1	1	REINERTSON, TARA K LMFT	7/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	445 BELLEVUE AVENUE	STE 303	OAKLAND	CA	94610	4923	01	06001	37.80910261	-122.2526914	Alameda County
82436	Fee-for-Service	1639196579	1639196579	2	1	R NANDAN MD INC	9/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	3650 SOUTH ST	STE 212	LAKEWOOD	CA	90712	1528	19	06037	33.86019847	-118.149255	Los Angeles County
82442	Fee-for-Service	1104160118	1104160118	1	1	ROSEN, ALEXIS M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
82453	Fee-for-Service	1780838961	1780838961	1	1	RODRIGUEZ, BRYN MARI MD	12/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DRIVE	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
82496	Fee-for-Service	1144286972	1144286972	1	1	RASHIDI, NASROLLAH MD	11/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38933	36	Psychiatry	0	In state provider	None	500 E ESPLANADE DR	STE 1520	OXNARD	CA	93036	0573	56	06111	34.22877446	-119.1713365	Ventura County
82543	Fee-for-Service	1235578444	1235578444	1	1	REEDLEY COMMUNITY HOSPITAL	1/16/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	54	06107	36.54592542	-119.39921	Tulare County
82549	Fee-for-Service	1548264013	1548264013	1	1	ROSEN, CHARLES D MD	2/8/2015	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	53395	20	Orthopedic Surgery	0	In state provider	None	101 CITY DRIVE SOUTH	#3	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
82578	Fee-for-Service	1629121421	1629121421	1	1	RECTOR, BRIAN P DC	11/12/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2511 GARDEN RD.	C-100	MONTEREY	CA	93940	5333	27	06053	36.58615449	-121.8533458	Monterey County
82610	Fee-for-Service	1568015220	1568015220	1	1	REINBOLT, ALEXIS PT	5/24/2024	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
82639	Fee-for-Service	1588205298	1588205298	1	1	RANCHO VISION CENTER OPTOMET	6/23/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10165 FOOTHILL BLVD	SUITE 6	RANCHO CUCAMONGA	CA	91730	0341	36	06071	34.10653497	-117.5834924	San Bernardino County
82642	Fee-for-Service	1497722912	1497722912	1	1	RUEDA, GAUDENCIA NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12501 IMPERIAL HWY	SUITE 400	NORWALK	CA	90650	1419	19	06037	33.91723852	-118.065834	Los Angeles County
82664	Fee-for-Service	1972027506	1972027506	1	1	RUH-WALSH, JANELLE A	3/1/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33716 SURFSIDE DRIVE	None	DANA POINT	CA	92629	2152	30	06059	33.47344127	-117.683221	Orange County
82714	Fee-for-Service	1124359179	1124359179	1	1	RAMESH, GEETA MD	3/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	110234	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
82723	Fee-for-Service	1790892230	1790892230	1	1	RAJUDIN, MOHAMED M	6/1/1993	207RN0300X	NA	Nephrology	026	PHYSICIANS	26154	None	None	0	In state provider	None	3010 W ORANGE AVE	STE 404	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
82743	Fee-for-Service	1780838961	1780838961	1	1	RODRIGUEZ, BRYN MARI MD	12/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 N TOWN CENTER DRIVE	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
82754	Fee-for-Service	1699041772	1699041772	1	1	RIVAS RODRIGUEZ, ERICA M MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143137	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
82786	Fee-for-Service	1487841482	1487841482	1	1	RUDRANGI, RAJANI MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109478	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
82801	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
82803	Fee-for-Service	1134196751	1134196751	2	1	RUNTE, KENNAN T	11/2/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	123 MARGARET LN	STE A-1	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
82806	Fee-for-Service	1346370137	1346370137	1	1	RADOJICIC, MILAN MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89225	08	Family Practice	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
82830	Fee-for-Service	1235578444	1235578444	1	1	REEDLEY COMMUNITY HOSPITAL	12/31/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	54	06107	36.54592542	-119.39921	Tulare County
82839	Fee-for-Service	1336206911	1336206911	1	1	RESCUE UNION ELEM SD	1/21/2004	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2390 BASS LAKE RD	None	RESCUE	CA	95672	9571	09	06017	38.69608287	-121.0078389	El Dorado County
82845	Fee-for-Service	1477926749	1477926749	1	1	ROWLAND, BROOKE L LCSW	4/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
82902	Fee-for-Service	1851642516	1851642516	1	1	RHODES, JOANNE M	2/10/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
82938	Fee-for-Service	1518030568	1518030568	1	1	RETINAL DIAGNOSTIC CENTER A	3/1/1994	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL CORPORATION	3395 SOUTH BASCOM AVE	STE 140	CAMPBELL	CA	95008	6770	43	06085	37.26369847	-121.9433017	Santa Clara County
82939	Fee-for-Service	1083792501	1083792501	1	1	REVILLA, ANA R	6/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81029	40	Pediatrics	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
82948	Fee-for-Service	1326126905	1326126905	1	1	RYAN, KATHLEEN M MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55556	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
83023	Fee-for-Service	1659628667	1659628667	1	1	RAJBHANDARI, PRATIVA MD	10/13/2023	207R00000X	NA	Other	026	PHYSICIANS	171976	None	None	0	In state provider	None	4201 TORRANCE BLVD	STE. 750	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
83039	Fee-for-Service	1982817755	1982817755	1	1	RANDHAWA, KANWALDEEP S	12/10/2008	207R00000X	NA	Other	026	PHYSICIANS	92776	41	Internal Medicine	0	In state provider	MD	3637 MISSION AVE	STE 6	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
83089	Fee-for-Service	1437695384	1437695384	1	1	ROBERGE, BARBARA L NP	3/25/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	100 W. CALIFORNIA BLVD.	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
83090	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	3/11/2025	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
83099	Fee-for-Service	1548721681	1548721681	1	1	ROBERTS, ERIN G MD	1/4/2023	208M00000X	NA	Other	026	PHYSICIANS	179565	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
83118	Fee-for-Service	1154593481	1154593481	1	1	RANCHO MIRAGE SURGERY CENTER	12/26/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	35-800 BOB HOPE DR	SUITE 100	RANCHO MIRAGE	CA	92270	1722	33	06065	33.78398109	-116.4059049	Riverside County
83170	Fee-for-Service	1639639990	1639639990	1	1	RISHI, KRITI DO	7/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22647	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
83175	Fee-for-Service	1780877845	1780877845	1	1	RESENDEZ, CYNTHIA I MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84098	36	Psychiatry	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
83197	Fee-for-Service	1821271248	1821271248	1	2	RETINA SPECIALISTS OF	11/4/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	959 LAS TABLES ROAD	STE A-3	TEMPLETON	CA	93465	9703	40	06079	35.55436153	-120.7148265	San Luis Obispo County
83235	Fee-for-Service	1326126905	1326126905	1	1	RYAN, KATHLEEN M MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55556	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
83248	Fee-for-Service	1366079790	1366079790	1	1	RUONA, JENNIFER PT	7/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
83284	Fee-for-Service	1902234065	1902234065	1	1	REDMAN, DINA LCSW	4/23/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	582 MARKET ST	STE 312	SAN FRANCISCO	CA	94104	5304	38	06075	37.78931415	-122.4013437	San Francisco County
83289	Fee-for-Service	1225057474	1225057474	1	1	RUTHS, STEVEN M MD INC	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79292	36	Psychiatry	0	In state provider	None	1304 E MAIN ST	STE D	VENTURA	CA	93001	3202	56	06111	34.2805373	-119.2804176	Ventura County
83296	Fee-for-Service	1326141862	1326141862	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
83298	Fee-for-Service	1235185992	1235185992	1	2	ROSS, CATHRYN MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25531	40	Pediatrics	0	In state provider	None	500 DOYLE PARK DR	STE G-04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
83306	Fee-for-Service	1497248314	1497248314	1	1	RICHARDS, SHEYLA D MD	9/4/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174209	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
83320	Fee-for-Service	1407041767	1407041767	1	1	REYES, AMBER LCSW	3/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23550 LYONS AVE	211	SANTA CLARITA	CA	91350	2947	19	06037	34.37938495	-118.5458635	Los Angeles County
83327	Fee-for-Service	1982817755	1982817755	1	1	RANDHAWA, KANWALDEEP S	12/10/2008	207R00000X	NA	Other	026	PHYSICIANS	92776	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	3637 MISSION AVE	STE 6	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
83354	Fee-for-Service	1467985259	1467985259	1	1	RODRIGUEZ, ANASTACIA L DO	11/19/2020	207R00000X	NA	Other	026	PHYSICIANS	18539	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
83360	Fee-for-Service	1033988969	1033988969	1	1	R2T2 TAXI	8/8/2024	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14701 CANYON 7 RD	None	GUERNEVILLE	CA	95446	1470	49	06097	38.52083587	-122.9803064	Sonoma County
83376	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	10/4/2023	261QM1300X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
83431	Fee-for-Service	1689668626	1689668626	1	1	RYAN, DONAL P MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71026	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
83449	Fee-for-Service	1437139557	1437139557	1	1	REDDEN, WILLIAM JORDAN	9/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	421 34TH ST	None	BAKERSFIELD	CA	93301	2236	15	06029	35.3904357	-119.0071827	Kern County
83462	Fee-for-Service	1669766473	1669766473	1	1	REDDY, DIVYA K MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130224	01	General Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
83486	Fee-for-Service	1124311592	1124311592	1	2	ROSEVILLE JOINT UNION HIGH	7/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	1750 CIRBY WAY	None	ROSEVILLE	CA	95661	5520	31	06061	38.72953047	-121.258368	Placer County
83518	Fee-for-Service	1770881104	1770881104	1	1	RICHARD F. GROSSMAN, M.D., I	9/7/2011	208200000X	NA	General Surgery	026	PHYSICIANS	70330	None	None	0	In state provider	None	1199 BUSH STREET	390	SAN FRANCISCO	CA	94109	5973	38	06075	37.7891291	-122.4167087	San Francisco County
83524	Fee-for-Service	1619915956	1619915956	1	1	ROWEN, DANIEL A MD	7/31/1995	207L00000X	NA	Other	026	PHYSICIANS	81547	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
83574	Fee-for-Service	1487267241	1487267241	1	1	RAUT, POONAM MD	9/14/2023	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
83582	Fee-for-Service	1043674435	1043674435	1	1	ROLDAN, ASHLEY N MD	10/23/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168439	18	Ophthalmology	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
83597	Fee-for-Service	1699776526	1699776526	1	1	RIVERSIDE RADIOLOGY	10/17/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
83601	Fee-for-Service	1134176241	1134176241	1	1	RANKIN, RONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 HILAND AVE	None	BURLEY	ID	83318	2682	00	None	42.53489313	-113.7833899	Cassia County
83611	Fee-for-Service	1649388059	1649388059	1	1	RAVNIK, ANTHONY S MD	6/11/1998	174400000X	NA	Other	026	PHYSICIANS	19823	41	Internal Medicine	0	In state provider	None	424 28TH ST	None	OAKLAND	CA	94609	3603	01	06001	37.81660247	-122.2659563	Alameda County
83659	Fee-for-Service	1770881104	1770881104	1	2	RICHARD F. GROSSMAN, M.D., I	8/1/2023	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NC.	1199 BUSH ST	390	SAN FRANCISCO	CA	94109	5999	38	06075	37.7891291	-122.4167087	San Francisco County
83665	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
83696	Fee-for-Service	1275611832	1275611832	1	1	RENDEROS, BONNIE A MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73326	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
83710	Fee-for-Service	1225396153	1225396153	1	1	RAMOS, NATALIA MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127552	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
83712	Fee-for-Service	1447484811	1447484811	1	1	RULLAN, JENNIFER M MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124794	None	None	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
83736	Fee-for-Service	1447918628	1447918628	1	1	RAMIREZ, EMILY L CNP	2/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2510 EL CAMINO REAL	None	CARLSBAD	CA	92008	1273	37	06073	33.17942276	-117.3266425	San Diego County
83737	Fee-for-Service	1649234543	1649234543	1	1	ROBERTS, MARK W MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72120	02	General Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
83792	Fee-for-Service	1740389154	1740389154	1	1	RICHMOND MEDICAL CENTER	9/21/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	355 BARD AVE	None	STATEN ISLAND	NY	10310	1664	00	None	40.635558	-74.106477	Richmond County
83894	Fee-for-Service	1154523975	1154523975	1	1	RISSER, JESSICA MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117845	07	Dermatology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
83929	Fee-for-Service	1780875393	1780875393	1	1	REDJAL, HAMID R MD	8/20/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	99471	08	Family Practice	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
83953	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
83992	Fee-for-Service	1679644124	1679644124	1	1	RICHARDS, CHARLES A	1/31/1986	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17151 MAIN ST	STE C	HESPERIA	CA	92345	6004	36	06071	34.41957589	-117.2883763	San Bernardino County
84060	Fee-for-Service	1447321484	1447321484	1	1	REYNOLDS, DAVID G MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47775	26	Psychiatry (child)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
84081	Fee-for-Service	1740389154	1740389154	1	1	RICHMOND MEDICAL CENTER	9/21/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	355 BARD AVE	None	STATEN ISLAND	NY	10310	1664	00	None	40.635558	-74.106477	Richmond County
84124	Fee-for-Service	1174786016	1174786016	1	1	RAWSON, RICHARD H DO	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10989	None	None	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
84129	Fee-for-Service	1205331923	1205331923	1	1	RAKHOLIA, MILAP V MD	6/13/2022	207L00000X	NA	Other	026	PHYSICIANS	163615	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84176	Fee-for-Service	1639186539	1639186539	1	1	RANCHO LOS AMIGOS	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NATIONAL REHAB CTR	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
84186	Fee-for-Service	1396372215	1396372215	1	1	REINHERZ, ISAAC MD	8/30/2023	207R00000X	NA	Other	026	PHYSICIANS	185658	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
84228	Fee-for-Service	1871047118	1871047118	1	1	RED OAKS HOSPITALIST GROUP	5/22/2018	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
84230	Fee-for-Service	1063997468	1063997468	1	1	RICHARDSON, MYESHA D LMFT	2/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
84240	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	4/8/2025	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84266	Fee-for-Service	1386862662	1386862662	1	1	RHANEY, PAULETTE	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15446 S WESTERN AVENUE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
84278	Fee-for-Service	1508437930	1508437930	1	1	RAWAL, BHAKTIDEVI M PSYD	12/20/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
84283	Fee-for-Service	1053535971	1053535971	1	1	ROSADO, IVANIA	10/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
84334	Fee-for-Service	1235211434	1235211434	1	1	RODRIGUEZ, CARLOS E PT	5/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
84346	Fee-for-Service	1447321484	1447321484	1	1	REYNOLDS, DAVID G MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47775	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
84373	Fee-for-Service	1003075128	1003075128	1	1	RAMSAHAI, SHWETA MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139272	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84376	Fee-for-Service	1568156214	1568156214	1	1	ROSSI, FERNANDA PHD	7/13/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84380	Fee-for-Service	1235492489	1235492489	1	1	RATANASEN, MITCH S MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128007	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
84389	Fee-for-Service	1851974042	1851974042	1	1	ROVNEY, JEFFERY T	9/13/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	91 LIBERTY STREET	None	TUSTIN	CA	92782	6514	30	06059	33.70462361	-117.8023283	Orange County
84395	Fee-for-Service	1164470480	1164470480	1	1	RECKARD, JUSTIN M MD FACS	5/17/2020	208600000X	NA	General Surgery	026	PHYSICIANS	120374	02	General Surgery	0	In state provider	None	71943 HIGHWAY 111	None	RANCHO MIRAGE	CA	92270	4848	33	06065	33.73726724	-116.4092742	Riverside County
84407	Fee-for-Service	1497963938	1497963938	1	1	REKAR, DAVID M MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50815	01	General Practice	0	In state provider	None	14407 HAMLIN ST	STE B	VAN NUYS	CA	91401	6200	19	06037	34.1887	-118.4468781	Los Angeles County
84424	Fee-for-Service	1629061882	1629061882	1	1	REGENTS OF THE UNIV OF CA	10/1/1999	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84439	Fee-for-Service	1952402190	1952402190	1	1	REDDING UROLOGIC ASSOCS	1/1/1979	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLAIRMONT DOCTOR'S PARK	2626 EDITH AVE	STE C	REDDING	CA	96001	3056	45	06089	40.57103976	-122.3974622	Shasta County
84464	Fee-for-Service	1639186539	1639186539	1	1	RANCHO LOS AMIGOS	7/1/2000	282N00000X	NA	Hospitals	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NATIONAL REHAB CTR	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
84517	Fee-for-Service	1871047118	1871047118	1	1	RED OAKS HOSPITALIST GROUP	5/22/2018	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
84528	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84588	Fee-for-Service	1831753847	1831753847	1	1	ROSTOVSKY, JACOB JOSEPH LMF	2/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35936 HARTLEY ST	None	PALM DESERT	CA	92211	0895	33	06065	33.78613609	-116.3679558	Riverside County
84624	Fee-for-Service	1346078540	1346078540	1	1	ROMAN, CRISTINA PHD	3/3/2025	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
84626	Fee-for-Service	1245492925	1245492925	1	1	ROSE, JOSEPH D MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121780	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	112 LA CASA VIA	SUITE 130	WALNUT CREEK	CA	94598	3016	07	06013	37.91229899	-122.0423696	Contra Costa County
84637	Fee-for-Service	1801523212	1801523212	1	1	RAPID RESPONSE TESTING LLC	4/25/2023	291U00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2130 BENEDICT DR	None	SAN LEANDRO	CA	94577	6338	01	06001	37.72205107	-122.1346189	Alameda County
84639	Fee-for-Service	1659411999	1659411999	1	1	RENNEKER, MARK L MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45873	01	General Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
84661	Fee-for-Service	1063583953	1063583953	1	1	RIZKALLAH, ADEL B DO	7/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6583	08	Family Practice	0	In state provider	None	10210 ORR AND DAY RD	STE A	SANTA FE SPRINGS	CA	90670	3500	19	06037	33.94432489	-118.090377	Los Angeles County
84673	Fee-for-Service	1063943025	1063943025	1	1	ROBINSON, JOHN MD	7/28/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	176312	None	None	0	In state provider	None	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
84676	Fee-for-Service	1851974042	1851974042	1	1	ROVNEY, JEFFERY T	9/13/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	91 LIBERTY STREET	None	TUSTIN	CA	92782	6514	30	06059	33.70462361	-117.8023283	Orange County
84693	Fee-for-Service	1497963938	1497963938	1	1	REKAR, DAVID M MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50815	25	Physical Medicine and Rehabilitation	0	In state provider	None	14407 HAMLIN ST	STE B	VAN NUYS	CA	91401	6200	19	06037	34.1887	-118.4468781	Los Angeles County
84702	Fee-for-Service	1750311791	1750311791	1	1	ROOZROKH, BABAK MD INC	12/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81646	None	None	0	In state provider	None	1700 WESTWOOD BLVD	STE 2D	LOS ANGELES	CA	90024	5608	19	06037	34.05159882	-118.4385447	Los Angeles County
84711	Fee-for-Service	1235206087	1235206087	1	4	REDWOODS RURAL HEALTH CT	2/12/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6831 AVE OF THE GIANTS	None	MIRANDA	CA	95553	0000	12	06023	40.23689324	-123.8242718	Humboldt County
84714	Fee-for-Service	1629061882	1629061882	1	1	REGENTS OF THE UNIV OF CA	5/1/1983	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84718	Fee-for-Service	1902449184	1902449184	1	1	RIVERA, STEPHEN	10/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
84719	Fee-for-Service	1982998647	1982998647	1	1	ROSE, JENNA M CRNA	6/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
84726	Fee-for-Service	1467507749	1467507749	1	1	ROBINSON, LAWRENCE M MD	8/13/1996	207L00000X	NA	Other	026	PHYSICIANS	61068	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
84776	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	9/25/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
84785	Fee-for-Service	1639106610	1639106610	1	1	RAJ, DIVYA T MD	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	81826	-	NOT APPLICABLE	0	In state provider	None	6666 OWENS DRIVE	None	PLEASANTON	CA	94588	3334	01	06001	37.69743706	-121.9098578	Alameda County
84803	Fee-for-Service	1871047118	1871047118	1	1	RED OAKS HOSPITALIST GROUP	5/22/2018	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
84815	Fee-for-Service	1952998973	1952998973	1	4	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4860 Y STREET	SUITE 1701	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84844	Fee-for-Service	1508386251	1508386251	1	1	RAFAILMEHR, NAVID LMFT	10/6/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1180 S BEVERLY DR	SUITE #608	LOS ANGELES	CA	90035	1153	19	06037	34.05550055	-118.395555	Los Angeles County
84853	Fee-for-Service	1790721454	1790721454	1	1	RALPH, LORRAINCE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
84854	Fee-for-Service	1679640239	1679640239	1	1	RAUM, SILVIA MD	1/1/1982	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	36738	01	General Practice	0	In state provider	None	13132 NEWPORT AVE	None	TUSTIN	CA	92780	3429	30	06059	33.74752359	-117.8125292	Orange County
84888	Fee-for-Service	1316278930	1316278930	1	1	RENDER, REBECCA M DO	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11067	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
84896	Fee-for-Service	1942745427	1942745427	1	1	RAZO, KARINA V NP	1/7/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1220 E AVE S	None	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
84940	Fee-for-Service	1740344597	1740344597	1	1	RENAL CARE CONSULTANTS PC	12/2/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	760 GOLF VIEW DRIVE	SUITE 200	MEDFORD	OR	97504	9685	00	None	42.315228	-122.8230985	Jackson County
84959	Fee-for-Service	1730853227	1730853227	1	1	REYNOSO, ALLISON PT	8/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON ST.	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
84974	Fee-for-Service	1730455015	1730455015	1	1	REESE, NICHOLAS D MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120727	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
84997	Fee-for-Service	1235206087	1235206087	1	4	REDWOODS RURAL HEALTH CT	2/12/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6831 AVE OF THE GIANTS	None	MIRANDA	CA	95553	0000	12	06023	40.23689324	-123.8242718	Humboldt County
85014	Fee-for-Service	1477501054	1477501054	1	1	RYDER, DAVID J DO MD	6/7/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54905	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
85037	Fee-for-Service	1124466289	1124466289	1	1	RIVERSIDE COUNTY CCS	8/5/2014	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	MTU	41350 GUAVA STREET	None	MURRIETA	CA	92562	9305	33	06065	33.54694048	-117.1907416	Riverside County
85053	Fee-for-Service	1104091008	1104091008	1	1	RAVI, DEEPA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	107255	40	Pediatrics	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
85065	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	1/6/2017	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85072	Fee-for-Service	1235232778	1235232778	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85082	Fee-for-Service	1730662651	1730662651	1	1	RODRIGUEZ, ARMANDO LCSW	8/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
85109	Fee-for-Service	1023092541	1023092541	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
85122	Fee-for-Service	1144676016	1144676016	1	1	ROSALES, MARISELA LCSW	1/18/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
85130	Fee-for-Service	1730180415	1730180415	1	3	RIVERSIDE MEDICAL CLINIC	12/16/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7160 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94273905	-117.3941945	Riverside County
85145	Fee-for-Service	1679640239	1679640239	1	1	RAUM, SILVIA MD	1/1/1982	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	36738	08	Family Practice	0	In state provider	None	13132 NEWPORT AVE	None	TUSTIN	CA	92780	3429	30	06059	33.74752359	-117.8125292	Orange County
85172	Fee-for-Service	1891858114	1891858114	1	1	READY MEDICAL SUPPLY INC	9/5/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9402 1/2 SOMERSET BLVD	None	BELLFLOWER	CA	90706	3009	19	06037	33.8964807	-118.133893	Los Angeles County
85179	Fee-for-Service	1588396535	1588396535	1	1	ROBIDOUX, STEVEN J PT	12/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
85197	Fee-for-Service	1679502702	1679502702	1	1	ROGERS DRUG STORE	12/1/1995	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	402 H ST	None	MODESTO	CA	95351	3308	50	06099	37.63436382	-121.0034811	Stanislaus County
85215	Fee-for-Service	1801129341	1801129341	1	1	REDDY, KAUNTEYA	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124301	None	None	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
85252	Fee-for-Service	1124552385	1124552385	1	1	ROSSIE, DANIEL J MD	5/7/2020	207P00000X	NA	Other	026	PHYSICIANS	157082	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
85256	Fee-for-Service	1730455015	1730455015	1	1	REESE, NICHOLAS D MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120727	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
85315	Fee-for-Service	1649731894	1649731894	1	1	RAJA, SHELLA K MD	7/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178862	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
85322	Fee-for-Service	1154580660	1154580660	1	1	RASHID, QURAT-UL-AIN A MD	4/12/2019	207R00000X	NA	Other	026	PHYSICIANS	118167	41	Internal Medicine	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
85353	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	6/1/1999	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85359	Fee-for-Service	1235232778	1235232778	1	1	REGENTS OF THE UNIVERSITY OF	3/1/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85418	Fee-for-Service	1730180415	1730180415	1	3	RIVERSIDE MEDICAL CLINIC	2/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7160 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94273905	-117.3941945	Riverside County
85459	Fee-for-Service	1427385988	1427385988	1	1	RAINA, ACHLA MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89920	08	Family Practice	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
85484	Fee-for-Service	1235338385	1235338385	1	1	RUPA KAPOOR MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
85530	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	7/6/2021	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
85588	Fee-for-Service	1891874681	1891874681	1	1	REDDY, UMAPATHI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49439	10	Gastroenterology (M.D. only)	0	In state provider	None	550 B ST	None	YUBA CITY	CA	95991	5067	51	06101	39.13299265	-121.6155493	Sutter County
85612	Fee-for-Service	1154327997	1154327997	1	1	RONALD DWORKIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5050 NE HOYT	STE 540	PORTLAND	OR	97213	0000	00	None	45.52717448	-122.611527	Multnomah County
85624	Fee-for-Service	1730221326	1730221326	1	1	RICHARDSON-SOLOMON, CANDICE	7/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	N-SOLOMON LMFT	1777 BOREL PL	#508	SAN MATEO	CA	94402	3514	41	06081	37.54884383	-122.3178505	San Mateo County
85625	Fee-for-Service	1437202124	1437202124	1	2	RIVERSIDE-SAN BERNARDINO	2/1/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	66735 MARTINEZ RD	None	THERMAL	CA	92274	9007	33	06065	33.5619786	-116.1513211	Riverside County
85641	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	2/12/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85690	Fee-for-Service	1821155250	1821155250	1	1	REISERT, MARIA M	10/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
85700	Fee-for-Service	1871989491	1871989491	1	1	RAY, JULIA DO	12/16/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16742	None	None	0	In state provider	None	1300 N. VERMONT AVENUE,	SUITE 501	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
85703	Fee-for-Service	1710415146	1710415146	1	1	RAHSEPAR, AMIR ALI MD	6/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172849	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
85706	Fee-for-Service	1730180415	1730180415	1	3	RIVERSIDE MEDICAL CLINIC	8/22/2022	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7160 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94273905	-117.3941945	Riverside County
85712	Fee-for-Service	1134508211	1134508211	1	1	RAMIREZ GASPAR, CARMEN G MD	1/8/2019	390200000X	NA	Other	026	PHYSICIANS	147791	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
85779	Fee-for-Service	1316530967	1316530967	1	1	RAPID HOSPICE CARE INC	8/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2654 HONOLULU AVE	STE A	MONTROSE	CA	91020	1732	19	06037	34.20958176	-118.2371215	Los Angeles County
85809	Fee-for-Service	1558383935	1558383935	1	1	RAJPER, MOHAMMAD A. MD	5/1/1995	207P00000X	NA	Other	026	PHYSICIANS	31699	02	General Surgery	0	In state provider	None	900 ESTATE CT	None	WALNUT	CA	91789	5011	19	06037	34.0361764	-117.8412041	Los Angeles County
85819	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	5/17/2023	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
85838	Fee-for-Service	1700112091	1700112091	1	1	ROTNER, SARA M MD	10/26/2010	207R00000X	NA	Other	026	PHYSICIANS	108614	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
85847	Fee-for-Service	1477537413	1477537413	1	1	RAFANOV, VLADIMIR S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56344	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
85864	Fee-for-Service	1093354672	1093354672	1	1	ROMAN, AMANDA F LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
85868	Fee-for-Service	1578908372	1578908372	1	1	ROSSETTIE, JOHN M MD	6/2/2017	207R00000X	NA	Other	026	PHYSICIANS	134486	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85876	Fee-for-Service	1891874681	1891874681	1	1	REDDY, UMAPATHI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49439	41	Internal Medicine	0	In state provider	None	550 B ST	None	YUBA CITY	CA	95991	5067	51	06101	39.13299265	-121.6155493	Sutter County
85878	Fee-for-Service	1457727562	1457727562	1	1	ROCA-NELSON, LIZ C MD	10/30/2021	207R00000X	NA	Other	026	PHYSICIANS	174453	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
85896	Fee-for-Service	1639141278	1639141278	1	1	RAMOS, RENIE A MD	5/17/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33236	40	Pediatrics	0	In state provider	None	360 E 7TH ST	STE N	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
85931	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	8/2/2023	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85960	Fee-for-Service	1154940161	1154940161	1	1	REDDY, ADITHI MD	7/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187953	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85992	Fee-for-Service	1235206087	1235206087	1	8	REDWOODS RURAL HEALTH CT	3/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	217 BRICELAND THORNE RD	None	REDWAY	CA	95560	0000	12	06023	40.12091042	-123.8263928	Humboldt County
86024	Fee-for-Service	1811307655	1811307655	1	1	RINDLER, RIMA S MD	2/20/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86055	Fee-for-Service	1659473320	1659473320	1	1	RICHMOND DISTRICT	3/20/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	700 25TH AVE	None	SAN FRANCISCO	CA	94121	3612	38	06075	37.77614003	-122.4844007	San Francisco County
86063	Fee-for-Service	1467950188	1467950188	1	1	ROJAS, GLADYS MD	12/6/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	169798	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
86065	Fee-for-Service	1316530967	1316530967	1	1	RAPID HOSPICE CARE INC	8/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2654 HONOLULU AVE	STE A	MONTROSE	CA	91020	1732	19	06037	34.20958176	-118.2371215	Los Angeles County
86103	Fee-for-Service	1659543791	1659543791	1	1	RAJANI, ANAND K MD	2/8/2015	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	97594	40	Pediatrics	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
86110	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	12/7/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
86123	Fee-for-Service	1497968457	1497968457	1	1	RINGO, PATRICE M MD	7/15/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83233	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
86146	Fee-for-Service	1598887945	1598887945	1	1	ROSENBERG, DAVID A MD INC	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	42241	None	None	0	In state provider	None	10941 BLOOMFIELD ST	STE A	LOS ALAMITOS	CA	90720	2530	30	06059	33.804234	-118.0632055	Orange County
86175	Fee-for-Service	1760190110	1760190110	1	1	REID, SOUNISRA	5/16/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
86211	Fee-for-Service	1508831017	1508831017	1	1	ROSSER, CHARLES J MD	2/18/2020	208800000X	NA	Other	026	PHYSICIANS	158684	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
86217	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	1/6/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86235	Fee-for-Service	1669817987	1669817987	1	1	REDDY, SRIDHAR M MD	7/28/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167870	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
86250	Fee-for-Service	1649722950	1649722950	1	1	RODRIGUEZ, MICAELA I NP	9/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
86275	Fee-for-Service	1235206087	1235206087	1	8	REDWOODS RURAL HEALTH CT	3/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	217 BRICELAND THORNE RD	None	REDWAY	CA	95560	0000	12	06023	40.12091042	-123.8263928	Humboldt County
86282	Fee-for-Service	1184910135	1184910135	1	1	RAMANATHAN, DINESH MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145651	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
86286	Fee-for-Service	1518120575	1518120575	2	1	ROWE, ANTHONY MD	8/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	125795	30	Radiology	0	In state provider	None	100 W. CALIFORNIA BLVD.	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
86292	Fee-for-Service	1699852889	1699852889	1	1	RUSSELL, SHERI L LMFT	12/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7877 WREN AVE	STE A	GILROY	CA	95020	4980	43	06085	37.01154605	-121.5869689	Santa Clara County
86310	Fee-for-Service	1114792215	1114792215	1	1	RAGHANI, ANIKA P POSTPARTUM	5/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
86325	Fee-for-Service	1932565751	1932565751	1	1	RAMOS, JULIA MD	11/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183466	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
86330	Fee-for-Service	1821155326	1821155326	1	1	RIZNIS, TENGIS MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86212	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
86339	Fee-for-Service	1558435024	1558435024	1	1	ROVNER, DANIEL M MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36547	13	Neurology (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 1080W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
86342	Fee-for-Service	1801464185	1801464185	1	1	RAHMAN, BAKHT MD	3/25/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
86380	Fee-for-Service	1669464277	1669464277	1	1	ROSAS CARILLO, JORGE F MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	44839	None	None	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
86389	Fee-for-Service	1689746331	1689746331	1	1	ROWBERRY, JENNIFER M MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70867	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
86394	Fee-for-Service	1659543791	1659543791	1	1	RAJANI, ANAND K MD	2/8/2015	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	97594	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
86402	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	6/21/2021	261QM1300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
86471	Fee-for-Service	1528065588	1528065588	1	1	RICHARDS PHYSICAL THERAPY	2/3/2014	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	INC	26471 CROWN VALLEY PKWY	STE 200	MISSION VIEJO	CA	92691	8547	30	06059	33.56398265	-117.6599724	Orange County
86481	Fee-for-Service	1841258886	1841258886	1	1	ROMERO, JAIRO MD	12/31/1985	207R00000X	NA	Other	026	PHYSICIANS	56983	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
86498	Fee-for-Service	1275518821	1275518821	1	1	RAMIREZ, JESUS IGNACIO	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71020	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
86506	Fee-for-Service	1760552343	1760552343	1	1	REGENTS OF THE UNIVERSITY OF	3/17/2023	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	DEPT OF MEDICINE	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86512	Fee-for-Service	1205828704	1205828704	1	1	RISEMAN, REBECCA NP	10/21/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7999 GATEWAY BLVD	SUITE 200	NEWARK	CA	94560	1188	01	06001	37.53814232	-122.0629661	Alameda County
86525	Fee-for-Service	1013978063	1013978063	1	1	REYNOLDS, PAUL D MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86095	41	Internal Medicine	0	In state provider	None	251 TURNPIKE DR	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
86545	Fee-for-Service	1154674299	1154674299	1	1	RAMIREZ, DAVE A LMFT	10/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
86551	Fee-for-Service	1073000105	1073000105	1	4	RADIOLOGICA INC.	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
86587	Fee-for-Service	1063746873	1063746873	1	1	RADWAN, MOHAMED O MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154339	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9850 GENESEE AVENUE	SUITE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
86595	Fee-for-Service	1215962956	1215962956	1	1	RICE, DALE H MD	10/6/1977	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	36861	04	Otology, Laryngology, Rhinology	0	In state provider	None	10833 LE CONTE AVE	BLDG 62	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
86622	Fee-for-Service	1023130242	1023130242	1	1	RABBANI, AMIR B MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125200	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86624	Fee-for-Service	1710270442	1710270442	1	1	RODRIGUEZ, VALENTINA M MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126046	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86629	Fee-for-Service	1629061882	1629061882	1	2	REGENTS OF THE UNIV OF CA	5/20/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
86641	Fee-for-Service	1255516142	1255516142	1	1	REED-MALDONADO, AMANDA B MD	6/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134650	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86654	Fee-for-Service	1215015961	1215015961	1	1	RYGG, DANA H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70012	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
86664	Fee-for-Service	1114169489	1114169489	1	1	RIVERS, AIMEE L MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126273	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
86666	Fee-for-Service	1164658589	1164658589	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3080 MINOA WAY	None	SAN DIEGO	CA	92139	3722	37	06073	32.6664236	-117.0542656	San Diego County
86683	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	10/4/2023	261QM1300X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
86702	Fee-for-Service	1356521603	1356521603	1	1	ROSENBLUM, MICHAEL D MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101640	07	Dermatology	0	In state provider	None	1701 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
86734	Fee-for-Service	1760541569	1760541569	1	12	RETINA INSTITUTE OF CALIFORN	11/22/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1620 ALPINE BLVD	117	ALPINE	CA	91901	1103	37	06073	32.83781579	-116.7799366	San Diego County
86745	Fee-for-Service	1679723175	1679723175	1	1	RAMZY, DANNY MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117478	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1801	19	06037	34.07671715	-118.3799413	Los Angeles County
86786	Fee-for-Service	1275518821	1275518821	1	1	RAMIREZ, JESUS IGNACIO	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71020	02	General Surgery	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
86788	Fee-for-Service	1629002407	1629002407	1	1	RAGLAND, ALAN S DO	1/30/1997	207R00000X	NA	Other	026	PHYSICIANS	5843	41	Internal Medicine	0	In state provider	None	513 W COLUMBUS ST	None	BAKERSFIELD	CA	93301	5848	15	06029	35.395245	-119.006073	Kern County
86798	Fee-for-Service	1124603097	1124603097	1	1	RUSSELL, JACQUELYN NP	3/23/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
86875	Fee-for-Service	1063746873	1063746873	1	1	RADWAN, MOHAMED O MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154339	01	General Practice	0	In state provider	None	9850 GENESEE AVENUE	SUITE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
86918	Fee-for-Service	1629061882	1629061882	1	2	REGENTS OF THE UNIV OF CA	5/1/1999	207W00000X	NA	Ophthalmology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
86934	Fee-for-Service	1598723538	1598723538	1	1	REZA, ALI H M MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50089	41	Internal Medicine	0	In state provider	None	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
86937	Fee-for-Service	1518541960	1518541960	1	1	ROSSIE, HANNAH F NP	9/10/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
86943	Fee-for-Service	1922150382	1922150382	1	1	RODRIGUEZ, RAY MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58903	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
86956	Fee-for-Service	1518408715	1518408715	1	1	RABIEZADEH, NICOLE LMFT	6/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8415 CANOGA AVE	None	CANOGA PARK	CA	91304	2607	19	06037	34.22303541	-118.5975522	Los Angeles County
86963	Fee-for-Service	1083980056	1083980056	1	1	RAPER, DANIEL M MD	6/25/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	158789	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86976	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	5/12/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
86990	Fee-for-Service	1588068415	1588068415	1	1	RIFFEL, GUSTAVO A D MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141811	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
86992	Fee-for-Service	1811069115	1811069115	1	1	RODLER, EVE T MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	68252	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
86996	Fee-for-Service	1013948959	1013948959	1	1	ROSEN, EVAN G MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143954	34	Urology and Urological Surgery	0	In state provider	None	12922 VICTORY BLVD	None	N HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
87013	Fee-for-Service	1174524359	1174524359	1	1	ROSEN, HOWARD R MD	5/15/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	15770	41	Internal Medicine	0	In state provider	None	3152 GILMORE ST	None	PLACERVILLE	CA	95667	5500	09	06017	38.72384085	-120.8036596	El Dorado County
87022	Fee-for-Service	1760541569	1760541569	1	12	RETINA INSTITUTE OF CALIFORN	11/22/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1620 ALPINE BLVD	117	ALPINE	CA	91901	1103	37	06073	32.83781579	-116.7799366	San Diego County
87040	Fee-for-Service	1205925773	1205925773	1	1	ROXAS, CATHLEEN D MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83152	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
87179	Fee-for-Service	1699262683	1699262683	1	1	ROUBAKHA, MIKHAIL MD	1/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176054	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
87206	Fee-for-Service	1629061882	1629061882	1	2	REGENTS OF THE UNIV OF CA	2/1/2021	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
87226	Fee-for-Service	1245613678	1245613678	1	1	RANCHO SAN ANTONIO BOYS HOME	9/14/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC.	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	19	06037	34.24271597	-118.5915861	Los Angeles County
87233	Fee-for-Service	1922150382	1922150382	1	1	RODRIGUEZ, RAY MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58903	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
87263	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	8/15/2023	261QM1300X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
87297	Fee-for-Service	1518030568	1518030568	1	4	RETINAL DIAGNOSTIC CENTER A	2/2/2015	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	65 NIELSON ST	STE 115	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
87365	Fee-for-Service	1649202888	1649202888	1	1	REGIONAL RADIOLOGICAL	6/1/1996	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCS.,INC MEDICAL GRP	2020 COURT STREET	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
87371	Fee-for-Service	1538553748	1538553748	1	1	ROSE, KELSEY MD	12/30/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	144593	09	Gynecology (D.O. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
87409	Fee-for-Service	1477828416	1477828416	1	1	ROBERTS, MICHAEL DO	9/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11503	08	Family Practice	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
87434	Fee-for-Service	1114224540	1114224540	1	1	RENDLA, SUDHAKAR MD	1/18/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	130225	None	None	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
87472	Fee-for-Service	1295720316	1295720316	1	1	REYES, JOAQUIN MD	3/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77434	08	Family Practice	0	In state provider	REYES MEDICAL GROUP	3838 SHERMAN DR	STE 203	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
87483	Fee-for-Service	1760915649	1760915649	1	1	RIVERA, ANA G MD	9/30/2020	207R00000X	NA	Other	026	PHYSICIANS	162282	41	Internal Medicine	0	In state provider	None	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
87496	Fee-for-Service	1215585690	1215585690	1	1	RIDENHOUR, MAGGIE C	1/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
87498	Fee-for-Service	1053861211	1053861211	1	1	ROBERTSON, NELTON J AU	10/4/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4477 118TH ST	403	HAWTHORNE	CA	90250	2255	19	06037	33.92734752	-118.354221	Los Angeles County
87522	Fee-for-Service	1609963461	1609963461	1	1	RAJI, NALINI L MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53125	02	General Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
87539	Fee-for-Service	1881640373	1881640373	1	1	RAE, DARLENE MD	3/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55358	08	Family Practice	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
87541	Fee-for-Service	1174711006	1174711006	1	1	RYLEY, SHANE CPO	5/8/2009	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	23451 MADISON ST	None	TORRANCE	CA	90505	4763	19	06037	33.81197627	-118.3478154	Los Angeles County
87543	Fee-for-Service	1669768420	1669768420	1	1	RODRIGUEZ BALLESTAS, MARIA A	4/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	128978	09	Gynecology (D.O. only)	0	In state provider	MD	2581 SAMARITAN DR	None	SAN JOSE	CA	95124	4112	43	06085	37.25305684	-121.9507351	Santa Clara County
87552	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
87568	Fee-for-Service	1518439603	1518439603	1	1	REYES, LISA MARIE RCP	2/5/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
87595	Fee-for-Service	1376732487	1376732487	1	1	RJR CARE, INC	12/9/2009	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	NATIONAL ADULT DAY HLTH	11261B NATIONAL BLVD	None	LOS ANGELES	CA	90064	3921	19	06037	34.0265856	-118.4308309	Los Angeles County
87612	Fee-for-Service	1790513133	1790513133	1	1	RENTERIA, YESENIA	3/21/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
87629	Fee-for-Service	1306842802	1306842802	1	1	ROSENFELT, FRED P MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	32656	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 1165W	LOS ANGELES	CA	90048	6104	19	06037	34.07361928	-118.3803143	Los Angeles County
87637	Fee-for-Service	1386637346	1386637346	1	2	REGENTS/UCDPBG/PEDIATRIC	3/19/2024	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
87641	Fee-for-Service	1487608931	1487608931	1	1	RENAISSANCE IMAGING MED	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
87646	Fee-for-Service	1457994709	1457994709	1	1	RAMOS, LAURA J LCSW	4/11/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
87656	Fee-for-Service	1760496939	1760496939	1	1	ROWLEY, JASON MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87049	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
87659	Fee-for-Service	1598095028	1598095028	1	1	REBOLLEDO, SANDRA	5/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
87667	Fee-for-Service	1639194236	1639194236	1	1	RALPHS GROCERY COMPANY	6/21/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #757	24975 PICO CANYON RD	None	STEVENSON RANCH	CA	91381	1708	19	06037	34.38190649	-118.5743325	Los Angeles County
87676	Fee-for-Service	1194162859	1194162859	1	1	RAMOS, RUTH R NP	6/2/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1498 SOUTHGATE AVE	STE 102	DALY CITY	CA	94015	4015	41	06081	37.67558947	-122.4761175	San Mateo County
87721	Fee-for-Service	1003195603	1003195603	1	1	RAMIREZ-MCLAUGHLIN, MICHALLE	9/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	G NP	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87751	Fee-for-Service	1780918508	1780918508	1	1	RILES, DANELLE G LCSW	12/27/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 PROVIDENCE MINE ROAD	SUITE 106B	NEVADA CITY	CA	95959	2937	29	06057	39.24969422	-121.0286134	Nevada County
87795	Fee-for-Service	1285069658	1285069658	1	1	ROHSIG-MOESER, DEISI	11/4/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2009 PALO VERDE AVE	SUITE A	LONG BEACH	CA	90815	3322	19	06037	33.792597	-118.1080155	Los Angeles County
87797	Fee-for-Service	1477968857	1477968857	1	1	ROBLES-GUERRERO, CLARA E	12/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	9666 BUSINESSPARK AVENUE	SUITE 207	SAN DIEGO	CA	92131	1646	37	06073	32.89839401	-117.1124102	San Diego County
87805	Fee-for-Service	1235161621	1235161621	1	1	ROHATGI, NITIN MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79447	68	Hematology	0	In state provider	None	2800 L ST	STE 300	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
87828	Fee-for-Service	1669768420	1669768420	1	1	RODRIGUEZ BALLESTAS, MARIA A	4/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	128978	15	Obstetrics (D.O. only)	0	In state provider	MD	2581 SAMARITAN DR	None	SAN JOSE	CA	95124	4112	43	06085	37.25305684	-121.9507351	Santa Clara County
87834	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	5/26/2022	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
87857	Fee-for-Service	1780857839	1780857839	1	1	RUSSELL, MILICA K	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
87905	Fee-for-Service	1992756852	1992756852	1	1	RONALD R QUINTON M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	525 LILLY RD NE	STE 200	OLYMPIA	WA	98506	0000	00	None	47.053944	-122.8444465	Thurston County
87922	Fee-for-Service	1144538778	1144538778	1	1	REDDY, DANA A C MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115598	83	Rheumatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
87923	Fee-for-Service	1386637346	1386637346	1	2	REGENTS/UCDPBG/PEDIATRIC	4/14/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
87925	Fee-for-Service	1598109027	1598109027	1	1	RODRIGUES, DARRYL J MD INC	2/20/2013	193400000X	NA	Other	026	PHYSICIANS	74969	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
87950	Fee-for-Service	1811080575	1811080575	1	1	REYNOLD TROWERS	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
87955	Fee-for-Service	1386637346	1386637346	1	1	REGENTS/UCDPBG/PEDIATRIC	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
87993	Fee-for-Service	1437604006	1437604006	1	1	RECKER, KATHRYN OD	8/1/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 SATURN BLVD	SUITE H	SAN DIEGO	CA	92154	4734	37	06073	32.58472439	-117.0925745	San Diego County
88024	Fee-for-Service	1164612545	1164612545	1	1	RATINOFF, GREGG A LMFT	12/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
88028	Fee-for-Service	1154611341	1154611341	1	1	ROJAS, JOSEPH R	1/12/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	124229	40	Pediatrics	0	In state provider	ER	14445 OLIVE VIEW DR	COTTAGE S	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
88035	Fee-for-Service	1033535059	1033535059	1	1	ROSSI, ANNEMARIE OT	10/24/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	711 VAN NESS AVE	260	SAN FRANCISCO	CA	94102	3244	38	06075	37.78218473	-122.4208156	San Francisco County
88045	Fee-for-Service	1558623421	1558623421	1	1	RYAN, COLIN C MD	1/27/2020	207P00000X	NA	Other	026	PHYSICIANS	165078	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
88072	Fee-for-Service	1851169486	1851169486	1	1	ROGERS, LAUREN K LMFT	2/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11230 SORRENTO VALLEY RD	STE 220	SAN DIEGO	CA	92121	1300	37	06073	32.90734306	-117.2281918	San Diego County
88090	Fee-for-Service	1235161621	1235161621	1	1	ROHATGI, NITIN MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79447	78	Neoplastic Diseases/Oncology	0	In state provider	None	2800 L ST	STE 300	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
88091	Fee-for-Service	1821183153	1821183153	1	1	ROBBINS, GENICA PSYD	10/8/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2416A CENTRAL AVE	SUITE B	ALAMEDA	CA	94501	4516	01	06001	37.76386528	-122.2421907	Alameda County
88097	Fee-for-Service	1932119450	1932119450	1	1	ROSE, SHANNON	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77178	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
88106	Fee-for-Service	1346266954	1346266954	1	1	REEKSTIN ENTERPRISES INC.	8/28/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1027 N HARBOR BLVD	SUITE B	FULLERTON	CA	92832	1310	30	06059	33.88084265	-117.9245141	Orange County
88126	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	4/28/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
88164	Fee-for-Service	1124205869	1124205869	1	1	ROCO, CARMELO L MD MC	12/30/1990	305R00000X	NA	Other	026	PHYSICIANS	47770	41	Internal Medicine	0	In state provider	None	490 POST ST	STE 901	SAN FRANCISCO	CA	94102	1410	38	06075	37.78812774	-122.4096884	San Francisco County
88167	Fee-for-Service	1689616302	1689616302	1	1	RIESENBERGER, TIMOTHY M MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVENUE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
88183	Fee-for-Service	1396770103	1396770103	2	1	RIAZ, MOHAMMAD MD	10/7/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32746	02	General Surgery	0	In state provider	None	16660 PARAMOUNT BLVD	STE 104	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
88208	Fee-for-Service	1205194719	1205194719	1	1	REOUK, DIVYA A MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132496	08	Family Practice	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
88210	Fee-for-Service	1144538778	1144538778	1	1	REDDY, DANA A C MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115598	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
88212	Fee-for-Service	1386637346	1386637346	1	2	REGENTS/UCDPBG/PEDIATRIC	5/1/1999	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
88216	Fee-for-Service	1760541569	1760541569	1	24	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 NORTH BROADWAY	None	LOS ANGELES	CA	90031	2219	19	06037	34.07360257	-118.2166466	Los Angeles County
88231	Fee-for-Service	1013199843	1013199843	1	2	ROWE, MICHELLE J	1/23/2019	207QS0010X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	9607	-	NOT APPLICABLE	0	In state provider	None	955 W CENTER STREET	STE 12A, 12B & 14	MANTECA	CA	95337	7300	39	06077	37.79916144	-121.2300132	San Joaquin County
88233	Fee-for-Service	1508229071	1508229071	1	1	ROBBINS, JENNA L MD	9/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168714	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
88243	Fee-for-Service	1386637346	1386637346	1	1	REGENTS/UCDPBG/PEDIATRIC	1/17/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
88255	Fee-for-Service	1235344961	1235344961	2	1	RAE STAR HEALTH SYSTEMS INC	8/15/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17215 STUDEBAKER ROAD	SUITE 175	CERRITOS	CA	90703	2556	19	06037	33.874686	-118.0998595	Los Angeles County
88256	Fee-for-Service	1205851805	1205851805	1	1	RALPHS GROCERY COMPANY	9/22/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #271	1240 LOS OSOS VALLEY RD	None	LOS OSOS	CA	93402	3373	40	06079	35.31067579	-120.8273349	San Luis Obispo County
88263	Fee-for-Service	1508093766	1508093766	1	1	RADMANESH, ALIREZA MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128343	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
88290	Fee-for-Service	1821462938	1821462938	1	2	RUDNICK, ERIC MD	1/16/2024	207P00000X	NA	Other	026	PHYSICIANS	76393	None	None	0	In state provider	None	2440 SISTER MARY COLUMBA	SUITE 300	RED BLUFF	CA	96080	4356	52	06103	40.14870072	-122.2217028	Tehama County
88337	Fee-for-Service	1063038974	1063038974	1	1	REYNOSO, NATALIE LMFT	4/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
88343	Fee-for-Service	1487640868	1487640868	1	1	REDDING FAMILY MEDICAL	6/14/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2510 AIRPARK DR	STE 201	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
88353	Fee-for-Service	1700289675	1700289675	1	1	ROMERO, ABEL PT	5/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
88360	Fee-for-Service	1508927914	1508927914	1	1	RANAVAT, AMRITLAL C MD	2/28/1988	207R00000X	NA	Other	026	PHYSICIANS	35341	None	None	0	In state provider	HOLLYWOOD PRESB. MED CTR	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
88362	Fee-for-Service	1609970870	1609970870	1	1	RANDHAWA, TEJINDER S MD	3/27/2007	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	A PROFESSIONAL CORP	5043 E CESAR CHAVEZ BLVD	#101	FRESNO	CA	93727	3962	10	06019	36.74493575	-119.714868	Fresno County
88394	Fee-for-Service	1376508010	1376508010	1	1	ROMEISER, RYAN M MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST STREET	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
88409	Fee-for-Service	1952998973	1952998973	1	2	REGENTS OF THE UNIVERSITY OF	5/12/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
88449	Fee-for-Service	1164441200	1164441200	1	1	RAHIMI, MARYAM A MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96367	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
88474	Fee-for-Service	1326086828	1326086828	1	1	RAMANATHAN, SARASWATHY MD	11/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87938	18	Ophthalmology	0	In state provider	None	1001 POTRERO	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
88480	Fee-for-Service	1073707048	1073707048	1	1	RNC MEDICAL GROUP INC	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46134	20	Orthopedic Surgery	0	In state provider	None	2160 COURT ST	None	REDDING	CA	96001	2530	45	06089	40.57698594	-122.3931348	Shasta County
88501	Fee-for-Service	1386637346	1386637346	1	2	REGENTS/UCDPBG/PEDIATRIC	1/23/2023	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
88505	Fee-for-Service	1760541569	1760541569	1	24	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2400 NORTH BROADWAY	None	LOS ANGELES	CA	90031	2219	19	06037	34.07360257	-118.2166466	Los Angeles County
88520	Fee-for-Service	1104277938	1104277938	1	1	RAMASWAMY, PRIYA MD	9/15/2020	207L00000X	NA	Other	026	PHYSICIANS	168828	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
88533	Fee-for-Service	1386637346	1386637346	1	1	REGENTS/UCDPBG/PEDIATRIC	1/23/2023	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
88540	Fee-for-Service	1841819018	1841819018	1	1	RAPHAEL, MONA MD	10/16/2023	207R00000X	NA	Other	026	PHYSICIANS	187671	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
88548	Fee-for-Service	1710392535	1710392535	1	1	RETROGEN INC	6/7/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	6645 NANCY RIDGE DRIVE	None	SAN DIEGO	CA	92121	2253	37	06073	32.88652189	-117.179058	San Diego County
88578	Fee-for-Service	1568923183	1568923183	1	1	RISO, GENNARINA L MD	5/29/2024	207P00000X	NA	Other	026	PHYSICIANS	19381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
88596	Fee-for-Service	1679849129	1679849129	1	1	RIZK, JENNIFER LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
88631	Fee-for-Service	1487640868	1487640868	1	1	REDDING FAMILY MEDICAL	11/13/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	2510 AIRPARK DR	STE 201	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
88648	Fee-for-Service	1063522472	1063522472	1	1	RUBINSTEIN, EDWARD	7/8/1988	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2211 POST ST	STE 203	SAN FRANCISCO	CA	94115	3467	38	06075	37.78446663	-122.4382772	San Francisco County
88664	Fee-for-Service	1457731747	1457731747	1	1	REZAEI, MASHA E MD	7/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146947	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
88677	Fee-for-Service	1407870520	1407870520	1	1	ROBERTSON, DEBORA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 HOSPITAL DR	None	BOISE	ID	83340	0000	00	None	43.6482607	-114.3490716	Blaine County
88734	Fee-for-Service	1356785505	1356785505	1	1	RAMGREN, AILEEN N DO	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14418	40	Pediatrics	0	In state provider	None	25485 MEDICAL CENTER DR	SUITE 220	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
88741	Fee-for-Service	1497033278	1497033278	1	1	ROBERTA D. SENGELMANN MD INC	9/26/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	2921 DE LA VINA ST	None	SANTA BARBARA	CA	93105	3309	42	06083	34.43816014	-119.7277541	Santa Barbara County
88760	Fee-for-Service	1851046015	1851046015	1	1	REAL CARE ADHC CBAS INC	6/2/2022	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	8158 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	4806	19	06037	34.219566	-118.4487405	Los Angeles County
88792	Fee-for-Service	1942301437	1942301437	1	1	RASTAWAN, SIYAMAC PT	2/22/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1751 W ROMNEYA DR	SUITE M	ANAHEIM	CA	92801	1815	30	06059	33.85068001	-117.9438835	Orange County
88799	Fee-for-Service	1194295469	1194295469	1	2	RASOOLI, AZIZ DPM	12/9/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1075 BONITA AVE	None	LA VERNE	CA	91750	5109	19	06037	34.10654819	-117.7884856	Los Angeles County
88800	Fee-for-Service	1558864595	1558864595	1	1	REGENHARDT, KATHERINE DO	10/9/2023	207P00000X	NA	Other	026	PHYSICIANS	21570	None	None	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
88830	Fee-for-Service	1629500210	1629500210	1	1	ROMANOV, SERGEI S MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	179680	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
88838	Fee-for-Service	1982920500	1982920500	1	1	RMVR 8 INC	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89166	40	Pediatrics	0	In state provider	None	6508 LONETREE BLVD	STE 103	ROCKLIN	CA	95765	5885	31	06061	38.80314	-121.2936385	Placer County
88843	Fee-for-Service	1376954602	1376954602	1	1	RACHEL WOOD	3/8/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
88856	Fee-for-Service	1811372600	1811372600	1	1	RENEWMD COASTAL, INC.	1/21/2021	2083P0011X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	6260 EL CAMINO REAL	None	CARLSBAD	CA	92009	1609	37	06073	33.12215813	-117.266659	San Diego County
88956	Fee-for-Service	1790059228	1790059228	1	1	RESER, ISA	2/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	545 OCEAN VIEW AVE	None	SANTA CRUZ	CA	95062	3363	44	06087	36.97603287	-122.0166335	Santa Cruz County
88976	Fee-for-Service	1578910840	1578910840	1	1	ROXAS, ROGER R MD	8/18/2020	207P00000X	NA	Other	026	PHYSICIANS	166981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4304	37	06073	32.63282707	-117.0829101	San Diego County
89009	Fee-for-Service	1245232685	1245232685	1	1	RIGGS, PEYTON D DO	4/10/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7665	08	Family Practice	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
89032	Fee-for-Service	1306189485	1306189485	1	1	RICHARDS, SARA M MD	1/24/2019	207L00000X	NA	Other	026	PHYSICIANS	135105	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
89040	Fee-for-Service	1164742243	1164742243	1	1	RAKIC, MARKO MD	9/26/2018	207R00000X	NA	Other	026	PHYSICIANS	154985	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
89049	Fee-for-Service	1740379809	1740379809	1	1	RAFIJAH, GREGORY H MD	8/19/2008	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	78365	20	Orthopedic Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89051	Fee-for-Service	1629225479	1629225479	1	1	REVERTE, CHRISTOPHER M MD	3/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110267	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
89061	Fee-for-Service	1962482513	1962482513	1	4	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1111 EXPOSITION BLVD	STE 200	SACRAMENTO	CA	95815	4324	34	06067	38.598876	-121.4502885	Sacramento County
89117	Fee-for-Service	1124260880	1124260880	1	1	ROOBINI, BABAK MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123363	18	Ophthalmology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
89120	Fee-for-Service	1760962492	1760962492	1	1	ROSSELL, KAYLA PSYD	12/20/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
89130	Fee-for-Service	1386722189	1386722189	1	1	RUTHERFORD, YVONNE MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42571	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
89154	Fee-for-Service	1356746267	1356746267	1	1	RED CHIP OF NEVADA	7/17/2015	193200000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18009 SKY PARK CIRCLE	STE F	IRVINE	CA	92614	6516	30	06059	33.68782107	-117.856866	Orange County
89170	Fee-for-Service	1376106377	1376106377	1	1	REYES, ESTELA A LAC	10/9/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
89183	Fee-for-Service	1114448487	1114448487	1	1	ROCA, VICTORIA LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
89205	Fee-for-Service	1447949532	1447949532	1	1	REMARK MARTINEZ, DOROTHEA G	9/17/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OD	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
89235	Fee-for-Service	1124221056	1124221056	1	1	RODRIGUEZ, CARLOS MD	4/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107649	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
89293	Fee-for-Service	1598005605	1598005605	1	1	RICHARDSON, TONNETTE M LMFT	5/19/2021	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
89303	Fee-for-Service	1346233434	1346233434	1	1	RAHIMI, AFSHIN D MD	10/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63668	07	Dermatology	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
89328	Fee-for-Service	1962922823	1962922823	1	1	REID, RANDALL MD	11/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158156	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
89348	Fee-for-Service	1962482513	1962482513	1	4	REGENTS OF THE UNIVERSITY OF	3/23/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	STE 200	SACRAMENTO	CA	95815	4324	34	06067	38.598876	-121.4502885	Sacramento County
89410	Fee-for-Service	1821596693	1821596693	1	2	RJHH ACTIVE HEARING INC	10/31/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3940 HANCOCK ST	STE 117	SAN DIEGO	CA	92110	5159	37	06073	32.755374	-117.2121975	San Diego County
89412	Fee-for-Service	1205465218	1205465218	1	1	ROBERTSON, LAURA B MD	7/18/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186498	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
89450	Fee-for-Service	1245389113	1245389113	1	1	ROBBINS, PETER S MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85255	42	Nuclear Medicine	0	In state provider	None	1950 COURT ST	None	REDDING	CA	96001	1823	45	06089	40.57884166	-122.3939309	Shasta County
89534	Fee-for-Service	1649459850	1649459850	1	1	RAFIEI, NASTARAN MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100901	13	Neurology (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
89541	Fee-for-Service	1588856017	1588856017	1	1	ROZAKIS, KATERINA LCSW	7/1/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2821 CROW CANYON	202	SAN RAMON	CA	94583	1659	07	06013	37.77494135	-121.9805388	Contra Costa County
89549	Fee-for-Service	1720644081	1720644081	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1360 W 6TH ST	SUITE 165	SAN PEDRO	CA	90732	3540	19	06037	33.73886546	-118.3075065	Los Angeles County
89582	Fee-for-Service	1225036445	1225036445	1	1	RORK, PAUL W MD	10/27/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41328	08	Family Practice	0	In state provider	None	1090 3RD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
89633	Fee-for-Service	1316924707	1316924707	1	1	RAFFEL, COREY MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	46212	14	Neurological Surgery	0	In state provider	None	1001 POTRERO AVE	RM 4M39	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
89636	Fee-for-Service	1962482513	1962482513	1	4	REGENTS OF THE UNIVERSITY OF	8/16/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	STE 200	SACRAMENTO	CA	95815	4324	34	06067	38.598876	-121.4502885	Sacramento County
89667	Fee-for-Service	1326556218	1326556218	1	1	ROSADO, JADE M LCSW	6/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
89708	Fee-for-Service	1295733657	1295733657	1	1	ROGERS, ROBERT J MD	3/1/1984	207L00000X	NA	Other	026	PHYSICIANS	50749	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
89723	Fee-for-Service	1073623484	1073623484	1	1	RENARD, ROBERT N LCSW	7/16/2004	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	570 POLI ST	None	VENTURA	CA	93001	2633	56	06111	34.2821039	-119.2920818	Ventura County
89790	Fee-for-Service	1760541569	1760541569	1	20	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11525 BROOKSHIRE AVE	201A	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
89795	Fee-for-Service	1922613207	1922613207	1	1	RESURGENT HEAD AND NECK SURG	1/8/2025	207YX0007X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	EONS, INC.	6848 MAGNOLIA AVE	STE 220	RIVERSIDE	CA	92506	2858	33	06065	33.94954856	-117.3989256	Riverside County
89804	Fee-for-Service	1255323945	1255323945	1	1	REDWOOD, FIONA MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51019	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1301 SOUTHPOINT BLVD	None	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
89813	Fee-for-Service	1336502079	1336502079	1	1	RAMIN, JONATHAN DO	6/9/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20305	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
89826	Fee-for-Service	1003232026	1003232026	1	1	ROSA, ENA C LMFT	6/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
89837	Fee-for-Service	1720644081	1720644081	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 W 6TH ST	SUITE 165	SAN PEDRO	CA	90732	3540	19	06037	33.73886546	-118.3075065	Los Angeles County
89841	Fee-for-Service	1396773560	1396773560	1	1	RECORD, SHARON C NP	1/1/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
89853	Fee-for-Service	1487725396	1487725396	1	1	RABBANI, SOHRAB MD	1/31/1992	207R00000X	NA	Other	026	PHYSICIANS	50384	01	General Practice	0	In state provider	None	16661 VENTURA BLVD	STE 105	ENCINO	CA	91436	1901	19	06037	34.15820737	-118.496492	Los Angeles County
89864	Fee-for-Service	1740292341	1740292341	1	1	RIAR, NAVDEEP K MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94571	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
89896	Fee-for-Service	1366004079	1366004079	1	1	ROSAS, SEAN A LCSW	11/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12383 MAYS CANYON RD	None	GUERNEVILLE	CA	95446	9499	49	06097	38.48356205	-122.9832464	Sonoma County
89900	Fee-for-Service	1821211673	1821211673	1	1	RODMAN CARA RITTER AND INABA	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MDS INC	710 N EUCLID ST	SUITE 206	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
89905	Fee-for-Service	1336552553	1336552553	1	1	RAMOS, MAYRA A LMFT	3/11/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21 N EL CIRCULO AVE	None	PATTERSON	CA	95363	2535	50	06099	37.47121868	-121.1322863	Stanislaus County
89918	Fee-for-Service	1497754907	1497754907	1	1	ROWEN, MARSHALL MD	11/27/1972	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16470	30	Radiology	0	In state provider	None	1000 W LA VETA AVE	None	ORANGE	CA	92868	4304	30	06059	33.78028244	-117.8635552	Orange County
89922	Fee-for-Service	1083655740	1083655740	2	1	RICKMAN, DAVID M MD	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
89926	Fee-for-Service	1962482513	1962482513	1	4	REGENTS OF THE UNIVERSITY OF	11/16/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1111 EXPOSITION BLVD	STE 200	SACRAMENTO	CA	95815	4324	34	06067	38.598876	-121.4502885	Sacramento County
89938	Fee-for-Service	1316970122	1316970122	1	1	RUNION, LANCE K. MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W. MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
89944	Fee-for-Service	1588676472	1588676472	1	1	RODRIGUEZ, ANGELA M MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83992	24	Plastic Surgery	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
89946	Fee-for-Service	1366750416	1366750416	1	1	RANDOLPH, MELANIE L LCSW	8/30/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
89975	Fee-for-Service	1093971293	1093971293	1	1	RUDNER, LANNY MD	4/10/2019	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	118170	None	None	0	In state provider	None	99 N LA CIENEGA BLVD	SUITE 304	BEVERLY HILLS	CA	90211	2286	19	06037	34.06736471	-118.3763201	Los Angeles County
89976	Fee-for-Service	1942240189	1942240189	1	1	REFUGIO COUNTY MEMORIAL HOSP	3/19/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	107 SWIFT ST	None	REFUGIO	TX	78377	2425	00	None	28.30663325	-97.2794285	Refugio County
90024	Fee-for-Service	1457467169	1457467169	1	1	RMS HEALTHCARE INC	10/14/2009	207R00000X	NA	Other	026	PHYSICIANS	64108	41	Internal Medicine	0	In state provider	None	27420 TOURNEY ROAD	STE 200	VALENCIA	CA	91355	5634	19	06037	34.42122797	-118.5787489	Los Angeles County
90072	Fee-for-Service	1962530725	1962530725	1	1	REDWOOD COAST MED SVS	11/1/1993	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1100	46900 OCEAN DR	None	GUALALA	CA	95445	8353	23	06045	38.80460137	-123.5780677	Mendocino County
90078	Fee-for-Service	1760541569	1760541569	1	20	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	11525 BROOKSHIRE AVE	201A	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
90092	Fee-for-Service	1255323945	1255323945	1	1	REDWOOD, FIONA MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51019	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	None	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
90104	Fee-for-Service	1528127115	1528127115	1	1	RAHMIM, AREZOO MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77509	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
90138	Fee-for-Service	1487693701	1487693701	1	2	REHFIELD, PATRICIA L DO	10/25/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	10854	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
90141	Fee-for-Service	1992221303	1992221303	1	1	RASKIN-LI, JULIE S LMFT	4/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2531 FOREST AVE	110	CHICO	CA	95928	7716	04	06007	39.71810753	-121.794534	Butte County
90207	Fee-for-Service	1588045686	1588045686	1	1	RAJEBI, HAMID MD	5/25/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175279	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
90208	Fee-for-Service	1013124635	1013124635	1	1	ROWHANIAN, KIARASH MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
90301	Fee-for-Service	1073532883	1073532883	1	1	ROSENTHAL, JOHN T MD	6/11/1998	208800000X	NA	Other	026	PHYSICIANS	59107	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
90337	Fee-for-Service	1679725485	1679725485	1	1	RILEY, JAMES L MD	1/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51674	05	Anesthesiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
90359	Fee-for-Service	1962530725	1962530725	1	1	REDWOOD COAST MED SVS	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1100	46900 OCEAN DR	None	GUALALA	CA	95445	8353	23	06045	38.80460137	-123.5780677	Mendocino County
90364	Fee-for-Service	1942505219	1942505219	1	1	RICHES RUBENS, ALANA L LCSW	4/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO ST	202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
90400	Fee-for-Service	1649360264	1649360264	1	1	RICHARD KENT SANDERS, MD	12/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CITY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
90409	Fee-for-Service	1720041452	1720041452	1	1	RINNERT, KATHY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
90412	Fee-for-Service	1639469877	1639469877	1	1	ROGERS, STEPHANIE E MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124451	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90464	Fee-for-Service	1336441229	1336441229	1	1	ROBINSON, LESLIE C MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154682	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90486	Fee-for-Service	1003941329	1003941329	1	1	RHINE, WILLIAM MD	9/30/1987	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	56348	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
90528	Fee-for-Service	1194869693	1194869693	1	1	RODAS, SERGIO U MD	6/30/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55286	08	Family Practice	0	In state provider	None	845 N 10TH ST	None	SANTA PAULA	CA	93060	1300	56	06111	34.36592531	-119.0656897	Ventura County
90529	Fee-for-Service	1356556021	1356556021	1	1	RITTER, STEVEN F DO	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	7435	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
90537	Fee-for-Service	1457314262	1457314262	1	1	RIVERSIDE CARDIOLOGY	8/1/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ASSOC MEDICAL GROUP	4500 BROCKTON AVE	STE 203	RIVERSIDE	CA	92501	4027	33	06065	33.97785263	-117.3836152	Riverside County
90573	Fee-for-Service	1578763850	1578763850	1	1	RAMISETTI, D K MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	36545	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	320 SUPERIOR AVENUE	SUITE 240	NEWPORT BEACH	CA	92663	2779	30	06059	33.62657138	-117.9330754	Orange County
90588	Fee-for-Service	1487895066	1487895066	1	1	RA, HENRY HO-HIN MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110407	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
90595	Fee-for-Service	1245325463	1245325463	1	1	REGENTS, UNIV OF CALIF	8/1/1987	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	SFGH MED GRP DIALYSIS	1001 POTRERO AVE	RM 342	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
90610	Fee-for-Service	1679581060	1679581060	1	1	ROBERTS,JEFFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14601 DETROIT AVE	STE 700	LAKEWOOD	OH	44107	0000	00	None	41.48523047	-81.79739884	Cuyahoga County
90613	Fee-for-Service	1003236191	1003236191	1	1	REDINSKI, JOHN J DO	7/23/2019	207RC0200X	NA	Other	026	PHYSICIANS	14597	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
90627	Fee-for-Service	1932134145	1932134145	1	1	REYES, ADRIAN V MD	2/21/2009	207L00000X	NA	Other	026	PHYSICIANS	51386	05	Anesthesiology	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
90647	Fee-for-Service	1699965095	1699965095	1	1	RUSSELL, MICHAEL J MD	9/9/2019	207ZP0101X	NA	Other	026	PHYSICIANS	152203	22	Pathology (M.D. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
90649	Fee-for-Service	1962530725	1962530725	1	1	REDWOOD COAST MED SVS	7/16/1993	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1100	46900 OCEAN DR	None	GUALALA	CA	95445	8353	23	06045	38.80460137	-123.5780677	Mendocino County
90655	Fee-for-Service	1790815140	1790815140	1	1	REINSCH, JOHN A MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	32827	68	Hematology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
90671	Fee-for-Service	1568663797	1568663797	1	1	ROBERTSON, HEIDI A MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84410	41	Internal Medicine	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
90693	Fee-for-Service	1790762763	1790762763	1	1	RUBIN, OLEG F MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81462	41	Internal Medicine	0	In state provider	None	1241 ALAMO DR	STE 6	VACAVILLE	CA	95687	5620	48	06095	38.34094223	-121.9921712	Solano County
90747	Fee-for-Service	1376593004	1376593004	1	1	ROWLAND, CONVALESCENT	5/1/1980	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	330 W ROWLAND ST	None	COVINA	CA	91723	2941	19	06037	34.07894101	-117.8952421	Los Angeles County
90752	Fee-for-Service	1225297864	1225297864	1	1	REDJAL, NAVID MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137547	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
90769	Fee-for-Service	1134277924	1134277924	1	1	RIDOLFI, REN L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38700	22	Pathology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
90805	Fee-for-Service	1912530809	1912530809	1	1	RIVERA, VICTORIA L NP	8/12/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
90809	Fee-for-Service	1366559429	1366559429	1	2	RAMOS, MARIO MD APC	1/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	60764	None	None	0	In state provider	None	560 PASEO DOROTEA	SUITE 2	PALM SPRINGS	CA	92264	1434	33	06065	33.8146094	-116.5017737	Riverside County
90816	Fee-for-Service	1558435875	1558435875	1	1	ROBERTS, ROBIN D MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65371	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
90852	Fee-for-Service	1558364836	1558364836	1	1	ROSS, STEVEN D K MD	6/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	37046	20	Orthopedic Surgery	0	In state provider	None	101 CITY DR	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90856	Fee-for-Service	1265433072	1265433072	1	1	ROSENBERG, ROBERT M MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50480	07	Dermatology	0	In state provider	None	515 S BEACH BLVD	# 1	ANAHEIM	CA	92804	1812	30	06059	33.82559703	-117.9934832	Orange County
90862	Fee-for-Service	1578763850	1578763850	1	1	RAMISETTI, D K MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	36545	41	Internal Medicine	0	In state provider	None	320 SUPERIOR AVENUE	SUITE 240	NEWPORT BEACH	CA	92663	2779	30	06059	33.62657138	-117.9330754	Orange County
90865	Fee-for-Service	1083870042	1083870042	1	1	REGAN, SHAWN P CRNA	8/13/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
90935	Fee-for-Service	1962530725	1962530725	1	1	REDWOOD COAST MED SVS	11/1/1993	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1100	46900 OCEAN DR	None	GUALALA	CA	95445	8353	23	06045	38.80460137	-123.5780677	Mendocino County
90968	Fee-for-Service	1306039771	1306039771	1	1	RICHARDSON, RODNEY B PT	5/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	35023 MISSION HILLS DR	BLDG A	RANCHO MIRAGE	CA	92270	1317	33	06065	33.79890054	-116.4319423	Riverside County
90969	Fee-for-Service	1558496182	1558496182	1	1	ROBERT J STAHL & AMY J	5/17/2006	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CALDER ODS	1142 REDONDO BEACH BLV	None	GARDENA	CA	90247	3538	19	06037	33.89230906	-118.2953793	Los Angeles County
90981	Fee-for-Service	1790762763	1790762763	1	1	RUBIN, OLEG F MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81462	45	Nephrology (Renal-Kidney)	0	In state provider	None	1241 ALAMO DR	STE 6	VACAVILLE	CA	95687	5620	48	06095	38.34094223	-121.9921712	Solano County
91054	Fee-for-Service	1518332261	1518332261	1	1	RABIZADEH, SAMUEL N PT	3/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2001 SOLAR DR	STE 150	OXNARD	CA	93036	0680	56	06111	34.22025454	-119.1449192	Ventura County
91080	Fee-for-Service	1952480600	1952480600	1	1	REDDY, KURUGANTI P MD	12/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81914	41	Internal Medicine	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
91230	Fee-for-Service	1861468373	1861468373	1	1	RETTENMAIER, DENISE A DO	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6474	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
91239	Fee-for-Service	1649357583	1649357583	1	1	READY, JOANNA B MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68624	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
91320	Fee-for-Service	1629032982	1629032982	1	1	REGENTS OF THE UNIV OF	5/31/1995	193400000X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	RM 64-128	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
91337	Fee-for-Service	1295915585	1295915585	1	1	RHEEM, DAE S MD	2/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92866	10	Gastroenterology (M.D. only)	0	In state provider	None	44725 10TH ST W	STE 250	LANCASTER	CA	93534	3048	19	06037	34.695693	-118.1480965	Los Angeles County
91342	Fee-for-Service	1760541569	1760541569	1	1	RETINA INSTITUTE OF CALIFORN	1/17/2007	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
91380	Fee-for-Service	1790713394	1790713394	1	4	RIVERSIDE FAMILY	10/11/2023	193400000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	#150	RIVERSIDE	CA	92505	3373	33	06065	33.90336622	-117.49394	Riverside County
91417	Fee-for-Service	1346342896	1346342896	1	1	RILEY, TARRON D LCSW	9/4/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CHURCH ST.	SUITE 124	RANCHO CUCAMONGA	CA	91730	6863	36	06071	34.11301097	-117.5717343	San Bernardino County
91424	Fee-for-Service	1942477807	1942477807	1	1	REDDY, PAVANI R MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106724	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
91510	Fee-for-Service	1427176338	1427176338	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91550	Fee-for-Service	1225079585	1225079585	1	1	ROBERT ALLAN MARGULIES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5304 N ROAD 68	None	PASCO	WA	99301	9189	00	None	46.27476646	-119.1854431	Franklin County
91568	Fee-for-Service	1356346936	1356346936	1	1	ROBERTS, JAMES MD	9/18/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	186352	02	General Surgery	0	In state provider	None	1541 FLORIDA AVE	SUITE 305	MODESTO	CA	95350	4439	50	06099	37.666863	-120.9962775	Stanislaus County
91608	Fee-for-Service	1770254054	1770254054	1	1	RUNNELS, CHANTEL R CD	2/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
91627	Fee-for-Service	1760541569	1760541569	1	1	RETINA INSTITUTE OF CALIFORN	10/16/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
91634	Fee-for-Service	1205894821	1205894821	1	1	ROSENTHAL, JORDAN S MD	9/30/1992	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9100 S SEPULVEDA BLVD	STE 100	LOS ANGELES	CA	90045	4849	19	06037	33.954147	-118.396111	Los Angeles County
91654	Fee-for-Service	1578973350	1578973350	1	1	RITCHEY, JAMES MD	9/6/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145388	08	Family Practice	0	In state provider	None	1301 MISSION STREET	None	SANTA CRUZ	CA	95030	3528	44	06087	36.96817615	-122.0381947	Santa Cruz County
91662	Fee-for-Service	1760798284	1760798284	1	1	ROMINE, SILVIA MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
91668	Fee-for-Service	1578909107	1578909107	1	1	RICHARD, THEODORE LCSW	7/10/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	930 TRUXTUN AVE	202	BAKERSFIELD	CA	93301	4700	15	06029	35.37343547	-119.012751	Kern County
91670	Fee-for-Service	1790713394	1790713394	1	4	RIVERSIDE FAMILY	11/10/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4244 RIVERWALK PKWY	#150	RIVERSIDE	CA	92505	3373	33	06065	33.90336622	-117.49394	Riverside County
91683	Fee-for-Service	1427190362	1427190362	1	1	RODARTE FRANCO, ROSIE LMFT	6/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	216 E PINE ST	None	EXETER	CA	93221	2094	54	06107	36.2964192	-119.1405448	Tulare County
91686	Fee-for-Service	1487677902	1487677902	1	1	ROGERS, STEPHEN N MD	10/18/1985	207L00000X	NA	Other	026	PHYSICIANS	39517	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
91687	Fee-for-Service	1770025181	1770025181	1	1	RIGGIO, ANGELA J LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
91722	Fee-for-Service	1811436413	1811436413	1	1	ROBERSON, SARAH	9/30/2022	207P00000X	NA	Other	026	PHYSICIANS	181480	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
91724	Fee-for-Service	1881741247	1881741247	2	1	ROSENTHAL, JOHANNA L MD	8/24/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	40976	13	Neurology (M.D. only)	0	In state provider	None	17021 YORBA LINDA BLVD	STE 20	YORBA LINDA	CA	92886	3742	30	06059	33.88847378	-117.8372198	Orange County
91752	Fee-for-Service	1841521150	1841521150	1	1	ROWINSKI, ASHLEY A MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110597	40	Pediatrics	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
91784	Fee-for-Service	1710967401	1710967401	1	1	RUSNAK, ANDREW A MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55149	01	General Practice	0	In state provider	None	525 THIRD AVE	None	CHULA VISTA	CA	91910	5696	37	06073	32.63367609	-117.0769202	San Diego County
91797	Fee-for-Service	1427176338	1427176338	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91807	Fee-for-Service	1922046085	1922046085	2	1	RAC & ASSOCIATES INC	3/8/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9541 RIDGEHAVEN CT	None	SAN DIEGO	CA	92123	1624	37	06073	32.82082427	-117.1233688	San Diego County
91813	Fee-for-Service	1396812293	1396812293	1	1	REYES, ARNEL H MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55236	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
91823	Fee-for-Service	1417367186	1417367186	1	1	RUGGLE, ADAM MD	3/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155672	36	Psychiatry	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
91824	Fee-for-Service	1710173844	1710173844	1	1	RICE, ROBERT T OD &	10/1/1996	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ALLRED, C TROY OD	1342 E CHAPMAN AVE	None	FULLERTON	CA	92831	3954	30	06059	33.87409201	-117.9039639	Orange County
91831	Fee-for-Service	1225088214	1225088214	1	1	RIES, ANDREW MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33984	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
91845	Fee-for-Service	1497319446	1497319446	1	1	ROSE, NATELY LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
91861	Fee-for-Service	1992798912	1992798912	1	2	REGENTS/UCDPBG/OB REI	6/26/2020	207VE0102X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
91868	Fee-for-Service	1598810590	1598810590	1	1	RICHMOND, LEON F MD	9/20/2007	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37530	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	411 30TH ST	STE 502	OAKLAND	CA	94609	3300	01	06001	37.81903474	-122.2649444	Alameda County
91891	Fee-for-Service	1356413132	1356413132	1	1	ROR INC	7/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9308 TELEPHONE RD	STE B	VENTURA	CA	93004	2680	56	06111	34.27167627	-119.1712565	Ventura County
91894	Fee-for-Service	1629507496	1629507496	1	1	REID, BROOKE I AU	11/9/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
91906	Fee-for-Service	1265612816	1265612816	1	1	ROBINSON, LORI A PT	10/26/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27107 TOURNEY RD	None	SANTA CLARITA	CA	91355	1860	19	06037	34.41607441	-118.5761057	Los Angeles County
91915	Fee-for-Service	1730171497	1730171497	1	1	RATHLE, HABIB E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1025 W 24TH ST	STE 6	YUMA	AZ	85364	8369	00	None	32.683824	-114.631668	Yuma County
91920	Fee-for-Service	1457456030	1457456030	1	1	ROBERTSON, ELISA L LCSW	12/9/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	441 N MAIN ST	None	ALTURAS	CA	96101	3457	25	06049	41.48803571	-120.542554	Modoc County
91944	Fee-for-Service	1760541569	1760541569	1	9	RETINA INSTITUTE OF CALIFORN	5/3/2021	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	47474 WASHINGTON ST	None	LA QUINTA	CA	92253	8846	33	06065	33.70440716	-116.2947003	Riverside County
91950	Fee-for-Service	1528012325	1528012325	1	1	RAJESWARA-RAO, KOSARAJU	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30703	47	Miscellaneous	0	In state provider	None	350 S MADERA AVE	STE A	MADERA	CA	93637	5465	20	06039	36.95131911	-120.0561168	Madera County
91958	Fee-for-Service	1790713394	1790713394	1	4	RIVERSIDE FAMILY	4/11/2022	193400000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	#150	RIVERSIDE	CA	92505	3373	33	06065	33.90336622	-117.49394	Riverside County
92003	Fee-for-Service	1639217136	1639217136	1	1	REIMER, RICHARD J MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76516	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92066	Fee-for-Service	1902852767	1902852767	1	1	REID, ERIN G MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73308	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92072	Fee-for-Service	1598844649	1598844649	1	1	RIBAUDO, JOHN MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	57643	13	Neurology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
92081	Fee-for-Service	1346301934	1346301934	1	1	REDDING PETROLEUM INC	6/27/2005	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA TRACABOUT	469 LOPES RD	STE B	FAIRFIELD	CA	94534	1623	48	06095	38.20673177	-122.1384937	Solano County
92085	Fee-for-Service	1326066887	1326066887	1	1	ROTHBAUM, ROBERT J MD	1/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158847	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92116	Fee-for-Service	1649761917	1649761917	1	1	RAFAY S CHEEMA	4/11/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
92128	Fee-for-Service	1952440042	1952440042	1	1	RIKLEEN, DANIEL A	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	43868	01	General Practice	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
92150	Fee-for-Service	1992798912	1992798912	1	2	REGENTS/UCDPBG/OB REI	5/1/1999	207VE0102X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
92157	Fee-for-Service	1891387601	1891387601	1	1	RING OF SALVATION HOSPICE	4/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	14545 FRIAR STREET	STE 181	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
92178	Fee-for-Service	1801816004	1801816004	1	1	RICH, KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50272	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2640 ZOE AVE	None	HUNTINGTON PARK	CA	90255	4132	19	06037	33.9791997	-118.2239296	Los Angeles County
92182	Fee-for-Service	1508286709	1508286709	1	1	RAJAIPOUR, NEGIN MD	3/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145480	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
92234	Fee-for-Service	1760541569	1760541569	1	9	RETINA INSTITUTE OF CALIFORN	5/3/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	47474 WASHINGTON ST	None	LA QUINTA	CA	92253	8846	33	06065	33.70440716	-116.2947003	Riverside County
92237	Fee-for-Service	1760552343	1760552343	1	2	REGENTS OF THE UNIVERSITY OF	12/12/2024	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	520 ILLINOIS ST	None	SAN FRANCISCO	CA	94107	0000	38	06075	37.76487693	-122.3880446	San Francisco County
92242	Fee-for-Service	1790713394	1790713394	1	4	RIVERSIDE FAMILY	11/22/2016	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	#150	RIVERSIDE	CA	92505	3373	33	06065	33.90336622	-117.49394	Riverside County
92292	Fee-for-Service	1639217136	1639217136	1	1	REIMER, RICHARD J MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76516	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92298	Fee-for-Service	1780267948	1780267948	1	1	RANCHO SECO CARE CENTER LLC	5/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	144 F STREET	None	GALT	CA	95632	1833	34	06067	38.247795	-121.3078005	Sacramento County
92301	Fee-for-Service	1013208826	1013208826	1	1	RAMIREZ, JESSICA V MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123405	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	6TH FLOOR	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
92350	Fee-for-Service	1902852767	1902852767	1	1	REID, ERIN G MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73308	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92375	Fee-for-Service	1326066887	1326066887	1	1	ROTHBAUM, ROBERT J MD	1/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158847	10	Gastroenterology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92445	Fee-for-Service	1891387601	1891387601	1	1	RING OF SALVATION HOSPICE	4/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	14545 FRIAR STREET	STE 181	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
92459	Fee-for-Service	1750555454	1750555454	1	1	RICKARD, DIANA G MD	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	99589	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
92466	Fee-for-Service	1801816004	1801816004	1	1	RICH, KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50272	08	Family Practice	0	In state provider	None	2640 ZOE AVE	None	HUNTINGTON PARK	CA	90255	4132	19	06037	33.9791997	-118.2239296	Los Angeles County
92496	Fee-for-Service	1043674682	1043674682	1	1	ROWE, ROBERT MD	2/21/2018	390200000X	NA	Other	026	PHYSICIANS	145750	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
92507	Fee-for-Service	1760541569	1760541569	1	10	RETINA INSTITUTE OF CALIFORN	11/21/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	3816 WOODRUFF AVE	STE 100	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
92530	Fee-for-Service	1760552343	1760552343	1	2	REGENTS OF THE UNIVERSITY OF	7/19/2024	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	520 ILLINOIS ST	None	SAN FRANCISCO	CA	94107	0000	38	06075	37.76487693	-122.3880446	San Francisco County
92544	Fee-for-Service	1316441249	1316441249	1	1	RICHARDVILLE, KYLE MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	177867	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
92574	Fee-for-Service	1255755401	1255755401	1	1	REYES, STEPHANIE LMFT	1/27/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
92687	Fee-for-Service	1659371250	1659371250	1	1	RAMONA FIRE DEPARTMENT	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RAMONA MUNCPL WATER DIST	105 EARLHAM ST	None	RAMONA	CA	92065	1558	37	06073	33.05116996	-116.8556026	San Diego County
92691	Fee-for-Service	1205365814	1205365814	1	1	ROBINSON, SAMUEL J DO	3/27/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18447	70	Clinic (mixed specialty)	0	In state provider	None	2575 E BIDWELL ST	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
92697	Fee-for-Service	1205139094	1205139094	1	1	RANDERIA, KALYANI MD INC	8/12/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45174	08	Family Practice	0	In state provider	None	101 E BEVERLY BLVD	#405	MONTEBELLO	CA	90640	4317	19	06037	34.01556395	-118.0983878	Los Angeles County
92707	Fee-for-Service	1588670533	1588670533	1	1	RODRIGUEZ, JORGE E.C.	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54207	40	Pediatrics	0	In state provider	None	1519 GARCES HWY	STE 105	DELANO	CA	93215	3694	15	06029	35.76146003	-119.2367778	Kern County
92709	Fee-for-Service	1619958113	1619958113	1	1	RUDNITSKY, BENJAMIN S MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2420 PROFESSIONAL COURT	SUITE 150	LAS VEGAS	NV	89128	0837	00	None	36.203769	-115.2550845	Clark County
92716	Fee-for-Service	1265729362	1265729362	1	1	REINBERG, MICHAEL MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152069	41	Internal Medicine	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95442	6710	17	06033	38.93612361	-122.6201499	Lake County
92727	Fee-for-Service	1295967727	1295967727	1	1	RHONDA HAUSER LCSW, INC.	3/3/2019	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LING	30497 CANWOOD ST	SUITE 103	AGOURA HILLS	CA	91301	4330	19	06037	34.14702019	-118.7854422	Los Angeles County
92745	Fee-for-Service	1093118101	1093118101	1	1	RANKIN, DEVON L LMFT	1/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
92751	Fee-for-Service	1285065136	1285065136	1	1	RAMIREZ, ORFA LMFT	12/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
92757	Fee-for-Service	1063148211	1063148211	1	1	RANGU, SOWMITH MD	7/3/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	180859	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
92794	Fee-for-Service	1760541569	1760541569	1	10	RETINA INSTITUTE OF CALIFORN	11/22/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3816 WOODRUFF AVE	STE 100	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
92809	Fee-for-Service	1104301001	1104301001	1	1	RIZVI, MUHAMMAD M CRNA	1/25/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
92818	Fee-for-Service	1740255306	1740255306	1	1	RAFEEA, IBTESAM M MD	9/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98961	40	Pediatrics	0	In state provider	None	900 S MAIN ST	STE 209A	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
92823	Fee-for-Service	1649357179	1649357179	1	1	ROLAND, MICHELLE E MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	60457	01	General Practice	0	In state provider	None	995 POTRERO AVE	BLDG 80	SAN FRANCISCO	CA	94110	2859	38	06075	37.75729541	-122.4066641	San Francisco County
92861	Fee-for-Service	1841565454	1841565454	1	1	RAGUDO, JOHN S PT	5/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
92867	Fee-for-Service	1629162250	1629162250	1	1	RANCHO OBSTETRICS AND	1/18/2006	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GYNECOLOGY, INC	25395 HANCOCK AVE	STE 210	MURRIETA	CA	92562	6927	33	06065	33.5591482	-117.185187	Riverside County
92876	Fee-for-Service	1629301544	1629301544	1	1	RASHMI S. KATRE, M.D.	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
92877	Fee-for-Service	1235124561	1235124561	1	1	RUFFOLO, ALDO C DO	1/28/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	14291	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
92882	Fee-for-Service	1356940696	1356940696	1	1	ROTUNNO, NICOLE	10/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
92893	Fee-for-Service	1750398624	1750398624	1	1	RHEE, CHANG W MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32617	05	Anesthesiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
92901	Fee-for-Service	1558593640	1558593640	1	1	RESEDA URGENT CARE, INC	10/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	6830 RESEDA BLVD	None	RESEDA	CA	91335	4204	19	06037	34.19499052	-118.5360141	Los Angeles County
92950	Fee-for-Service	1598056236	1598056236	1	1	ROUEIHEB, NICHOLAS W DO	9/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12591	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
92979	Fee-for-Service	1205365814	1205365814	1	1	ROBINSON, SAMUEL J DO	3/27/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18447	08	Family Practice	0	In state provider	None	2575 E BIDWELL ST	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
92982	Fee-for-Service	1295705606	1295705606	1	1	REDDY, MUNI N MD INC	5/17/1989	174400000X	NA	Other	026	PHYSICIANS	37982	34	Urology and Urological Surgery	0	In state provider	None	2950 SYCAMORE DR	STE 202	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
93003	Fee-for-Service	1265729362	1265729362	1	1	REINBERG, MICHAEL MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152069	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95442	6710	17	06033	38.93612361	-122.6201499	Lake County
93019	Fee-for-Service	1164036547	1164036547	1	1	ROCCO, STEFANI R NP	5/6/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
93067	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	10/4/2023	261QM1300X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
93099	Fee-for-Service	1578852307	1578852307	1	1	REBONG, RACHELLE A MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124449	18	Ophthalmology	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
93157	Fee-for-Service	1699762609	1699762609	1	1	RYAN MEYER M.D.	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W COLUMBIA ST	STE 420	EVANSVILLE	IN	47710	1782	00	None	37.98476683	-87.56872569	Vanderburgh County
93161	Fee-for-Service	1699739961	1699739961	1	1	RUSSACK, VALENTINA MD	12/31/1989	207ZC0500X	NA	Other	026	PHYSICIANS	58905	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
93224	Fee-for-Service	1497198485	1497198485	1	1	RADHAKRISHNAN, KAVITA MD	8/29/2020	207R00000X	NA	Other	026	PHYSICIANS	133792	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
93253	Fee-for-Service	1053730978	1053730978	1	1	RIOS, NANCY MD	5/30/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
93261	Fee-for-Service	1932696853	1932696853	1	1	REEDER, OLIVIA M	8/26/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11326 LOCUST AVENUE	None	HESPERIA	CA	92345	1930	36	06071	34.45670093	-117.3341672	San Bernardino County
93305	Fee-for-Service	1437684057	1437684057	1	1	ROTH, TAYLOR	6/26/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	8280 W WARM SPRINGS RD	None	LAS VEGAS	NV	89113	3612	00	None	36.057384	-115.2721395	Clark County
93311	Fee-for-Service	1144406463	1144406463	1	1	ROSEN, STEPHANIE L LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
93353	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	3/11/2025	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
93364	Fee-for-Service	1467489526	1467489526	1	1	RIDDER, CHERYL L MD	10/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66581	08	Family Practice	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	43	06085	37.35228637	-121.9754073	Santa Clara County
93367	Fee-for-Service	1033172135	1033172135	1	1	RENAL TREATMENT CENTERS	12/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	4361 LATHAM ST	STE 100	RIVERSIDE	CA	92501	1767	33	06065	34.00212634	-117.3743133	Riverside County
93376	Fee-for-Service	1851338016	1851338016	1	1	ROFFEY, PETER J MD	8/31/1995	207L00000X	NA	Other	026	PHYSICIANS	78845	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
93388	Fee-for-Service	1942521075	1942521075	1	1	RO, DANIEL I MD	10/27/2020	390200000X	NA	Other	026	PHYSICIANS	169428	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
93446	Fee-for-Service	1912976424	1912976424	1	1	RING-HARRIS, SUSAN L LMFT	6/11/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20406 BRIAN WAY	4D	TEHACHAPI	CA	93561	6757	15	06029	35.1251559	-118.4919517	Kern County
93477	Fee-for-Service	1487730131	1487730131	1	1	ROSEN, ERIC L MD	10/18/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76213	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93486	Fee-for-Service	1225509375	1225509375	1	1	ROUPOLI, MELISSA CRNA	5/8/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
93496	Fee-for-Service	1639584758	1639584758	1	1	ROBY, JENNIFER G DO MD	8/15/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14504	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
93504	Fee-for-Service	1992440440	1992440440	1	1	RAJAN, SHRUTI MD	7/28/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	190582	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
93513	Fee-for-Service	1497198485	1497198485	1	1	RADHAKRISHNAN, KAVITA MD	8/29/2020	207R00000X	NA	Other	026	PHYSICIANS	133792	10	Gastroenterology (M.D. only)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
93550	Fee-for-Service	1932696853	1932696853	1	1	REEDER, OLIVIA M	8/26/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11326 LOCUST AVENUE	None	HESPERIA	CA	92345	1930	36	06071	34.45670093	-117.3341672	San Bernardino County
93572	Fee-for-Service	1194951855	1194951855	1	1	RATTU, MANMEET PSYD	9/12/2024	101YS0200X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
93577	Fee-for-Service	1730162074	1730162074	1	1	ROTHAM, ABRAHAM MD	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
93627	Fee-for-Service	1255489209	1255489209	1	1	RYAN, RANDALL T MD	12/1/1997	204D00000X	NA	Other	026	PHYSICIANS	77941	20	Orthopedic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
93629	Fee-for-Service	1083640650	1083640650	1	1	REGENTS OF UNIVERSITY CA	8/8/1990	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10850 WHITE ROCK RD	None	RANCHO CORDOVA	CA	95670	6044	34	06067	38.587077	-121.284594	Sacramento County
93640	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	1/12/2023	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
93677	Fee-for-Service	1811423908	1811423908	1	1	ROBERTS, ZACHARY T MD	9/21/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	188710	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93725	Fee-for-Service	1982215992	1982215992	1	1	ROSHAN T MELVANI MD INC	9/11/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	12677 HESPERIA	140	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
93755	Fee-for-Service	1003100553	1003100553	1	1	RAMIREZ, ALEJANDRA LCSW	10/10/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
93791	Fee-for-Service	1083694616	1083694616	1	1	REGENTS OF THE UNIV CAL	3/24/2008	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
93793	Fee-for-Service	1255643938	1255643938	1	1	RIVELLO, ANN T LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	7037	41	06081	37.48948529	-122.2232468	San Mateo County
93845	Fee-for-Service	1053015065	1053015065	1	1	ROAZOL, RAY R CRNA	3/28/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
93866	Fee-for-Service	1730162074	1730162074	1	1	ROTHAM, ABRAHAM MD	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
93899	Fee-for-Service	1629401344	1629401344	1	1	ROSE, KIMBERLY E PHD	10/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
93909	Fee-for-Service	1396893350	1396893350	1	1	RUIZ, JUAN C., MD	11/30/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70550	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
93918	Fee-for-Service	1326228776	1326228776	1	1	RICARDO-VENTURA, ARIAMSI A M	5/6/2020	208M00000X	NA	Other	026	PHYSICIANS	151369	41	Internal Medicine	0	In state provider	D	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
93926	Fee-for-Service	1528299849	1528299849	1	1	RAPOZA, RUSSELL P MD APC	8/23/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71959	None	None	0	In state provider	None	11190 WARNER AVENUE	SUITE 410	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.714	-117.9333585	Orange County
93930	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	9/12/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
93931	Fee-for-Service	1962688614	1962688614	1	1	RUPP, LIEU T MD INC	8/12/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64515	08	Family Practice	0	In state provider	None	4440 BROCKTON AVE	STE 100	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
93963	Fee-for-Service	1639106610	1639106610	1	2	RAJ, DIVYA T MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81826	01	General Practice	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
93983	Fee-for-Service	1487608931	1487608931	1	5	RENAISSANCE IMAGING MED	10/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2 DOLE DR	None	WESTLAKE VILLAGE	CA	91362	7300	19	06037	34.15196446	-118.8043687	Los Angeles County
94004	Fee-for-Service	1417563016	1417563016	1	1	R PLACE DUARTE LLC	12/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3002 FREEBORN ST	None	DUARTE	CA	91010	1507	19	06037	34.1445759	-117.9407594	Los Angeles County
94043	Fee-for-Service	1912353129	1912353129	1	1	RATTO, CHRISTINA E MD	8/2/2021	207L00000X	NA	Other	026	PHYSICIANS	153951	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
94081	Fee-for-Service	1083694616	1083694616	1	1	REGENTS OF THE UNIV CAL	6/1/1994	213EP1101X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	UC DAVIS MEDICAL GROUP	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
94090	Fee-for-Service	1326800459	1326800459	1	1	RIVADA, RACHEL BIRTH DOULA	6/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
94101	Fee-for-Service	1114919255	1114919255	1	1	REDDY, MALINI M MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84196	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
94127	Fee-for-Service	1528106192	1528106192	1	1	RAJA, NAVEEN DO	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6160	None	None	0	In state provider	None	12291 WASHINGTON BLVD	STE 300	WHITTIER	CA	90606	2549	19	06037	33.96734104	-118.0508773	Los Angeles County
94133	Fee-for-Service	1326436270	1326436270	1	1	REGENT VILLA RETIREMENT HOME	11/18/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	201 W WARDLOW ROAD	None	LONG BEACH	CA	90807	4497	19	06037	33.81915213	-118.1942831	Los Angeles County
94156	Fee-for-Service	1184653974	1184653974	1	1	RUBINSTEIN, JOAN E MD	6/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37285	08	Family Practice	0	In state provider	None	119 S 6TH ST	None	FOWLER	CA	93625	2439	10	06019	36.62995919	-119.678276	Fresno County
94159	Fee-for-Service	1720072903	1720072903	1	1	RUNDBAKEN, GRAIG M. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14418 W MEEKER BLVD	STE D	SUN CITY WEST	AZ	85375	5283	00	None	33.65982	-112.3699545	Maricopa County
94171	Fee-for-Service	1336700772	1336700772	1	1	RIVERSIDE SNF LLC	2/25/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17040 ARNOLD DRIVE	None	RIVERSIDE	CA	92518	2813	33	06065	33.8730097	-117.2923955	Riverside County
94202	Fee-for-Service	1689232142	1689232142	1	1	RAMOS, ELIZABETH LCSW	4/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
94218	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	3/17/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
94219	Fee-for-Service	1093097925	1093097925	1	1	RABANES-LEE, CAROLINA NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
94220	Fee-for-Service	1194766436	1194766436	1	1	ROTH, DAVID M MD	2/28/1995	207L00000X	NA	Other	026	PHYSICIANS	80698	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
94336	Fee-for-Service	1194195362	1194195362	1	1	RESSLER, ALLISON LMFT	1/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1616 W SHAW AVE	SUITE D-7	FRESNO	CA	93711	3513	10	06019	36.8084467	-119.8224562	Fresno County
94338	Fee-for-Service	1811913833	1811913833	1	1	RESENDES, MARIELA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	58114	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
94348	Fee-for-Service	1336464023	1336464023	1	1	ROLON, LETICIA MD	6/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119691	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVENUE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
94365	Fee-for-Service	1912131772	1912131772	1	1	REED, CHRYSTAL M MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123260	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVELRY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
94367	Fee-for-Service	1083694616	1083694616	1	1	REGENTS OF THE UNIV CAL	5/22/2024	213EP1101X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
94369	Fee-for-Service	1013996529	1013996529	1	1	RHEE, KYUNG E MD	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112676	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
94419	Fee-for-Service	1417962085	1417962085	1	1	RAMRAKHIANI, SANJAY MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51528	10	Gastroenterology (M.D. only)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
94461	Fee-for-Service	1841293164	1841293164	1	1	RAGHURAM, NANDKISHORE B MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
94494	Fee-for-Service	1083741235	1083741235	1	1	ROBINSON, MONICA C OD	6/2/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 RIVER PARK DR	STE 100	SACRAMENTO	CA	95815	4605	34	06067	38.599947	-121.437279	Sacramento County
94504	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	2/6/2023	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
94507	Fee-for-Service	1972835692	1972835692	1	1	RIOS, EUNICE V MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110868	41	Internal Medicine	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
94515	Fee-for-Service	1588312433	1588312433	1	1	RESEDA PROSTHETICS, INC.	1/5/2023	261Q00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2220 LYNN RD	306	THOUSAND OAKS	CA	91360	1904	56	06111	34.20863046	-118.8852156	Ventura County
94581	Fee-for-Service	1043638406	1043638406	1	1	RIBEIRO, KRYSTAL L MD	1/5/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	4855 BLUE DIAMOND RD	None	LAS VEGAS	NV	89139	7602	00	None	36.03258913	-115.2074608	Clark County
94587	Fee-for-Service	1134194186	1134194186	1	1	RAMAKRISHNAN, CHITRA MD	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75747	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	201 S BUENA VISTA ST	STE 440	BURBANK	CA	91505	4577	19	06037	34.15978726	-118.3289164	Los Angeles County
94597	Fee-for-Service	1699751891	1699751891	1	1	ROBERT H HOWE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
94601	Fee-for-Service	1922295971	1922295971	1	1	ROHLEN, BROOKS H MD	10/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99038	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
94654	Fee-for-Service	1083694616	1083694616	1	1	REGENTS OF THE UNIV CAL	7/5/2018	213EP1101X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
94663	Fee-for-Service	1689747867	1689747867	1	1	RINELLA, SCOTT M DO INC	1/22/2008	261QU0200X	NA	Other	026	PHYSICIANS	7167	08	Family Practice	0	In state provider	None	41715 WINCHESTER RD	STE 106	TEMECULA	CA	92590	4853	33	06065	33.51843041	-117.1680022	Riverside County
94665	Fee-for-Service	1912131772	1912131772	1	1	REED, CHRYSTAL M MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123260	14	Neurological Surgery	0	In state provider	None	8700 BEVELRY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
94681	Fee-for-Service	1336554690	1336554690	1	1	RUIZ, RACHEL A LCSW	9/15/2021	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
94693	Fee-for-Service	1801207634	1801207634	1	1	REIMERS, REBECCA M MD	7/25/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176526	None	None	0	In state provider	None	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
94699	Fee-for-Service	1235296583	1235296583	1	1	RALPHS GROCERY COMPANY	3/1/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #105	10525 4S COMMONS DR	None	SAN DIEGO	CA	92127	3512	37	06073	33.01950876	-117.1128996	San Diego County
94748	Fee-for-Service	1003833021	1003833021	1	1	ROBERT OSTENDORF	12/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1026 GOODYEAR AVE	None	GADSDEN	AL	35903	1102	00	None	34.00948741	-85.9704143	Etowah County
94749	Fee-for-Service	1205889144	1205889144	1	1	REGIONAL PHYSICIANS	2/1/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	1974 SANTA FE AVE.	None	LONG BEACH	CA	90810	4064	19	06037	33.793137	-118.2153705	Los Angeles County
94752	Fee-for-Service	1841293164	1841293164	1	1	RAGHURAM, NANDKISHORE B MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
94769	Fee-for-Service	1528347739	1528347739	1	1	ROSSER, LINDSAY A LMFT	2/15/2019	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2120 HUNTINGTON DR	STE A	SOUTH PASADENA	CA	91030	4984	19	06037	34.10603924	-118.136188	Los Angeles County
94793	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	4/1/2023	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
94796	Fee-for-Service	1972835692	1972835692	1	1	RIOS, EUNICE V MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110868	40	Pediatrics	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
94841	Fee-for-Service	1386278885	1386278885	1	1	RAY, ANGELA M MD	9/11/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
94873	Fee-for-Service	1134194186	1134194186	1	1	RAMAKRISHNAN, CHITRA MD	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75747	41	Internal Medicine	0	In state provider	None	201 S BUENA VISTA ST	STE 440	BURBANK	CA	91505	4577	19	06037	34.15978726	-118.3289164	Los Angeles County
94892	Fee-for-Service	1265772602	1265772602	1	1	RINGER, DIANE R LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	STE 440	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
94897	Fee-for-Service	1245294644	1245294644	1	1	ROYALTY NEPHROLOGY	10/28/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
94901	Fee-for-Service	1588126908	1588126908	1	1	RENALDY, HILARY K MD	11/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176985	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
94904	Fee-for-Service	1194771097	1194771097	1	1	RICHARD CATALAN	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
94930	Fee-for-Service	1295065647	1295065647	1	1	RINCON, CHRISTINA M MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114030	08	Family Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
94943	Fee-for-Service	1518193267	1518193267	1	1	ROSTAMLOO, HELEN MD INC	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99811	41	Internal Medicine	0	In state provider	None	435 ARDEN AVE	STE 430	GLENDALE	CA	91203	4022	19	06037	34.15848148	-118.2628845	Los Angeles County
94944	Fee-for-Service	1972002228	1972002228	1	1	REYES, TRISH B NP	12/19/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1851 NORTH LOMBARD	STE 100	OXNARD	CA	93030	8230	56	06111	34.2183512	-119.1493247	Ventura County
94999	Fee-for-Service	1821008111	1821008111	1	1	RAVIKUMAR, KALPANA MD	7/31/1981	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	35711	25	Physical Medicine and Rehabilitation	0	In state provider	None	44215 15TH ST W	STE 114	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
95019	Fee-for-Service	1235458027	1235458027	1	1	ROBERTSON, JEFFREY DPM	10/12/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
95025	Fee-for-Service	1710291166	1710291166	1	1	ROMANIELLO, JO LMFT	7/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6630 HIGHWAY 9	STE 205	FELTON	CA	95018	9711	44	06087	37.05726381	-122.0760563	Santa Cruz County
95046	Fee-for-Service	1609452002	1609452002	1	1	RUIZ, JANELLE	2/3/2024	390200000X	NA	Other	026	PHYSICIANS	189427	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
95054	Fee-for-Service	1972957546	1972957546	1	1	ROBINSON, ANN C MD	6/28/2019	390200000X	NA	Other	026	PHYSICIANS	157610	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
95058	Fee-for-Service	1528347739	1528347739	1	1	ROSSER, LINDSAY A LMFT	2/15/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2120 HUNTINGTON DR	STE A	SOUTH PASADENA	CA	91030	4984	19	06037	34.10603924	-118.136188	Los Angeles County
95077	Fee-for-Service	1942367107	1942367107	1	1	ROBB, CANDACE J CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	930 MISSION ST	STE 2	SANTA CRUZ	CA	95060	3559	44	06087	36.97153329	-122.0360703	Santa Cruz County
95080	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	3/17/2022	261QM1300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
95100	Fee-for-Service	1063825552	1063825552	1	1	RIESCHICK, AMY E CRNA	4/19/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
95128	Fee-for-Service	1154871754	1154871754	1	1	ROGERS, SHANA L NP	7/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95139	Fee-for-Service	1922256023	1922256023	1	1	RAKE, CHRISTOPHER B MD	10/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94972	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
95146	Fee-for-Service	1033222500	1033222500	1	1	ROH, JAMES W	2/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88140	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
95156	Fee-for-Service	1902939390	1902939390	1	1	RUNNING SPRINGS FIRE	2/25/1984	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DEPT	31250 HILLTOP BLVD	None	RUNNING SPRINGS	CA	92382	0000	36	06071	34.2154966	-117.1244542	San Bernardino County
95186	Fee-for-Service	1619334778	1619334778	1	1	RAMOS, MARIEFAYE T NP	8/25/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
95200	Fee-for-Service	1144207002	1144207002	1	2	RHODES, SHANE D DPM	7/1/1998	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	25078 PEACHLAND AVE	SUITE B	NEWHALL	CA	91321	2557	19	06037	34.37865037	-118.5468731	Los Angeles County
95201	Fee-for-Service	1215332044	1215332044	1	1	RENTERIA, BRIANDA I LCSW	2/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
95210	Fee-for-Service	1952751331	1952751331	1	1	RIGGIO, ROBERT T MD	10/11/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
95347	Fee-for-Service	1528347739	1528347739	1	1	ROSSER, LINDSAY A LMFT	2/15/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2120 HUNTINGTON DR	STE A	SOUTH PASADENA	CA	91030	4984	19	06037	34.10603924	-118.136188	Los Angeles County
95349	Fee-for-Service	1467543272	1467543272	1	1	RODILES & CHEN MED GRP	4/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	GASTROENTEROLOGY CONSULT	10861 CHERRY ST	STE 302	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
95350	Fee-for-Service	1093857088	1093857088	1	1	ROBERT A PICK DO INC	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	4258	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2638 EDITH AVENUE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
95368	Fee-for-Service	1952998973	1952998973	1	3	REGENTS OF THE UNIVERSITY OF	2/10/2023	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
95390	Fee-for-Service	1578769964	1578769964	1	1	RAMIREZ, COURTNEY M MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101470	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
95395	Fee-for-Service	1083620421	1083620421	1	1	RIDGEWAY, BERI M MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86211	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 TACHEVAH DR	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
95415	Fee-for-Service	1043695646	1043695646	1	1	REYES, ERIKA MAE OD	10/25/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
95480	Fee-for-Service	1336167550	1336167550	2	2	REEDLEY COMMUNITY HOSPITAL	1/23/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	54	06107	36.54592542	-119.39921	Tulare County
95556	Fee-for-Service	1205061645	1205061645	1	1	RSCR CALIFORNA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1412 OCALA COURT	None	CHULA VISTA	CA	91911	5527	37	06073	32.61049529	-117.0357297	San Diego County
95583	Fee-for-Service	1366437667	1366437667	1	1	RUPPERT, JAMES S MD	12/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61972	01	General Practice	0	In state provider	None	6485 DAY ST	STE 206	RIVERSIDE	CA	92507	0930	33	06065	33.931809	-117.2789185	Riverside County
95596	Fee-for-Service	1881871036	1881871036	1	1	RODRIGUEZ, RODOLFO PHD	5/8/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	227 SUNNYVALE DR	None	HEALDSBURG	CA	95448	3224	49	06097	38.62951097	-122.8700982	Sonoma County
95624	Fee-for-Service	1285852012	1285852012	1	1	RIVERA, EMILY F LCSW	7/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 W LACEY BLVD	STE 308A	HANFORD	CA	93230	4487	16	06031	36.32804371	-119.6480935	Kings County
95627	Fee-for-Service	1891128823	1891128823	1	1	REYES ACOSTA, BRICIA N LCSW	9/19/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
95659	Fee-for-Service	1740668193	1740668193	1	1	RATZ, KRISTIN MD	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148434	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
95736	Fee-for-Service	1912001637	1912001637	2	1	RAMOS, JASMINE L MD	9/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	60750	40	Pediatrics	0	In state provider	None	73555 SAN GORGONIO WAY	None	PALM DESERT	CA	92260	3549	33	06065	33.7231981	-116.3812055	Riverside County
95772	Fee-for-Service	1407080450	1407080450	1	1	RAMARAJAN, NARESH MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113658	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
95774	Fee-for-Service	1023504511	1023504511	1	1	ROFF, HEATHER A NP	9/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
95789	Fee-for-Service	1912273970	1912273970	1	1	RICE, LAWRENCE S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31021	18	Ophthalmology	0	In state provider	A MEDICAL CORPORATION	5565 GROSSMONT CENTER DR	BLDG 3, STE 551	LA MESA	CA	91942	3007	37	06073	32.77978322	-117.0094766	San Diego County
95866	Fee-for-Service	1326225764	1326225764	1	1	ROSENBERG, STEVEN H MD INC	8/16/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37233	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 LOMITA BLVD	STE 400	TORRANCE	CA	90505	4927	19	06037	33.81309744	-118.3448635	Los Angeles County
95869	Fee-for-Service	1366437667	1366437667	1	1	RUPPERT, JAMES S MD	12/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61972	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6485 DAY ST	STE 206	RIVERSIDE	CA	92507	0930	33	06065	33.931809	-117.2789185	Riverside County
95883	Fee-for-Service	1083038764	1083038764	1	1	RISE PHYSICAL THERAPY INC	7/12/2023	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	380 STEVENS AVE	314	SOLANA BEACH	CA	92075	2063	37	06073	32.99328265	-117.2619437	San Diego County
95885	Fee-for-Service	1487635694	1487635694	1	1	ROBINSON, JEFFREY L MD	4/29/1999	207P00000X	NA	Other	026	PHYSICIANS	56981	66	Emergency Medicine (Urgent Care)	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
95887	Fee-for-Service	1336227123	1336227123	1	1	RUEDA, JEFFREY F MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71903	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
95971	Fee-for-Service	1114398864	1114398864	1	2	RO HEALTH, LLC	7/2/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3880 MURPHY CANYON RD	110	SAN DIEGO	CA	92123	4403	37	06073	32.81486073	-117.1162882	San Diego County
95986	Fee-for-Service	1487751798	1487751798	1	1	RETTIG, MATTHEW MD	8/15/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	52586	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
95997	Fee-for-Service	1053355313	1053355313	1	1	RANGEL, LIONEL CHRIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2931 MONTANA AVE	STE A	EL PASO	TX	79903	2409	00	None	31.7837913	-106.4603498	El Paso County
96035	Fee-for-Service	1912632555	1912632555	1	1	ROYAL SENIOR LIVING-OC LLC	9/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	31742 ISLE ROYAL DR.	None	LAGUNA NIGUEL	CA	92677	2815	30	06059	33.50221653	-117.7210115	Orange County
96107	Fee-for-Service	1497711410	1497711410	1	1	ROTHMAN AND HERR MDS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MED CORP	7301 MEDICAL CENTER DR	STE 201	CANOGA PARK	CA	91307	1935	19	06037	34.20285756	-118.6294575	Los Angeles County
96123	Fee-for-Service	1386637346	1386637346	1	3	REGENTS/UCDPBG/PEDIATRIC	3/19/2024	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4900 BRAODWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
96247	Fee-for-Service	1376571943	1376571943	1	1	RAFFEL, LESLIE J MD	5/16/2016	174400000X	NA	Other	026	PHYSICIANS	44711	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
96267	Fee-for-Service	1861435877	1861435877	1	1	REED, JOHN B MD	8/22/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	26882	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 DOYLE PARK DR	STE 205	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
96277	Fee-for-Service	1487751798	1487751798	1	1	RETTIG, MATTHEW MD	8/15/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	52586	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
96280	Fee-for-Service	1578566071	1578566071	1	1	ROBERT A MOFFITT	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 E CAMELBACK RD	STE 180	PHOENIX	AZ	85018	2396	00	None	33.5097	-112.009401	Maricopa County
96282	Fee-for-Service	1447755889	1447755889	1	1	RAYMUNDO, CYNTHIA A OD	12/6/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15330 AMAR RD	STE A	LA PUENTE	CA	91744	2001	19	06037	34.03714077	-117.9509701	Los Angeles County
96292	Fee-for-Service	1760541569	1760541569	1	26	RETINA INSTITUTE OF CALIFORN	2/20/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17833 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	1729	19	06037	33.99017251	-117.9153748	Los Angeles County
96302	Fee-for-Service	1871908319	1871908319	1	1	READ, JACOB M LMFT	11/29/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110261	-	NOT APPLICABLE	0	In state provider	None	2430 BIRD STREET	None	OROVILLE	CA	95965	4908	04	06007	39.51511183	-121.5497741	Butte County
96320	Fee-for-Service	1083620256	1083620256	1	1	RUSSELL,MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CTR DRIVE	None	ANN ARBOR	MI	48109	5204	00	None	42.28391347	-83.72716554	Washtenaw County
96329	Fee-for-Service	1417183831	1417183831	1	1	RSCR CALIFORNIA INCORPORATED	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2244 E 4TH STREET	None	NATIONAL CITY	CA	91950	2053	37	06073	32.68583328	-117.084887	San Diego County
96342	Fee-for-Service	1891156501	1891156501	1	1	REED, GINA LCSW	1/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5170 GOLDEN FOOTHILL PKW	None	EL DORADO HILLS	CA	95762	7648	09	06017	38.64013136	-121.0681138	El Dorado County
96352	Fee-for-Service	1700225869	1700225869	1	1	RODRIGUEZ, MONIQUE LMFT	8/31/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4433 E VILLAGE RD	P	LONG BEACH	CA	90808	1505	19	06037	33.83397238	-118.1408189	Los Angeles County
96400	Fee-for-Service	1528466034	1528466034	1	1	RICHARDSON, KIMBERLY LPCC	5/18/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
96413	Fee-for-Service	1386637346	1386637346	1	3	REGENTS/UCDPBG/PEDIATRIC	4/14/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BRAODWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
96444	Fee-for-Service	1457807109	1457807109	1	1	ROSALES, ALVINA PHD	9/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
96445	Fee-for-Service	1790852648	1790852648	1	1	REDDY, SUNIPA S MD	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90825	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
96450	Fee-for-Service	1225614068	1225614068	1	1	RIVER CITY MEDICAL GROUP, IN	5/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7311 GREENHAVEN	200	SACRAMENTO	CA	95831	3572	34	06067	38.492622	-121.5219195	Sacramento County
96519	Fee-for-Service	1700970035	1700970035	1	1	RAEBURN, CHRISTOPHER D MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
96531	Fee-for-Service	1891267696	1891267696	1	1	REBOLLIDO, JENNIFER P RCP	12/30/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
96543	Fee-for-Service	1689241150	1689241150	1	2	REGIONAL IMAGING, PC	7/29/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	60 EASTER AVE	None	WEAVERVILLE	CA	96093	8054	53	06105	40.73771688	-122.9398498	Trinity County
96545	Fee-for-Service	1669591475	1669591475	1	1	RUBALCAVA, LAURA E LCSW	2/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19556 MIRA LOMA WAY	None	WALNUT	CA	91789	4355	19	06037	34.02675565	-117.8740866	Los Angeles County
96557	Fee-for-Service	1417143793	1417143793	1	1	RAMACHANDRAN, KISHAN MD	1/27/2025	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
96563	Fee-for-Service	1568424521	1568424521	1	1	REINGOLD, JACK A DPM	11/30/1980	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	550 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1343	37	06073	32.99561172	-117.2643917	San Diego County
96564	Fee-for-Service	1801199260	1801199260	1	1	RAMIREZ, VERONICA D NP	2/20/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
96571	Fee-for-Service	1942404488	1942404488	1	1	ROSENBLATT-BENATAR, MICHELLE	7/31/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2404 MADISON AVE	None	SAN DIEGO	CA	92116	2920	37	06073	32.76101652	-117.1386135	San Diego County
96572	Fee-for-Service	1962839647	1962839647	1	1	RATNER, JAMIE A PHD	6/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
96573	Fee-for-Service	1760541569	1760541569	1	26	RETINA INSTITUTE OF CALIFORN	2/20/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	17833 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	1729	19	06037	33.99017251	-117.9153748	Los Angeles County
96610	Fee-for-Service	1831280726	1831280726	1	1	RAMADAN, AMR HASSAN MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51610	01	General Practice	0	In state provider	None	153A PIONEER LN	None	BISHOP	CA	93514	2557	14	06027	37.36214662	-118.4074305	Inyo County
96655	Fee-for-Service	1619109873	1619109873	1	1	RODRIGUEZ, JOSE D PHD	2/19/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
96702	Fee-for-Service	1386637346	1386637346	1	3	REGENTS/UCDPBG/PEDIATRIC	1/1/1992	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BRAODWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
96716	Fee-for-Service	1871698357	1871698357	1	1	RAO, SHEELA MD	3/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92501	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
96799	Fee-for-Service	1922233469	1922233469	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	833 FAIRWAY COURT	None	CHULA VISTA	CA	91911	1424	37	06073	32.62485432	-117.0655014	San Diego County
96861	Fee-for-Service	1164872453	1164872453	1	1	RAPOPORT, ANNA CNM	12/7/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
96862	Fee-for-Service	1790995934	1790995934	1	1	RADFORD, SHAWN C MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
96895	Fee-for-Service	1972695500	1972695500	1	1	RECALDE, MARGARETTE R OD	4/6/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
96897	Fee-for-Service	1831280726	1831280726	1	1	RAMADAN, AMR HASSAN MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51610	08	Family Practice	0	In state provider	None	153A PIONEER LN	None	BISHOP	CA	93514	2557	14	06027	37.36214662	-118.4074305	Inyo County
96916	Fee-for-Service	1417389487	1417389487	1	1	RODRIGUEZ, ALDON OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	956 SAN BENITO ST	STE A	HOLLISTER	CA	95023	4877	35	06069	36.8454512	-121.4023089	San Benito County
96977	Fee-for-Service	1821545187	1821545187	1	1	ROBERTS, JULIE A	11/3/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
96990	Fee-for-Service	1629360912	1629360912	1	1	RIVERA, NANCY MD	9/1/2018	2086S0127X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	3196 S MARYLAND PKWAY	STE 101A	LAS VEGAS	NV	89109	2317	00	None	36.13194	-115.136873	Clark County
97013	Fee-for-Service	1356950455	1356950455	1	1	RINALDI SENIOR CARE INC	1/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11565 LAUREL CANYON BLVD	STE 200	SAN FERNANDO	CA	91340	4651	19	06037	34.28018218	-118.4549135	Los Angeles County
97088	Fee-for-Service	1316430499	1316430499	1	1	ROBERTS, CALE J MD	9/1/2024	2080P0204X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
97109	Fee-for-Service	1912192881	1912192881	1	1	RICHARDSON, GREGGORY G	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	LOWERYS AMER HEAR AID CE	6709 BROCKTON AVE	None	RIVERSIDE	CA	92506	3022	33	06065	33.95151	-117.3967655	Riverside County
97122	Fee-for-Service	1942378369	1942378369	1	1	RASHTI, JALIL MD	12/20/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48983	20	Orthopedic Surgery	0	In state provider	None	16661 VENTURA BLVD	STE 701	ENCINO	CA	91436	1987	19	06037	34.15820737	-118.496492	Los Angeles County
97123	Fee-for-Service	1366523441	1366523441	1	1	RASIAH, LAKSHMAN W	9/30/1984	2084P0800X	NA	Psychiatry	026	PHYSICIANS	41027	36	Psychiatry	0	In state provider	None	206 N SIGNAL ST	STE B	OJAI	CA	93023	2656	56	06111	34.44943682	-119.2460368	Ventura County
97184	Fee-for-Service	1831280726	1831280726	1	1	RAMADAN, AMR HASSAN MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51610	15	Obstetrics (D.O. only)	0	In state provider	None	153A PIONEER LN	None	BISHOP	CA	93514	2557	14	06027	37.36214662	-118.4074305	Inyo County
97204	Fee-for-Service	1841392867	1841392867	1	1	RUNNING, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	555 S 70TH ST	None	LINCOLN	NE	68510	2462	00	None	40.808151	-96.62516802	Lancaster County
97326	Fee-for-Service	1679613277	1679613277	1	1	RAMZAN, SUMA D MD	2/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80264	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97343	Fee-for-Service	1598843302	1598843302	1	1	RAEMSCH, ELLEN S MD	4/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78612	05	Anesthesiology	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
97345	Fee-for-Service	1477847531	1477847531	1	1	REHAL, BALVINDER K MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122439	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
97376	Fee-for-Service	1316430499	1316430499	1	1	ROBERTS, CALE J MD	9/1/2024	2080P0204X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
97382	Fee-for-Service	1952705113	1952705113	1	1	RINALDI, MARIE E NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97398	Fee-for-Service	1124098421	1124098421	1	1	RENOWN REGIONAL MED CTR	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1474	00	None	39.52483792	-119.7968314	Washoe County
97401	Fee-for-Service	1811924319	1811924319	1	1	RAMACHANDRAN, RANI V MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48819	77	Infectious Disease	0	In state provider	APC	105 N BASCOM AVENUE	SUITE 203A	SAN JOSE	CA	95128	1638	43	06085	37.325853	-121.932068	Santa Clara County
97432	Fee-for-Service	1013587187	1013587187	1	1	REYNOLDS, FELICIA H LCSW	9/6/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
97487	Fee-for-Service	1831123868	1831123868	1	1	RADIOLOGY MEDICAL GROUP OF	4/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
97514	Fee-for-Service	1962465104	1962465104	1	1	RAMOS, DAVID F MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79350	08	Family Practice	0	In state provider	None	3105 CEDAR RAVINE RD	SUITE 103	PLACERVILLE	CA	95667	6561	09	06017	38.72626462	-120.7945035	El Dorado County
97517	Fee-for-Service	1669549499	1669549499	1	1	RICH, ALLEGRA M MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74148	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
97559	Fee-for-Service	1003872946	1003872946	1	1	RUSSELL,ISOBEL A MD	6/30/1988	207L00000X	NA	Other	026	PHYSICIANS	43339	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97582	Fee-for-Service	1619139284	1619139284	1	1	RIDALL, LESLIE A DO	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
97591	Fee-for-Service	1982629580	1982629580	1	1	RALPHS GROCERY COMPANY	7/15/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #33	380 E 17TH ST	None	COSTA MESA	CA	92627	3252	30	06059	33.63136172	-117.9128753	Orange County
97669	Fee-for-Service	1952613960	1952613960	1	1	RODRIGUEZ, ANALIZ MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143382	14	Neurological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
97681	Fee-for-Service	1114183464	1114183464	1	1	REDDY, RUPA S DO	3/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	9765	07	Dermatology	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
97688	Fee-for-Service	1124098421	1124098421	1	1	RENOWN REGIONAL MED CTR	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1474	00	None	39.52483792	-119.7968314	Washoe County
97691	Fee-for-Service	1811924319	1811924319	1	1	RAMACHANDRAN, RANI V MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48819	41	Internal Medicine	0	In state provider	APC	105 N BASCOM AVENUE	SUITE 203A	SAN JOSE	CA	95128	1638	43	06085	37.325853	-121.932068	Santa Clara County
97718	Fee-for-Service	1245535087	1245535087	1	2	ROMERO ARCEO, MARIA B LCSW	8/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1165 HOFF WAY	205	ORLAND	CA	95963	9196	11	06021	39.75251248	-122.2071532	Glenn County
97729	Fee-for-Service	1134315930	1134315930	1	1	ROSING, JAMES H MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93834	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
97734	Fee-for-Service	1346790458	1346790458	1	1	RAMIREZ-DIAZ, ANGELICA LMFT	10/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
97735	Fee-for-Service	1942290770	1942290770	1	1	RUPNIK, J KENYON MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	27568	77	Infectious Disease	0	In state provider	None	3443 VILLA LN	STE 9	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
97762	Fee-for-Service	MSS00024F	None	1	1	RIVERSIDE COUNTY	3/1/1999	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	OFFICE OF AGING	3610 CENTRAL AVENUE	5TH FLOOR	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
97765	Fee-for-Service	1528249240	1528249240	1	1	ROBERT ROSENZWEIG M D	3/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6511 SPRING BROOK AVE	None	RHINEBECK	NY	12572	3709	00	None	41.935527	-73.912626	Dutchess County
97805	Fee-for-Service	1962465104	1962465104	1	1	RAMOS, DAVID F MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79350	01	General Practice	0	In state provider	None	3105 CEDAR RAVINE RD	SUITE 103	PLACERVILLE	CA	95667	6561	09	06017	38.72626462	-120.7945035	El Dorado County
97813	Fee-for-Service	1386021541	1386021541	1	1	ROBERTS, MAYU T MD	6/1/2022	207R00000X	NA	Other	026	PHYSICIANS	174803	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
97842	Fee-for-Service	1831387513	1831387513	1	1	RUIZ, ELIZABETH L LMFT	9/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4401 ATLANTIC AVE	222	LONG BEACH	CA	90807	2218	19	06037	33.836976	-118.185096	Los Angeles County
97856	Fee-for-Service	1417930892	1417930892	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
97895	Fee-for-Service	1033645197	1033645197	1	1	ROMAGNOLO, ALBERTO P MD	9/12/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	163162	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
97903	Fee-for-Service	1568827418	1568827418	1	1	RECOVERY GRADS, LLC	10/29/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3077 UNIVERSITY AVE	STE 105	LOS ANGELES	CA	90007	3717	19	06037	34.0254271	-118.2825127	Los Angeles County
97907	Fee-for-Service	1821482381	1821482381	1	1	REGALADO-MAGDOS, ASHTON D MD	11/10/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	146456	None	None	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
97928	Fee-for-Service	1730941634	1730941634	1	1	RANCHO SPRINGS ANESTHESIA PA	3/1/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	RTNERS, INC	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
97958	Fee-for-Service	1952613960	1952613960	1	1	RODRIGUEZ, ANALIZ MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143382	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
97978	Fee-for-Service	1952363467	1952363467	1	1	ROSE, ANYA J	2/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89018	None	None	0	In state provider	None	420 W ROWLAND STREET	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
97987	Fee-for-Service	1245789916	1245789916	1	1	RESTIVO, BRADLEY A MD	7/25/2023	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	188083	None	None	0	In state provider	None	1100 SAN BERNARDINO RD	1100	UPLAND	CA	91786	4923	36	06071	34.10129201	-117.636283	San Bernardino County
98005	Fee-for-Service	1316138142	1316138142	1	1	RAINA, AMIT MD	1/10/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	174668	None	None	0	In state provider	None	4111 MAINE AVE	None	BALDWIN PARK	CA	91706	3307	19	06037	34.08715391	-117.9604861	Los Angeles County
98011	Fee-for-Service	1760541569	1760541569	1	35	RETINA INSTITUTE OF CALIFORN	4/7/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5565 GROSSMONT CENTER DR	BUILDING 3 #551	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
98042	Fee-for-Service	1003983917	1003983917	1	1	RAWAL, RITA K MD	12/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86247	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
98072	Fee-for-Service	1619041381	1619041381	1	1	RAI CARE CENTERS SO CA	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	II LLC	46767 MONROE ST	STE 101	INDIO	CA	92201	5593	33	06065	33.70923844	-116.233889	Riverside County
98092	Fee-for-Service	1265069025	1265069025	1	1	RATY-KERSTETTER, LAURA S CNP	7/15/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
98146	Fee-for-Service	1417930892	1417930892	2	1	REEDLEY COMMUNITY HOSPITAL	10/2/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
98191	Fee-for-Service	1992853717	1992853717	1	1	RAMSEY, JOHN T MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76797	84	Surgery-Head and Neck	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
98194	Fee-for-Service	1427190958	1427190958	1	1	RYAN, STEPHEN J PT	9/28/2015	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6005 SHELLMOUND ST	None	EMERYVILLE	CA	94608	2270	01	06001	37.84141257	-122.2934494	Alameda County
98203	Fee-for-Service	1457311938	1457311938	1	1	REES, LINDAKAY D MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	34824	40	Pediatrics	0	In state provider	None	17742 BEACH BLVD	#360	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
98262	Fee-for-Service	1962482513	1962482513	1	9	REGENTS OF THE UNIVERSITY OF	7/18/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	100 N WIGET LN	STE 150	WALNUT CREEK	CA	94598	5900	07	06013	37.92514495	-122.0237725	Contra Costa County
98274	Fee-for-Service	1679869325	1679869325	1	1	REBECCA KATZMAN MD	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1401 MADISON ST	STE 100	SEATTLE	WA	98104	1316	00	None	47.61086143	-122.3214551	King County
98288	Fee-for-Service	1942732870	1942732870	1	1	RICHARDSON, JULIAN L MD	7/14/2021	207P00000X	NA	Other	026	PHYSICIANS	171614	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
98293	Fee-for-Service	1760541569	1760541569	1	27	RETINA INSTITUTE OF CALIFORN	2/20/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 EUCLID AVE	302	NATIONAL CITY	CA	91950	2973	37	06073	32.68353398	-117.082625	San Diego County
98316	Fee-for-Service	1265812820	1265812820	1	1	ROY, MOHANA MD	6/18/2021	207R00000X	NA	Other	026	PHYSICIANS	154975	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
98327	Fee-for-Service	1083891014	1083891014	1	1	ROZINA AND SMITH PHYSICAL	4/16/2012	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	846 W FOOTHILL BLVD	STE C	UPLAND	CA	91786	3784	36	06071	34.10694555	-117.662049	San Bernardino County
98328	Fee-for-Service	1982800082	1982800082	1	1	ROGOWAY, WILLIAM M OD	10/24/2007	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORONA VISION CENTER OPT	734 N MAIN ST	None	CORONA	CA	92880	1439	33	06065	33.89171973	-117.5640251	Riverside County
98374	Fee-for-Service	1861580029	1861580029	1	1	RIVIERA SANATARIUM INC	1/1/1979	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME	7246 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	4010	19	06037	33.97968128	-118.0995603	Los Angeles County
98433	Fee-for-Service	1417930892	1417930892	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
98456	Fee-for-Service	1952525370	1952525370	1	2	RAPP, JONATHAN S MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56799	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
98470	Fee-for-Service	1033487327	1033487327	1	1	RIVERSIDE COUNTY CCS	4/1/2011	251K00000X	NA	Other	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	25100 RED MAPLE LANE	BLDG H	MORENO VALLEY	CA	92551	1120	33	06065	33.8847155	-117.224172	Riverside County
98481	Fee-for-Service	1992853717	1992853717	1	1	RAMSEY, JOHN T MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76797	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
98551	Fee-for-Service	1962482513	1962482513	1	9	REGENTS OF THE UNIVERSITY OF	1/6/2023	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 N WIGET LN	STE 150	WALNUT CREEK	CA	94598	5900	07	06013	37.92514495	-122.0237725	Contra Costa County
98584	Fee-for-Service	1245535087	1245535087	1	1	ROMERO ARCEO, MARIA B LCSW	8/16/2022	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15 ILAHEE LN	STE 100	CHICO	CA	95973	7205	04	06007	39.75224248	-121.8701858	Butte County
98586	Fee-for-Service	1760541569	1760541569	1	35	RETINA INSTITUTE OF CALIFORN	4/7/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	5565 GROSSMONT CENTER DR	BUILDING 3 #551	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
98588	Fee-for-Service	1811296650	1811296650	1	1	ROBB, PAUL M MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130293	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
98617	Fee-for-Service	1942385638	1942385638	1	1	RADIOLOGY MEDICAL GROUP OF	9/14/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	NAPA	100 HOSPITAL DR	None	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
98621	Fee-for-Service	1831306448	1831306448	1	1	RIVERSIDE COUNTY	11/16/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	OFFICE OF EDUCATION	3939 13TH ST	None	RIVERSIDE	CA	92501	3505	33	06065	33.97849414	-117.3806754	Riverside County
98633	Fee-for-Service	1770554933	1770554933	1	1	RAMAZANKHANI, REZA MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	77800	None	None	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
98684	Fee-for-Service	1033100284	1033100284	1	1	ROUNSAVILLE, MARK C MD	1/1/1992	2085R0001X	NA	Other	026	PHYSICIANS	39060	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
98701	Fee-for-Service	1790956407	1790956407	1	1	RICHARDSON, JACLYN LMFT	5/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
98724	Fee-for-Service	1417930892	1417930892	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
98730	Fee-for-Service	1528134947	1528134947	1	1	RIVERSIDE HEALTHCARE	2/17/2005	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	SYSTEM LP	4500 BROCKTON AVE	STE 101	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
98733	Fee-for-Service	1396092789	1396092789	1	1	RANGEL, MARSIA LCSW	5/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
98771	Fee-for-Service	1871530907	1871530907	2	1	REID, THOMAS K MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54353	None	None	0	In state provider	None	157 PIONEER LANE	None	BISHOP	CA	93514	2557	14	06027	37.362672	-118.407366	Inyo County
98838	Fee-for-Service	1962482513	1962482513	1	9	REGENTS OF THE UNIVERSITY OF	1/6/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	100 N WIGET LN	STE 150	WALNUT CREEK	CA	94598	5900	07	06013	37.92514495	-122.0237725	Contra Costa County
98858	Fee-for-Service	1932199478	1932199478	1	1	RAVEN, RAYMOND B III MD	8/7/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	66365	20	Orthopedic Surgery	0	In state provider	None	2625 W ALAMEDA AVE	STE 116	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
98868	Fee-for-Service	1760541569	1760541569	1	27	RETINA INSTITUTE OF CALIFORN	2/20/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	655 EUCLID AVE	302	NATIONAL CITY	CA	91950	2973	37	06073	32.68353398	-117.082625	San Diego County
98879	Fee-for-Service	1427435601	1427435601	1	1	REINERT, KAELA MD	8/26/2019	207P00000X	NA	Other	026	PHYSICIANS	155947	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
98900	Fee-for-Service	1265468144	1265468144	1	1	ROSENQUIST, JANET A MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85479	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
98939	Fee-for-Service	1730179136	1730179136	1	1	RUOSI, GIACOMO MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53162	08	Family Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
98943	Fee-for-Service	1508897489	1508897489	1	1	RAGAB, HASSAN MD	12/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	48982	41	Internal Medicine	0	In state provider	None	2100 W LINCOLN AVE	None	ANAHEIM	CA	92801	5640	30	06059	33.83243153	-117.954828	Orange County
98976	Fee-for-Service	1396707238	1396707238	1	1	ROGERS, JOHN D OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2620 HURLEY WAY	#A	SACRAMENTO	CA	95864	3789	34	06067	38.58822	-121.400838	Sacramento County
99041	Fee-for-Service	1194913996	1194913996	1	1	ROWE, ANGELA M LCSW	6/17/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21162	-	NOT APPLICABLE	0	In state provider	None	4990 WILLIAMS AVE	None	LA MESA	CA	91942	7409	37	06073	32.76933362	-117.0371085	San Diego County
99042	Fee-for-Service	1003341116	1003341116	1	1	RAZZOUK, ATHEER	4/21/2020	207R00000X	NA	Other	026	PHYSICIANS	165276	41	Internal Medicine	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
99066	Fee-for-Service	1942382668	1942382668	1	1	ROSEMIRE, ROXANNE LCSW	12/2/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5575 LAKE PARKWAY	SUITE 100	LA MESA	CA	91942	1664	37	06073	32.78201664	-117.0342615	San Diego County
99134	Fee-for-Service	1841425030	1841425030	1	1	RUDNICK, MONA R MD	5/1/2018	207L00000X	NA	Other	026	PHYSICIANS	147572	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
99149	Fee-for-Service	1730682394	1730682394	1	10	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15630 18TH	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
99213	Fee-for-Service	1730549858	1730549858	1	1	REINHOLD-SMITH, KRISTINA L	12/5/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
99234	Fee-for-Service	1578625414	1578625414	1	1	RAYA, MARIO LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
99253	Fee-for-Service	1427497866	1427497866	1	1	REEDLEY COMMUNITY HOSPITAL	1/16/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
99294	Fee-for-Service	1497894190	1497894190	1	1	RABIN, PAUL A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32853	18	Ophthalmology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
99304	Fee-for-Service	1629215934	1629215934	1	1	ROMANO, KAREN L CRNA	3/16/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
99331	Fee-for-Service	1518334465	1518334465	1	1	RYAZANTSEVA, MARIYA I NP	2/8/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
99334	Fee-for-Service	1750700357	1750700357	1	1	RAGOONANAN, LAURA MD	1/23/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	154208	13	Neurology (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
99335	Fee-for-Service	1205487386	1205487386	1	2	RANU PEDIATRICS INCOROPORATE	6/17/2020	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	D	5557 E KINGS CANYON RD	None	FRESNO	CA	93727	4528	10	06019	36.73596559	-119.7021794	Fresno County
99372	Fee-for-Service	1437154275	1437154275	1	1	ROBERT E. HECKMANN	7/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4405 E 26TH ST	None	SIOUX FALLS	SD	57103	4187	00	None	43.528572	-96.6732075	Minnehaha County
99374	Fee-for-Service	1235206087	1235206087	1	1	REDWOODS RURAL HEALTH CT	10/1/2001	261QC1500X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	101 WEST COAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11704433	-123.8133408	Humboldt County
99383	Fee-for-Service	1457609679	1457609679	1	1	ROSNER, NICOLE CCC-SLP	10/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9565 WAPLES STREET	SUITE 100	SAN DIEGO	CA	92121	2973	37	06073	32.90339001	-117.1821141	San Diego County
99439	Fee-for-Service	1730682394	1730682394	1	10	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15630 18TH	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
99459	Fee-for-Service	1295913499	1295913499	1	1	REGENTS UNIVERSITY OF CA	10/20/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	662 GAYLEY AVE	#B140B	LOS ANGELES	CA	90095	7420	19	06037	34.06653017	-118.447465	Los Angeles County
99509	Fee-for-Service	1578109831	1578109831	1	1	RIOS, CYNDLE	3/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
99533	Fee-for-Service	1497107643	1497107643	1	1	ROBERTS, JAMIE D LMFT	12/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	STE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
99540	Fee-for-Service	1427497866	1427497866	1	1	REEDLEY COMMUNITY HOSPITAL	1/16/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
99564	Fee-for-Service	1447590633	1447590633	1	1	RINKOFF, JEFFREY S MD PC	7/23/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	110 CHESTNUT ST	None	MOUNT SHASTA	CA	96067	2209	47	06093	41.31295849	-122.3110503	Siskiyou County
99588	Fee-for-Service	1407923402	1407923402	1	1	REILLY, WILLIAM K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36824	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
99603	Fee-for-Service	1629498464	1629498464	1	1	REYES, KRISTINE S DO	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13927	40	Pediatrics	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
99618	Fee-for-Service	1649950874	1649950874	1	1	RANDHAWA, GAGANDEEP NP	12/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	10	06019	36.83695148	-119.7904013	Fresno County
99628	Fee-for-Service	1760638118	1760638118	1	1	RYAN, PATRICK R MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109977	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
99630	Fee-for-Service	1952471484	1952471484	1	2	RELUCIO, KAREN MD	11/21/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	086	MEDICAL DIRECTORS	68866	-	NOT APPLICABLE	0	In state provider	None	2751 NAPA VALLEY CORPOR	BLDG A & B	NAPA	CA	94558	6216	28	06055	38.24829023	-122.2745626	Napa County
99633	Fee-for-Service	1245343128	1245343128	1	1	RO, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66723	66	Emergency Medicine (Urgent Care)	0	In state provider	PROFESSIONAL CORPORATION	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
99648	Fee-for-Service	1013394204	1013394204	1	1	RAYMOND, CARYN A CCC-SLP	4/26/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
99662	Fee-for-Service	1235206087	1235206087	1	1	REDWOODS RURAL HEALTH CT	10/1/2001	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	101 WEST COAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11704433	-123.8133408	Humboldt County
99682	Fee-for-Service	1295485043	1295485043	1	1	RICARDO OJEDA, ERNESTO MD	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
99686	Fee-for-Service	1295380467	1295380467	1	1	RIVERSIDE ELITE ADVANTAGE	12/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17085 BIRCH HILL RD	None	RIVERSIDE	CA	92504	8823	33	06065	33.86427817	-117.3638365	Riverside County
99772	Fee-for-Service	1245291822	1245291822	1	1	ROMANO, WILLIAM J MD	6/19/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
99819	Fee-for-Service	1356493167	1356493167	1	1	ROQUE, RENNIE C MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54913	41	Internal Medicine	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
99829	Fee-for-Service	1427497866	1427497866	1	1	REEDLEY COMMUNITY HOSPITAL	3/17/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
99834	Fee-for-Service	1205914959	1205914959	1	1	RAMKUMAR, SUJATHA MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51204	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
99848	Fee-for-Service	1497228266	1497228266	1	1	RIVER BEND HOLDINGS, LLC	12/1/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2215 OAKMONT WAY	None	WEST SACRAMENTO	CA	95691	3022	57	06113	38.57628249	-121.539787	Yolo County
99877	Fee-for-Service	1700120102	1700120102	1	1	RICHARDSON, ANGELIQUE MD	5/1/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	123556	11	Aviation (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
99914	Fee-for-Service	1962704270	1962704270	1	1	REX MEDICAL GROUP, INC	6/20/2011	193400000X	NA	Other	026	PHYSICIANS	111544	08	Family Practice	0	In state provider	None	1161 HUNTINGTON DRIVE	None	DUARTE	CA	91010	2400	19	06037	34.13973294	-117.9791926	Los Angeles County
99931	Fee-for-Service	1346207180	1346207180	1	1	RIES, SAVITA G MD	5/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	79020	22	Pathology (M.D. only)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
99967	Fee-for-Service	1326641127	1326641127	1	1	RYABETS, ANASTASIYA CCC-SLP	3/5/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
99980	Fee-for-Service	1417489444	1417489444	1	1	RUVALCABA, MIGUEL A MD	7/1/2021	390200000X	NA	Other	026	PHYSICIANS	159377	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
99983	Fee-for-Service	1265475115	1265475115	1	1	REILLY, THOMAS M MD	5/10/2005	207P00000X	NA	Other	026	PHYSICIANS	48776	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
99994	Fee-for-Service	1164996658	1164996658	1	1	RESTORE MEDICAL INC	2/23/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7335 NORTH 1ST STREET	SUITE 109	FRESNO	CA	93720	9999	10	06019	36.843354	-119.774839	Fresno County
99995	Fee-for-Service	1952483232	1952483232	1	1	ROMERO BELTRAN, PABLO MD	5/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45197	01	General Practice	0	In state provider	None	335 KATHERINE AVE	SUITE 1	SALINAS	CA	93901	3176	27	06053	36.65981144	-121.6491192	Monterey County
100022	Fee-for-Service	1346332541	1346332541	1	1	REZVANI, NIKOO OD	2/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FRAME COTTAGE OPTOMETRY	16542 VENTURA BLVD	STE 115	ENCINO	CA	91436	2099	19	06037	34.15773086	-118.493868	Los Angeles County
100073	Fee-for-Service	1649690298	1649690298	1	1	RACADIO, MICHAEL LCSW	7/31/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	75339	-	NOT APPLICABLE	0	In state provider	None	707 E. TAHQUITZ CANYON W	14	PALM SPRINGS	CA	92262	6761	33	06065	33.8230137	-116.54049	Riverside County
100077	Fee-for-Service	1679899934	1679899934	1	1	RADECKI, MELISSA A MD	5/24/2018	2086S0105X	NA	General Surgery	026	PHYSICIANS	140503	46	Hand Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100085	Fee-for-Service	1477105450	1477105450	1	1	READE, WALKER LMFT	3/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132153	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD STREET	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
100117	Fee-for-Service	1609149434	1609149434	1	1	ROSARIO, PAMELA G NP	11/17/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
100118	Fee-for-Service	1427497866	1427497866	1	1	REEDLEY COMMUNITY HOSPITAL	7/16/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
100132	Fee-for-Service	1750685707	1750685707	1	1	RAMOS, DAISY LMFT	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
100185	Fee-for-Service	1013988807	1013988807	1	1	RAMAN, SHANKAR MD MPH	9/19/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	46570	77	Infectious Disease	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
100197	Fee-for-Service	1417960675	1417960675	1	1	ROWE, GARY J MD	2/8/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	11802	13	Neurology (M.D. only)	0	In state provider	None	1555 COURT ST	None	REDDING	CA	96001	1632	45	06089	40.5823489	-122.395346	Shasta County
100202	Fee-for-Service	1255561700	1255561700	1	1	REIMERS, KEVIN L LMFT	11/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2575 FOREST AVE	None	CHICO	CA	95928	7686	04	06007	39.71801447	-121.7927912	Butte County
100216	Fee-for-Service	1457557324	1457557324	1	1	REZK, SHERIF A MD	5/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93251	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
100313	Fee-for-Service	1437603685	1437603685	1	1	ROMERO-GALLEGOS, LESLIE S LC	9/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100371	Fee-for-Service	1437258464	1437258464	1	1	REHABFOCUS HOME HEALTH,	12/2/2003	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4643 QUAIL LAKES DR	SUITE 101	STOCKTON	CA	95207	5269	39	06077	37.987092	-121.343391	San Joaquin County
100397	Fee-for-Service	1689106528	1689106528	1	1	RULAND, CHRISTOPHER MD	1/1/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176679	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
100416	Fee-for-Service	1316146129	1316146129	1	1	ROSS, JARON D MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PLACE	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
100422	Fee-for-Service	1225055239	1225055239	1	1	RANCHO MIRAGE ANESTHESIA	8/17/1987	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CONSULTANTS MED GRP	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
100461	Fee-for-Service	1245444132	1245444132	1	1	ROMA, CHRISTOPHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
100532	Fee-for-Service	1518020445	1518020445	1	1	ROBALINO-RIVAS, EMMA R	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
100548	Fee-for-Service	1518946045	1518946045	1	1	RAVI, VINUTHA N MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74644	13	Neurology (M.D. only)	0	In state provider	None	1705 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477999	-119.0215335	Kern County
100562	Fee-for-Service	1518672716	1518672716	1	1	R Y WILLIAMS MD MEDICAL CORP	6/23/2023	261QM2500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ORATION	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
100566	Fee-for-Service	1457387987	1457387987	1	1	ROBERT MUELLEMAN MD	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	7400	00	None	0	0	None
100570	Fee-for-Service	1013956622	1013956622	1	1	RAMIREZ, DAVID L MD	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93887	41	Internal Medicine	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
100594	Fee-for-Service	1487608931	1487608931	1	3	RENAISSANCE IMAGING MED	4/22/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
100597	Fee-for-Service	1992844690	1992844690	1	1	RHEE, EUGENE Y MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54125	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
100646	Fee-for-Service	1417007469	1417007469	1	1	RECHT, LAWRENCE D MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87020	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
100654	Fee-for-Service	1578231262	1578231262	1	1	RAMIREZ, THALI J AU	4/4/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
100676	Fee-for-Service	1225665631	1225665631	1	1	RATTEY, KASE T DPM	8/28/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100677	Fee-for-Service	1790786523	1790786523	1	1	RONBACK, LISA M MD	4/18/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	175712	None	None	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
100744	Fee-for-Service	1639257454	1639257454	1	1	REDING, MICHAEL E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31421	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
100792	Fee-for-Service	1679700967	1679700967	1	1	RAO, SWATI MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116652	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
100883	Fee-for-Service	1306046073	1306046073	1	1	REITMAN, AARON J DO	1/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10539	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
100898	Fee-for-Service	1619684982	1619684982	1	1	RIVERA, ERNESTO PT	10/11/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2119 HATCH RD	STE. A	MODESTO	CA	95351	4814	50	06099	37.60927038	-120.9561263	Stanislaus County
100904	Fee-for-Service	1750790366	1750790366	1	1	ROSE, ANGELA LMFT	6/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2901 PARK AVE	STE B10	SOQUEL	CA	95073	2831	44	06087	36.98719899	-121.9363194	Santa Cruz County
100916	Fee-for-Service	1679271894	1679271894	1	1	RESTORATION LIVING LLC	5/23/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3109 MONTELLO STREET	None	BAKERSFIELD	CA	93306	4555	15	06029	35.38178587	-118.9389131	Kern County
100924	Fee-for-Service	1366731432	1366731432	1	1	ROSAS RUIZ, RUBY	8/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
100934	Fee-for-Service	1003989732	1003989732	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIF I LLC	1449 W REDLANDS BLVD	None	REDLANDS	CA	92373	8021	36	06071	34.06249025	-117.2064954	San Bernardino County
100952	Fee-for-Service	1326536129	1326536129	1	1	RAILEAN, ANASTASIA	10/3/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
100976	Fee-for-Service	1407035355	1407035355	1	1	RALPHS GROCERY COMPANY	1/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #287	811 AVENIDA TALEGA	None	SAN CLEMENTE	CA	92673	6849	30	06059	33.4632268	-117.5977943	Orange County
100984	Fee-for-Service	1740708668	1740708668	1	1	RAMOS, ALISON G PT	5/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
101017	Fee-for-Service	1295280485	1295280485	1	1	ROYALTY PHARMACY, INC.	7/14/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1902 ROYALTY DRIVE	110	POMONA	CA	91767	3036	19	06037	34.07791925	-117.746146	Los Angeles County
101035	Fee-for-Service	1114091840	1114091840	1	1	RAI CARE CENTER OF SO	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CA II LLC	7007 MISSION GORGE RD	FL 1	SAN DIEGO	CA	92120	2418	37	06073	32.80013277	-117.0914524	San Diego County
101068	Fee-for-Service	1184923245	1184923245	1	1	RAMBERG, DONALD A MD INC	4/7/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56939	14	Neurological Surgery	0	In state provider	None	699 CALIFORNIA BLVD	SUITE B	SAN LUIS OBISPO	CA	93401	2507	40	06079	35.28853572	-120.6568105	San Luis Obispo County
101078	Fee-for-Service	1295929685	1295929685	1	1	RODRIGUEZ, GUADALUPE LCSW	2/2/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
101079	Fee-for-Service	1679700967	1679700967	1	1	RAO, SWATI MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116652	01	General Practice	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
101181	Fee-for-Service	1871528638	1871528638	1	1	RANA, NAEEM A MD	9/1/1997	193400000X	NA	Other	026	PHYSICIANS	52541	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
101284	Fee-for-Service	1083458327	1083458327	1	1	ROBINS, NATALIE L CRNA	11/15/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
101301	Fee-for-Service	1871572925	1871572925	1	1	REILLY, ELLEN OD	2/11/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
101302	Fee-for-Service	1255342747	1255342747	1	1	RECOVERY PHARMACEUTICALS INC	11/30/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KNOLLWOOD PHARMACY	16911 SAN FERNANDO MSSN	None	GRANADA HILLS	CA	91344	4250	19	06037	34.27207425	-118.5004598	Los Angeles County
101315	Fee-for-Service	1659558799	1659558799	1	1	ROBERTSON, SHANICA NP	10/4/2024	163WC0400X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
101340	Fee-for-Service	1811004179	1811004179	1	1	ROGGIN, KEVN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60675	0001	00	None	41.788431	-87.60489252	Cook County
101342	Fee-for-Service	1124289657	1124289657	1	1	REZAI, FARZAD MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107800	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
101359	Fee-for-Service	1629367198	1629367198	1	1	RADEVA, IVANA A MD	3/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123727	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
101372	Fee-for-Service	1174702948	1174702948	1	1	RAI, KARISHMA K MD	11/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170094	None	None	0	In state provider	None	1625 STOCKTON BLVD	205	SACRAMENTO	CA	95816	7092	34	06067	38.56554	-121.4664615	Sacramento County
101379	Fee-for-Service	1669531232	1669531232	1	1	RODRIGUEZ, RODRIGO JR MD	11/30/1994	2084N0400X	NA	Neurology	026	PHYSICIANS	75975	13	Neurology (M.D. only)	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
101401	Fee-for-Service	1184135394	1184135394	1	1	RATHFON, MEGAN A NP	10/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101425	Fee-for-Service	1386872265	1386872265	1	1	RICHARDSON, CHRISTOPHER E MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3196 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2305	00	None	36.13194	-115.136873	Clark County
101439	Fee-for-Service	1245302561	1245302561	1	1	ROBERTS, WILLIAM D MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46026	68	Hematology	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
101464	Fee-for-Service	1760541569	1760541569	1	3	RETINA INSTITUTE OF CALIFORN	3/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	72301 COUNTRY CLUB DR	STE 109	RANCHO MIRAGE	CA	92270	8007	33	06065	33.75777052	-116.40249	Riverside County
101506	Fee-for-Service	1366405748	1366405748	1	1	RENAL TREATMENT CENTERS	12/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	3900 BEL AIRE PLZ	STE C	NAPA	CA	94558	2823	28	06055	38.3235404	-122.3073605	Napa County
101544	Fee-for-Service	1568800209	1568800209	1	1	RHETT R SMITH MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1109 N 100 W	None	BEAVER	UT	84713	7746	00	None	38.28916369	-112.6431749	Beaver County
101583	Fee-for-Service	1023565876	1023565876	1	1	ROTHSCHILD, ISABEL A LMFT	1/8/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107248	-	NOT APPLICABLE	0	In state provider	None	6736 LAUREL CANYON BLVD	STE 200	NORTH HOLLYWOOD	CA	91606	1576	19	06037	34.193493	-118.3964925	Los Angeles County
101593	Fee-for-Service	1083763957	1083763957	1	1	REINOW, DAVID J OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
101597	Fee-for-Service	1376503268	1376503268	1	1	RODY P COX, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
101612	Fee-for-Service	1043967516	1043967516	1	2	RAZ TRANSIT CORPORATION	6/20/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13615 VICTORY BLVD	UNIT 116	VAN NUYS	CA	91401	1775	19	06037	34.18671049	-118.429353	Los Angeles County
101661	Fee-for-Service	1154309599	1154309599	1	1	RENCUS, TAL MD	7/16/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144554	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
101747	Fee-for-Service	1760541569	1760541569	1	3	RETINA INSTITUTE OF CALIFORN	10/16/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	72301 COUNTRY CLUB DR	STE 109	RANCHO MIRAGE	CA	92270	8007	33	06065	33.75777052	-116.40249	Riverside County
101752	Fee-for-Service	1306959390	1306959390	1	1	RUSSO, LORENA B MD	9/25/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81050	08	Family Practice	0	In state provider	None	1820 41ST AVE	SUITE C	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
101765	Fee-for-Service	1578940094	1578940094	1	1	RECOVERY INNOVATIONS, INC	9/7/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9890 COUNTY FARM ROAD	BLDG 2	RIVERSIDE	CA	92503	3598	33	06065	33.92009951	-117.4574475	Riverside County
101772	Fee-for-Service	1154841245	1154841245	1	1	RAMSDEN-STEIN, BENJAMIN DO	8/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16801	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
101796	Fee-for-Service	1407934003	1407934003	1	1	REMEDIOS, PETER A MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69880	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
101820	Fee-for-Service	1770248593	1770248593	1	2	REACH HEALTHCARE	12/8/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
101824	Fee-for-Service	1811438997	1811438997	1	1	RATTNER VASCULAR MEDICAL	6/21/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER ASC LLC	995 GATEWAY CENTER WAY	SUITE 207	SAN DIEGO	CA	92102	4544	37	06073	32.71405516	-117.1158459	San Diego County
101844	Fee-for-Service	1518015486	1518015486	1	1	RICHARDS, STEVEN C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36137	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
101853	Fee-for-Service	1346477825	1346477825	1	1	ROTTKAMP, CATHERINE A MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120377	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
101875	Fee-for-Service	1881050789	1881050789	1	1	REA, FAITH J	9/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
101881	Fee-for-Service	1477926517	1477926517	1	1	RENNER, MAYONNE D NP	12/2/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	STE 2021	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
101894	Fee-for-Service	1578898250	1578898250	1	1	RODRIGUEZ, FRANCISCO G DO	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10175	01	General Practice	0	In state provider	None	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
101934	Fee-for-Service	1861238206	1861238206	1	1	REDWOOD CENTER STREET ONE OP	7/16/2024	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CO LLC	2431 CENTER ST	None	BAKERSFIELD	CA	93306	5105	15	06029	35.37217103	-118.963384	Kern County
101993	Fee-for-Service	1649856113	1649856113	1	1	RAVICHANDRAN, SANDHIYA MD	7/30/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
102006	Fee-for-Service	1861591034	1861591034	1	1	RANDEL, BRADLEY E MD	7/8/2008	207L00000X	NA	Other	026	PHYSICIANS	98743	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
102082	Fee-for-Service	1760541569	1760541569	1	22	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
102101	Fee-for-Service	1215909130	1215909130	1	1	RANCHO CUCAMONGA	8/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PERPETUAL HELP MEDICAL	9710 19TH ST	None	RANCHO CUCAMONGA	CA	91737	3538	36	06071	34.13274747	-117.593073	San Bernardino County
102121	Fee-for-Service	1285029421	1285029421	1	1	RENTERIA, SABRINA M MD	8/26/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145894	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
102185	Fee-for-Service	1740452259	1740452259	1	1	RUDRICH, HORST R DO	7/1/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5970	08	Family Practice	0	In state provider	MEDICAL CORP	255 TERRACINA BLVD	STE 105	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
102190	Fee-for-Service	1770004608	1770004608	1	1	RITTER, DANIEL J MD	10/6/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
102197	Fee-for-Service	1356337570	1356337570	1	1	ROBERTSON, BRIAN MD INC	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	43271	08	Family Practice	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
102234	Fee-for-Service	1891777876	1891777876	1	1	REGENTS/UCDPBG/IM NUTRIT	1/1/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
102281	Fee-for-Service	1295866598	1295866598	1	1	RAMOS, DIANA E MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61692	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	880 S ATLANTIC BLVD	STE 302	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
102289	Fee-for-Service	1588945026	1588945026	1	1	ROTTER, NICOLE M NP	2/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
102290	Fee-for-Service	1114398864	1114398864	1	1	RO HEALTH, LLC	7/17/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1867 WHIPPLE ROAD	None	HAYWARD	CA	94544	7384	01	06001	37.6060655	-122.052546	Alameda County
102305	Fee-for-Service	1447485859	1447485859	1	1	RHOME-BOROFF, AVIANCE A PHD	7/21/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
102308	Fee-for-Service	1588058887	1588058887	1	1	RIVAS, ANDREA T MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155933	40	Pediatrics	0	In state provider	None	950 CIRCLE DR	None	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
102324	Fee-for-Service	1699839142	1699839142	1	1	REEVES, LENI V MD	7/1/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	47461	01	General Practice	0	In state provider	None	1000 VENTURA AVE	None	CHOWCHILLA	CA	93610	2368	20	06039	37.12227595	-120.2716274	Madera County
102372	Fee-for-Service	1760541569	1760541569	1	22	RETINA INSTITUTE OF CALIFORN	2/17/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
102383	Fee-for-Service	1518030568	1518030568	1	10	RETINAL DIAGNOSTIC CENTER A	6/29/2017	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL CORPORATION	8833 MONTEREY RD	STE D	GILROY	CA	95020	7200	43	06085	37.02446941	-121.5774161	Santa Clara County
102411	Fee-for-Service	1295451607	1295451607	1	1	REYNOLDS, HAILEY E CRNA	3/27/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
102412	Fee-for-Service	1023280377	1023280377	1	1	RAY, KELLY M NP	10/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102420	Fee-for-Service	1417071622	1417071622	1	1	ROBLES, SANDRA L LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	855 N LARK ELLEN AVE	SUITE B	WEST COVINA	CA	91791	1069	19	06037	34.087707	-117.9166385	Los Angeles County
102422	Fee-for-Service	1922391796	1922391796	1	1	RODRIGUEZ, PAVEL MD	5/16/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	180411	None	None	0	In state provider	None	828 S GRAND AVE	STE 104	GLENDORA	CA	91740	4856	19	06037	34.124175	-117.8725705	Los Angeles County
102451	Fee-for-Service	1952595316	1952595316	1	1	RYNNING, RALPH E MD	9/11/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	103946	20	Orthopedic Surgery	0	In state provider	None	5555 RESERVOIR DR	STE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
102471	Fee-for-Service	1548267131	1548267131	1	1	RAY, CHRISTOPHER S MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
102503	Fee-for-Service	1356754287	1356754287	1	1	REVELS, SETH M MD	10/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150715	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
102518	Fee-for-Service	1831674720	1831674720	1	1	RINGLE, DANIELLE OD	12/22/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
102535	Fee-for-Service	1154464915	1154464915	1	1	RIVERA, ANDREA L	10/1/2007	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
102543	Fee-for-Service	1467568105	1467568105	1	1	RUBENSTEIN, RONALD L MD FACS	7/31/2020	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	33407	84	Surgery-Head and Neck	0	In state provider	None	13847 E14TH STREET	SUITE 200	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
102552	Fee-for-Service	1518030568	1518030568	1	7	RETINAL DIAGNOSTIC CENTER A	2/2/2015	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1663 DOMINICAN WAY	STE 110A	SANTA CRUZ	CA	95065	1579	44	06087	36.99029729	-121.9809324	Santa Cruz County
102588	Fee-for-Service	1033264346	1033264346	1	1	REEVES, SHIRLEY OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
102600	Fee-for-Service	1164913539	1164913539	1	2	RIAZI ESFAHANI, MOHAMMAD MD	12/5/2022	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	183138	None	None	0	In state provider	None	101 THE CIITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
102609	Fee-for-Service	1073737631	1073737631	1	1	ROSS, LAWRENCE MD	12/17/1996	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	28912	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
102611	Fee-for-Service	1699839142	1699839142	1	1	REEVES, LENI V MD	7/1/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	47461	40	Pediatrics	0	In state provider	None	1000 VENTURA AVE	None	CHOWCHILLA	CA	93610	2368	20	06039	37.12227595	-120.2716274	Madera County
102647	Fee-for-Service	1336227073	1336227073	1	1	RAUF, SHAISTA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65509	None	None	0	In state provider	None	4301 X ST	None	SACRAMENTO	CA	95817	2214	34	06067	38.5536003	-121.455135	Sacramento County
102703	Fee-for-Service	1265444137	1265444137	1	1	RAMOS, HECTOR M MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72058	08	Family Practice	0	In state provider	None	1379 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83694289	-119.7636839	Fresno County
102720	Fee-for-Service	1598769390	1598769390	1	1	RODGER R BROWN MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 MACK RD	None	FAIRFIELD	OH	45014	5335	00	None	39.31129717	-84.51710189	Butler County
102812	Fee-for-Service	1629785787	1629785787	1	1	ROUNDS, NICHOLAS R PT	1/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
102846	Fee-for-Service	1841685815	1841685815	1	1	REDDY, AJAY T MD	11/15/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	174525	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
102847	Fee-for-Service	1356444897	1356444897	1	1	REGENTS OF THE UNIVERSITY OF	12/18/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102881	Fee-for-Service	1891069381	1891069381	1	1	ROBLES-HUERTA, JOSE L DO	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12629	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
102883	Fee-for-Service	1366818775	1366818775	1	1	RIZK VALENCIA, DANIA C LMFT	11/26/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
102912	Fee-for-Service	1417046095	1417046095	1	1	RENAL CAREPARTNERS OF LOS	12/4/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES INC	9808 VENICE BOULEVARD	SUITE 200	CULVER CITY	CA	90232	6809	19	06037	34.0236396	-118.3980847	Los Angeles County
102920	Fee-for-Service	1720507437	1720507437	1	1	RIOS, SUSANA NP	7/30/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	95 3RD ST	STE 293	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
102931	Fee-for-Service	1508829185	1508829185	1	1	RODRIGUEZ, JOSE A MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78410	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
102932	Fee-for-Service	1912047036	1912047036	1	1	RANGEL-FRIEDMAN, DEBORAH M P	8/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HD	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
103013	Fee-for-Service	1124572144	1124572144	1	1	REYBET DEGAT, VINCENT LCSW	10/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
103044	Fee-for-Service	1215255385	1215255385	1	1	REIS, CESAR MD	10/19/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	152048	39	Preventive (M.D. only)	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
103046	Fee-for-Service	1124559729	1124559729	1	1	RAHMAN, AMREEN S MD	8/22/2022	207L00000X	NA	Other	026	PHYSICIANS	172049	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103071	Fee-for-Service	1316174352	1316174352	1	1	REED, JEWMAULL J MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135968	03	Allergy	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
103108	Fee-for-Service	1346246949	1346246949	1	1	ROSSO, JUDITH E	3/6/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	2	Out of state provider	None	1107 HIGHWAY 395	None	GARDNERVILLE	NV	89410	0000	00	None	38.76078609	-119.576046	Douglas County
103114	Fee-for-Service	1932213600	1932213600	1	1	RUSH UNIV MEDICAL CENTER	7/22/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1653 W CONGRESS PKWY	None	CHICAGO	IL	60612	3833	00	None	41.87509308	-87.6693474	Cook County
103132	Fee-for-Service	1548026008	1548026008	1	1	RUBYAN, MARIAM M NP	5/20/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	19	06037	34.24862229	-118.2886742	Los Angeles County
103135	Fee-for-Service	1356444897	1356444897	1	1	REGENTS OF THE UNIVERSITY OF	6/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103160	Fee-for-Service	1982611349	1982611349	1	1	REBONG, MARIE A MD	4/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45814	40	Pediatrics	0	In state provider	None	219 N JACKSON AVE	None	SAN JOSE	CA	95116	1625	43	06085	37.36332539	-121.8484023	Santa Clara County
103184	Fee-for-Service	1982813432	1982813432	1	1	RAZAQ BADAMOSI	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 8TH AVE	None	FORT WORTH	TX	76104	4110	00	None	32.72995601	-97.34376587	Tarrant County
103189	Fee-for-Service	1477180982	1477180982	1	1	RIOPELLE, ALEXANDRIA M MD	1/8/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
103228	Fee-for-Service	1649755901	1649755901	1	1	ROJAS, JACQUELINE	5/23/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
103245	Fee-for-Service	1619043445	1619043445	1	1	ROSALES, STEVEN J OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	533 MAIN ST	None	EL SEGUNDO	CA	90245	3006	19	06037	33.92301825	-118.4160652	Los Angeles County
103253	Fee-for-Service	1366062689	1366062689	1	1	RIAZ, TABISH	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
103263	Fee-for-Service	1801094792	1801094792	1	1	ROMEO, GINA M LCSW	6/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
103291	Fee-for-Service	1598291015	1598291015	1	1	RIOS, DR JAVIER RIOS AMC	5/5/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	31946 MISSION TRAIL	STE A	LAKE ELSINORE	CA	92530	4539	33	06065	33.65640803	-117.2979656	Riverside County
103313	Fee-for-Service	1760594998	1760594998	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103315	Fee-for-Service	1235206087	1235206087	1	7	REDWOODS RURAL HEALTH CT	3/15/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	930 S FORTUNA BLVD	None	FORTUNA	CA	95540	3009	12	06023	40.58128607	-124.1469193	Humboldt County
103316	Fee-for-Service	1013199843	1013199843	1	1	ROWE, MICHELLE J MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
103318	Fee-for-Service	1265783948	1265783948	1	1	RHEUMATOLOGY SERVICES	1/2/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
103335	Fee-for-Service	1609265008	1609265008	1	1	RAYAN, HANY A MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140406	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
103361	Fee-for-Service	1588695159	1588695159	1	1	R C DAVID MEDICAL CORPORATIO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53612	08	Family Practice	0	In state provider	RC DAVID MED CORP	2480 MISSION ST	STE 215	SAN FRANCISCO	CA	94110	2480	38	06075	37.75745685	-122.418984	San Francisco County
103388	Fee-for-Service	1932285004	1932285004	1	1	ROWELL, DIANA L MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73814	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103404	Fee-for-Service	1932213600	1932213600	1	1	RUSH UNIV MEDICAL CENTER	7/22/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1653 W CONGRESS PKWY	None	CHICAGO	IL	60612	3833	00	None	41.87509308	-87.6693474	Cook County
103407	Fee-for-Service	1598918302	1598918302	1	1	RODRIGUEZ-GOMEZ, GERARDO	9/3/2008	2084N0402X	NA	Neurology	026	PHYSICIANS	-	79	Neurology-Child	1	Border provider	D MD APC	1190 RYLAND ST	None	RENO	NV	89502	1702	00	None	39.52382862	-119.7952889	Washoe County
103417	Fee-for-Service	1447240213	1447240213	1	1	ROBERT ROSENGART MD	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	777 HEMLOCK STREET	None	MACON	GA	31201	2102	00	None	32.83300602	-83.63616787	Bibb County
103423	Fee-for-Service	1356444897	1356444897	1	1	REGENTS OF THE UNIVERSITY OF	2/20/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103429	Fee-for-Service	1235206087	1235206087	1	5	REDWOODS RURAL HEALTH CT	2/12/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	344 HUMBOLDT AVE	None	REDWAY	CA	95560	0000	12	06023	40.11947743	-123.8241129	Humboldt County
103444	Fee-for-Service	1952999724	1952999724	1	1	RODELANDER, MAYA LMFT	1/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
103451	Fee-for-Service	1104914217	1104914217	2	1	RIVERA-ORTIZ, WILLIAM MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46115	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	801 E MOUNTAIN VIEW ST	STE C	BARSTOW	CA	92311	3052	36	06071	34.89324445	-117.0177579	San Bernardino County
103526	Fee-for-Service	1770695967	1770695967	1	1	RENZ, HEATHER A CNM	10/19/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103528	Fee-for-Service	1336349919	1336349919	1	1	ROSENGART, CHRISTI	11/5/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	56047	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
103545	Fee-for-Service	1588686653	1588686653	1	1	RENO, LISA DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1102 E CENTENNIAL DR	None	PITTSBURG	KS	66762	6643	00	None	37.3817127	-94.68489589	Crawford County
103555	Fee-for-Service	1093847428	1093847428	1	1	RAUSEI-MILLS, VERONICA	5/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89299	22	Pathology (M.D. only)	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
103602	Fee-for-Service	1235206087	1235206087	1	7	REDWOODS RURAL HEALTH CT	3/15/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	930 S FORTUNA BLVD	None	FORTUNA	CA	95540	3009	12	06023	40.58128607	-124.1469193	Humboldt County
103614	Fee-for-Service	1528083599	1528083599	1	1	ROTMAN, BARRY L. MD	8/31/1993	207R00000X	NA	Other	026	PHYSICIANS	72260	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
103623	Fee-for-Service	1306186390	1306186390	1	1	RITE CARE HOSPICE INC	9/13/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2312 W VICTORY BLVD	SUITE 202	BURBANK	CA	91506	1281	19	06037	34.18452853	-118.336635	Los Angeles County
103639	Fee-for-Service	1912005745	1912005745	1	1	RACKWITZ, ROB S	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
103649	Fee-for-Service	1427664127	1427664127	1	1	RAINBOW HOME HEALTH CARE	3/22/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE B105A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
103683	Fee-for-Service	1346346897	1346346897	1	1	RADANY, ERIC H MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84235	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
103717	Fee-for-Service	1235206087	1235206087	1	5	REDWOODS RURAL HEALTH CT	2/12/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	344 HUMBOLDT AVE	None	REDWAY	CA	95560	0000	12	06023	40.11947743	-123.8241129	Humboldt County
103744	Fee-for-Service	1053670380	1053670380	1	1	RAGAN, SHERRI D LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
103746	Fee-for-Service	1336244896	1336244896	1	1	ROSA-RE, LISA M MD	11/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173044	None	None	0	In state provider	None	125 S 5TH ST	None	BRAWLEY	CA	92227	2402	13	06025	32.97758931	-115.5337892	Imperial County
103750	Fee-for-Service	1407983950	1407983950	1	1	RAO, GEETHA A MD	12/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68863	38	Geriatrics	0	In state provider	None	200 MED PLAZA	SUITE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
103751	Fee-for-Service	1518672716	1518672716	1	2	R Y WILLIAMS MD MEDICAL CORP	8/23/2024	261QM2500X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	ORATION	2705 LOMA VISTA RD	SUITE 205	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
103755	Fee-for-Service	1609981620	1609981620	2	1	RX CONSULTANTS GROUP INC	1/7/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11515 ARTESIA BLVD	STE 101	ARTESIA	CA	90701	3852	19	06037	33.87307453	-118.0885185	Los Angeles County
103764	Fee-for-Service	1821476292	1821476292	1	1	RIPP, KAMBRIA K MD	10/16/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146257	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
103783	Fee-for-Service	1255741724	1255741724	1	1	RUSSELL, LORI R	8/16/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
103802	Fee-for-Service	1760796809	1760796809	1	1	REDMOND, NATALIE C	12/12/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
103822	Fee-for-Service	1801922802	1801922802	1	1	RSCR CALIFORNIA, INC	2/5/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	818 S GILBUCK DR	None	ANAHEIM	CA	92802	1318	30	06059	33.82107074	-117.9333521	Orange County
103833	Fee-for-Service	1174609788	1174609788	1	1	RAI, DALJEET S MD	12/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53264	08	Family Practice	0	In state provider	None	630 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1902	43	06085	37.34243105	-121.8773044	Santa Clara County
103846	Fee-for-Service	1871669853	1871669853	1	1	ROWDEN, MONICA LCSW	12/31/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
103886	Fee-for-Service	1083176689	1083176689	1	1	RANGEL OROZCO, DANIELA MD	8/1/2022	390200000X	NA	Other	026	PHYSICIANS	177875	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
103909	Fee-for-Service	1033557525	1033557525	1	1	ROSE, ALEXANDRA MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143518	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
103910	Fee-for-Service	1306186390	1306186390	1	1	RITE CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2312 W VICTORY BLVD	SUITE 202	BURBANK	CA	91506	1281	19	06037	34.18452853	-118.336635	Los Angeles County
103923	Fee-for-Service	1336138924	1336138924	1	1	REDER, CHAD S MD	2/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82065	18	Ophthalmology	0	In state provider	None	1680 E HERNDON AVE	# 101	FRESNO	CA	93720	3305	10	06019	36.83756052	-119.7571005	Fresno County
103925	Fee-for-Service	1700863511	1700863511	1	1	RYAN, MICHAEL MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86911	None	None	0	In state provider	None	1428 PHILLIPS LN	STE 203	SAN LUIS OBISPO	CA	93401	2551	40	06079	35.28794905	-120.6574321	San Luis Obispo County
103951	Fee-for-Service	1932566189	1932566189	1	1	RIVERSIDE POSTACUTE CARE LLC	2/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8781 LAKEVIEW AVENUE	None	RIVERSIDE	CA	92509	5969	33	06065	33.97129309	-117.4754109	Riverside County
103960	Fee-for-Service	1558385914	1558385914	1	1	ROQUE, RONALDO V MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74823	41	Internal Medicine	0	In state provider	None	1760 TERMINO AVE	STE 104	LONG BEACH	CA	90804	2169	19	06037	33.78889871	-118.1458784	Los Angeles County
104002	Fee-for-Service	1275288029	1275288029	1	1	RINCON, NICHOLAS E CRNA	12/27/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
104018	Fee-for-Service	1023422292	1023422292	1	1	RASMUSSEN, LISA N M MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143161	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
104030	Fee-for-Service	1427353630	1427353630	1	1	RAMANATHAN, VIVEK S MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115442	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
104042	Fee-for-Service	1407983950	1407983950	1	1	RAO, GEETHA A MD	12/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68863	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	SUITE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
104081	Fee-for-Service	1508059007	1508059007	2	1	RIVERSIDE NEUROLOGY INC	7/21/2014	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7172 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3804	33	06065	33.94477707	-117.4034127	Riverside County
104095	Fee-for-Service	1154498079	1154498079	1	1	REILEY, DAVID G MD	6/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81299	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
104112	Fee-for-Service	1457316556	1457316556	1	1	RAYMOND K COKER	10/24/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1609 N MEDICAL DR	None	STUTTGART	AR	72160	3274	00	None	34.5157194	-91.5589784	Arkansas County
104125	Fee-for-Service	1770654535	1770654535	1	1	REZNIK, VIVIAN M MD	6/1/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36058	45	Nephrology (Renal-Kidney)	0	In state provider	U C SAN DIEGO	225 DICKINSON ST	# H212	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
104169	Fee-for-Service	1306818570	1306818570	1	1	RAPPOLD, JOSEPH F MD	10/27/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77850	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104179	Fee-for-Service	1164242962	1164242962	1	1	RESURRECCION, KRISTINE NP	10/25/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
104187	Fee-for-Service	1730685611	1730685611	1	1	ROBINSON, ADAM A MD	7/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165255	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104195	Fee-for-Service	1033557525	1033557525	1	1	ROSE, ALEXANDRA MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143518	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
104204	Fee-for-Service	1770099293	1770099293	1	1	REHFELD, DENYSE LMFT	6/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
104217	Fee-for-Service	1609414853	1609414853	1	1	REALM HEALTHCARE INC	9/7/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
104227	Fee-for-Service	1841656972	1841656972	1	1	REEVES, STEVEN M RCP	10/26/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
104239	Fee-for-Service	1457893992	1457893992	1	1	RITTER, CARLA PT	12/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
104247	Fee-for-Service	1740411628	1740411628	1	1	RANGEL, JAVIER R MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108995	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DRIVE	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
104253	Fee-for-Service	1649513292	1649513292	1	1	RODRIGUEZ, ADRIANA L LMFT	5/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
104255	Fee-for-Service	1104050897	1104050897	1	1	RAINES-KOHLER, JACQUELINE	3/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
104286	Fee-for-Service	1164508297	1164508297	1	1	ROBINS,EDWIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1638 OWEN DRIVE	None	FAYETTEVILLE	NC	28304	0000	00	None	35.032329	-78.933186	Cumberland County
104327	Fee-for-Service	1598977522	1598977522	1	1	RAD, PARMIS MD	4/4/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	168795	-	NOT APPLICABLE	0	In state provider	None	1466 LINCOLN AVE	None	SAN RAFAEL	CA	94901	2021	21	06041	37.98004532	-122.5221262	Marin County
104334	Fee-for-Service	1891187662	1891187662	1	1	ROJAS, CARIN D MD	9/20/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	176562	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
104343	Fee-for-Service	1891309175	1891309175	1	1	RIESER, LORI N CNP	11/24/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
104394	Fee-for-Service	1598021339	1598021339	1	1	ROBLES, MARIA D C MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127817	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
104415	Fee-for-Service	1770654535	1770654535	1	1	REZNIK, VIVIAN M MD	6/1/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36058	40	Pediatrics	0	In state provider	U C SAN DIEGO	225 DICKINSON ST	# H212	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
104452	Fee-for-Service	1205815073	1205815073	1	1	ROSENTHAL, PHILIP MD	11/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89264	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
104478	Fee-for-Service	1851326482	1851326482	1	1	RANDHAWA, MOHINDER P MD	6/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86803	33	Thoracic Surgery	0	In state provider	None	2780 EUREKA WAY	None	REDDING	CA	96001	0223	45	06089	40.58585835	-122.4124086	Shasta County
104502	Fee-for-Service	1629120704	1629120704	1	1	ROSALES, ANA M RN	12/21/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
104503	Fee-for-Service	1881282598	1881282598	1	1	REIB, LINDA J	1/29/2021	224900000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	4811 CHIPPENDALE DR	SUITE 208	SACRAMENTO	CA	95841	2555	34	06067	38.663046	-121.352472	Sacramento County
104505	Fee-for-Service	1609414853	1609414853	1	1	REALM HEALTHCARE INC	9/7/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
104528	Fee-for-Service	1598329575	1598329575	1	1	RANDALL, THOMAS S MD	8/29/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180340	None	None	0	In state provider	None	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
104536	Fee-for-Service	1285640433	1285640433	1	1	RAMOS, WILFREDO R MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84192	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
104538	Fee-for-Service	1033643093	1033643093	1	1	RUIZ, MIRIAM LCSW	9/27/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3727 W 6TH ST	STE 411	LOS ANGELES	CA	90020	5108	19	06037	34.06358655	-118.3037656	Los Angeles County
104556	Fee-for-Service	1023429701	1023429701	1	1	RIBEIRO, KAYLA J LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
104577	Fee-for-Service	1386809499	1386809499	1	1	RAIZADA, AKSHAY MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111209	41	Internal Medicine	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
104581	Fee-for-Service	1790074383	1790074383	1	1	REDDY, SUNAYANA V MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127231	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
104587	Fee-for-Service	1326068222	1326068222	1	1	RAHMAN, SARAH B MD	11/1/1998	207R00000X	NA	Other	026	PHYSICIANS	60027	41	Internal Medicine	0	In state provider	None	145 DIVISADERO ST	None	SAN FRANCISCO	CA	94117	3212	38	06075	37.76964592	-122.4367668	San Francisco County
104606	Fee-for-Service	1700999117	1700999117	1	1	RATINER, BORIS D MD INC	1/13/2014	302R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18376 CLARK ST	None	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
104611	Fee-for-Service	1255819215	1255819215	1	1	RODRIGUEZ, OLGA O RCP	9/4/2018	2278P1004X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104641	Fee-for-Service	1487608931	1487608931	1	4	RENAISSANCE IMAGING MED	10/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
104668	Fee-for-Service	1962126250	1962126250	1	1	ROSCHEVITZ, JASON	1/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
104710	Fee-for-Service	1730295395	1730295395	1	1	RODRIGUEZ, ELIAS S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77669	41	Internal Medicine	0	In state provider	RIO DEL MAR MEDICAL CLNC	1095 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	4164	44	06087	36.91768224	-121.7842484	Santa Cruz County
104766	Fee-for-Service	1013233790	1013233790	1	1	RICHTER, ALEXANDER MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134769	20	Orthopedic Surgery	0	In state provider	None	1325 N ROSE DR	STE 100	PLACENTIA	CA	92870	3800	30	06059	33.8868003	-117.8420447	Orange County
104767	Fee-for-Service	1467035469	1467035469	1	1	RACITI, CHRISTOPHER D MD	7/4/2024	163WE0003X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
104777	Fee-for-Service	1740821099	1740821099	1	1	REYNOLDS, ROBERT CRNA	4/30/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
104834	Fee-for-Service	1316472012	1316472012	1	1	RAMIREZ, ILEANA LMFT	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
104851	Fee-for-Service	1578595963	1578595963	1	1	RALPH T. SHIPLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
104874	Fee-for-Service	1104252147	1104252147	1	1	RIGGIO, THOMAS OD	10/3/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6325 HWY 193	SUITE 796	GEORGETOWN	CA	95634	9671	09	06017	38.90576139	-120.840417	El Dorado County
104875	Fee-for-Service	1326068222	1326068222	1	1	RAHMAN, SARAH B MD	11/1/1998	207R00000X	NA	Other	026	PHYSICIANS	60027	01	General Practice	0	In state provider	None	145 DIVISADERO ST	None	SAN FRANCISCO	CA	94117	3212	38	06075	37.76964592	-122.4367668	San Francisco County
104891	Fee-for-Service	1700999117	1700999117	1	1	RATINER, BORIS D MD INC	1/13/2014	302R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18376 CLARK ST	None	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
104894	Fee-for-Service	1376838235	1376838235	1	1	RAMSEY, MELISSA A MD	10/2/2020	207L00000X	NA	Other	026	PHYSICIANS	168216	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
104917	Fee-for-Service	1174080469	1174080469	1	1	REGAL HOME HEALTH CARE INC	7/23/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1123 E BROADWAY	None	GLENDALE	CA	91205	1315	19	06037	34.14625967	-118.2408126	Los Angeles County
104985	Fee-for-Service	1184752081	1184752081	1	1	RODGERSON, JEFF D MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68867	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
104998	Fee-for-Service	1518780519	1518780519	1	1	RAW COUNSELING INC.	11/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15409 ANACAPA RD	409-F	VICTORVILLE	CA	92392	2463	36	06071	34.50499906	-117.3255382	San Bernardino County
105053	Fee-for-Service	1790066348	1790066348	1	1	RX AMERICA INC	5/14/2014	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11 BERKSHIRE AVENUE	None	REDWOOD CITY	CA	94063	3632	41	06081	37.46958244	-122.2117005	San Mateo County
105055	Fee-for-Service	1407636715	1407636715	1	1	ROUGHT, STEPHEN LCSW	1/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
105074	Fee-for-Service	1174534069	1174534069	1	1	RAO, ANURADHA MD	10/4/2019	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	54982	40	Pediatrics	0	In state provider	None	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	15	06029	35.27289	-119.0212895	Kern County
105117	Fee-for-Service	1174906481	1174906481	1	1	RAMACHANDRAN, AMRUTHA MD	8/23/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167275	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105136	Fee-for-Service	1477968451	1477968451	1	1	RAWLS, ASHLEY E MD	6/7/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	153301	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
105137	Fee-for-Service	1447838156	1447838156	1	1	ROBERSON, CHARLES MD	7/8/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
105189	Fee-for-Service	1023198272	1023198272	1	1	REIKES, ANDREW REED MD	7/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74623	44	Public Health	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
105245	Fee-for-Service	1376704817	1376704817	1	1	RAMESH, BRINDHA MD	10/4/2019	207R00000X	NA	Other	026	PHYSICIANS	146057	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
105251	Fee-for-Service	1932510401	1932510401	1	1	RISER, ANDREA C NP	2/7/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
105289	Fee-for-Service	1528656089	1528656089	1	1	ROLLING GREEN SENIOR INC	2/28/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	42007 THOROUGHBRED LANE	None	MURRIETA	CA	92562	6105	33	06065	33.55788774	-117.2208164	Riverside County
105303	Fee-for-Service	1508869926	1508869926	1	1	ROBERTS, DOUGLAS E MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	35606	41	Internal Medicine	0	In state provider	None	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
105331	Fee-for-Service	1669886172	1669886172	1	1	ROBINSON, CHARITA M NP	8/19/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
105347	Fee-for-Service	1518544931	1518544931	1	1	RIELAND, ARRIANA T MD	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	18947	34	Urology and Urological Surgery	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
105361	Fee-for-Service	1346288628	1346288628	1	1	ROTH, JEREMY B MD	12/19/2024	207L00000X	NA	Other	026	PHYSICIANS	164554	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
105368	Fee-for-Service	1942623160	1942623160	1	1	RHEEM, DANIEL MD INC	8/20/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	92866	41	Internal Medicine	0	In state provider	None	505 S VIRGIL AVENUE	SUITE 102	LOS ANGELES	CA	90020	1407	19	06037	34.064883	-118.287086	Los Angeles County
105378	Fee-for-Service	1972699965	1972699965	1	1	RICE, JEFFREY W MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	37279	41	Internal Medicine	0	In state provider	None	901 PACIFIC ST	None	MONTEREY	CA	93940	4447	27	06053	36.59205474	-121.898679	Monterey County
105383	Fee-for-Service	1306109905	1306109905	1	1	RICHARDSON, BAXTER K IV MD	12/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148942	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
105388	Fee-for-Service	1699929158	1699929158	1	1	ROGERS, JOHN J LMFT	12/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3808 RIVERSIDE DR	SUITE 500	BURBANK	CA	91505	5301	19	06037	34.15252315	-118.3412174	Los Angeles County
105426	Fee-for-Service	1386673200	1386673200	1	1	ROSENBAUM, HARVEY K MD	6/30/1987	207L00000X	NA	Other	026	PHYSICIANS	45229	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
105429	Fee-for-Service	1851853964	1851853964	1	1	RIVERA, AGNES SARA L CNP	11/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
105435	Fee-for-Service	1801999206	1801999206	1	1	RAMANUJAM, THAILA MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51041	None	None	0	In state provider	None	1505 SOQUEL DR	STE 1	SANTA CRUZ	CA	95065	1716	44	06087	36.98803429	-121.9848045	Santa Cruz County
105467	Fee-for-Service	1285390872	1285390872	1	1	ROSALES, NORMA LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10718 WHITE OAK AVE.	6	GRANADA HILLS	CA	91344	4628	19	06037	34.265538	-118.519724	Los Angeles County
105483	Fee-for-Service	1023198272	1023198272	1	1	REIKES, ANDREW REED MD	7/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74623	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
105489	Fee-for-Service	1407021215	1407021215	1	1	RUIZ, REBECCA M MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122786	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
105519	Fee-for-Service	1265093116	1265093116	1	1	RAJWANT K PANESAR	1/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3700 DELTA FAIR BLVD	SUITE 200E	ANTIOCH	CA	94509	3700	07	06013	38.0038852	-121.8448833	Contra Costa County
105571	Fee-for-Service	1740414606	1740414606	1	1	RUNGE, SARA J MD	2/11/2011	208600000X	NA	General Surgery	026	PHYSICIANS	107577	02	General Surgery	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
105592	Fee-for-Service	1073542676	1073542676	1	1	RALPH, JEFFREY W MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74022	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105605	Fee-for-Service	1093823221	1093823221	1	1	ROOK, RONALD PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2134 MAIN ST	STE 250	HUNTINGTON BEACH	CA	92648	6455	30	06059	33.679467	-117.998469	Orange County
105612	Fee-for-Service	1316267388	1316267388	1	1	RAI, JASPREET K LMFT	5/3/2019	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
105657	Fee-for-Service	1942623160	1942623160	1	1	RHEEM, DANIEL MD INC	8/20/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	92866	10	Gastroenterology (M.D. only)	0	In state provider	None	505 S VIRGIL AVENUE	SUITE 102	LOS ANGELES	CA	90020	1407	19	06037	34.064883	-118.287086	Los Angeles County
105739	Fee-for-Service	1699091686	1699091686	1	1	RYAN CUSIC MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
105753	Fee-for-Service	1891000360	1891000360	1	1	ROBSAG, INC	9/1/2010	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATOR	811 E WASHINGTON ST	None	PASADENA	CA	91104	5013	19	06037	34.16899853	-118.134099	Los Angeles County
105783	Fee-for-Service	1881730208	1881730208	1	1	RAPHAEL, ELIZABETH H MD	5/31/1995	207P00000X	NA	Other	026	PHYSICIANS	83875	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
105791	Fee-for-Service	1821294000	1821294000	1	1	REZAIE, ANAHITA MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55510	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
105806	Fee-for-Service	1265093116	1265093116	1	1	RAJWANT K PANESAR	1/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3700 DELTA FAIR BLVD	SUITE 200E	ANTIOCH	CA	94509	3700	07	06013	38.0038852	-121.8448833	Contra Costa County
105859	Fee-for-Service	1649663378	1649663378	1	1	REILLY, APRIL J PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
105874	Fee-for-Service	1205995867	1205995867	1	1	REGLI, KEVIN J MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65128	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
105877	Fee-for-Service	1548205198	1548205198	1	1	RAGLAND, DOUGLAS W MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56101	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN ROAD	None	BIG BEAR LAKE	CA	92315	9999	36	06071	34.24602097	-116.8885243	San Bernardino County
105893	Fee-for-Service	1710149711	1710149711	1	1	RASTEGAR, HOOMAN MD	3/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106971	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
105910	Fee-for-Service	1720051337	1720051337	1	1	RODRIGUEZ, SONIA C MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52821	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
105945	Fee-for-Service	1114142304	1114142304	1	1	ROBERT L MCGHIE,MD APC	8/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	210 S PALISADE DR	STE 102	SANTA MARIA	CA	93454	5932	42	06083	34.95169604	-120.4120907	Santa Barbara County
105961	Fee-for-Service	1063504249	1063504249	1	1	RAD, BEN MD	2/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	40892	None	None	0	In state provider	CLINTON MEDICAL CLINIC	4590 E CLINTON AVE	None	FRESNO	CA	93703	2659	10	06019	36.77227171	-119.7457651	Fresno County
105976	Fee-for-Service	1760541569	1760541569	1	2	RETINA INSTITUTE OF CALIFORN	3/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	17138 COLIMA RD	STE B	HACIENDA HEIGHTS	CA	91745	6783	19	06037	33.9906657	-117.9329576	Los Angeles County
105982	Fee-for-Service	1124032461	1124032461	1	1	RIVERSIDE FACULTY MED	1/1/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
105989	Fee-for-Service	1104304930	1104304930	1	1	ROCHA, ANTON G RCP	6/25/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
105992	Fee-for-Service	1932394335	1932394335	1	1	RESTAURI, NICOLE L MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
106032	Fee-for-Service	1780664334	1780664334	1	1	REGENTS OF THE UNIV CA	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	2805 J ST	STE 300	SACRAMENTO	CA	95816	4307	34	06067	38.573982	-121.468419	Sacramento County
106037	Fee-for-Service	1568591527	1568591527	1	1	RUIZ, ESTHER NP	6/10/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	274449	-	NOT APPLICABLE	0	In state provider	None	3707 SUNSET LANE	None	ANTIOCH	CA	94509	6101	07	06013	37.98459755	-121.8042179	Contra Costa County
106058	Fee-for-Service	1235365362	1235365362	1	1	ROSCOE, JOSEPH N	7/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
106079	Fee-for-Service	1821294000	1821294000	1	1	REZAIE, ANAHITA MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55510	10	Gastroenterology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
106146	Fee-for-Service	1518030568	1518030568	1	6	RETINAL DIAGNOSTIC CENTER A	2/2/2015	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	200 JOSE FIGUERES AVE	STE 240	SAN JOSE	CA	95116	1586	43	06085	37.36122014	-121.8505998	Santa Clara County
106170	Fee-for-Service	1013997683	1013997683	1	1	ROCKER, JEFFREY F DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ALAFAYA WOODS FAMILY MED	110 ALAFAYA WOODS BLVD	None	OVIEDO	FL	32765	4000	00	None	28.648926	-81.2066085	Seminole County
106172	Fee-for-Service	1831434497	1831434497	1	1	R H EAR NOSE & THROAT MEDICA	2/5/2016	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	35077	01	General Practice	0	In state provider	L GROUP INC	9655 MONTE VISTA AVE	403	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
106180	Fee-for-Service	1033485222	1033485222	1	1	RAMSINGHANI, NISHA S DO	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12934	26	Psychiatry (child)	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4231	30	06059	33.78029455	-117.864369	Orange County
106195	Fee-for-Service	1023485216	1023485216	1	1	RICE, DANIEL E LMFT	3/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	426 14TH ST	111	MODESTO	CA	95354	2660	50	06099	37.63834873	-120.9904519	Stanislaus County
106198	Fee-for-Service	1790822203	1790822203	1	1	RETICKER, MARY BETH LMFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	33876	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
106231	Fee-for-Service	1417395328	1417395328	1	1	REED, PAUL H MD	7/15/2021	207P00000X	NA	Other	026	PHYSICIANS	170335	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
106263	Fee-for-Service	1760541569	1760541569	1	2	RETINA INSTITUTE OF CALIFORN	10/16/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17138 COLIMA RD	STE B	HACIENDA HEIGHTS	CA	91745	6783	19	06037	33.9906657	-117.9329576	Los Angeles County
106289	Fee-for-Service	1831161082	1831161082	1	1	ROBERTSON, GERALD MD	11/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 REDROCK DR	None	GALLUP	NM	87301	5683	00	None	35.50662903	-108.7272069	McKinley County
106291	Fee-for-Service	1336494145	1336494145	1	1	RAJANI, ROSHAN D MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136866	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
106295	Fee-for-Service	1063919801	1063919801	1	1	RANA, PUNEET MD	6/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1867 E FIR AVENUE	STE 101	FRESNO	CA	93720	3841	10	06019	36.8391095	-119.7486135	Fresno County
106305	Fee-for-Service	1598961708	1598961708	1	1	RUIZ, EDWARD A	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104554	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
106366	Fee-for-Service	1689187551	1689187551	1	1	ROUSSEAUX-PERSHING, JACQUELI	10/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NE LCSW	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
106373	Fee-for-Service	1841257391	1841257391	1	1	REMSA	12/1/1991	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	None	450 EDISON WAY	None	RENO	NV	89502	4117	00	None	39.50518864	-119.756467	Washoe County
106415	Fee-for-Service	1538425764	1538425764	1	1	RUIZ, MARIBETH S MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123511	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
106422	Fee-for-Service	1972614972	1972614972	1	1	RUDD, RICHARD N MD	5/31/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42981	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2999 REGENT ST	STE 225	BERKELEY	CA	94705	2117	01	06001	37.85592021	-122.2566436	Alameda County
106429	Fee-for-Service	1801811401	1801811401	1	1	RALPHS GROCERY COMPANY	12/13/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #686	33145 US HIGHWAY 79	None	TEMECULA	CA	92592	9141	33	06065	33.48561767	-117.0802877	Riverside County
106478	Fee-for-Service	1659609311	1659609311	1	1	RIVERLAKES SURGERY CTR LLC	10/19/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7508 MEANY AVE	STE B	BAKERSFIELD	CA	93308	5178	15	06029	35.3942895	-119.0858445	Kern County
106483	Fee-for-Service	1043442122	1043442122	1	1	RAMOS, WILFREDO R MD INC	7/2/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84192	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5301 F ST	STE 210	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
106497	Fee-for-Service	1003431206	1003431206	1	1	REACH AIR MEDICAL SERVICES L	6/2/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	LC	7156 COUNTY ROAD 154	None	SALIDA	CO	81201	9455	00	None	38.54478951	-106.0091589	Chaffee County
106501	Fee-for-Service	1841416294	1841416294	1	1	RAY, MARGREET A	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
106535	Fee-for-Service	1508368101	1508368101	1	1	RAVINSKY, ROBERT A MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156597	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
106547	Fee-for-Service	1295138022	1295138022	1	1	RAFFETTO, BRIAN J MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132697	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
106558	Fee-for-Service	1437349677	1437349677	1	1	RAJENDRA CHALASANI	4/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13657 W MCDOWELL RD	STE 210	GOODYEAR	AZ	85395	2603	00	None	33.463773	-112.353471	Maricopa County
106572	Fee-for-Service	1811940190	1811940190	1	1	REDULA, LUDOVICO K MD	11/28/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66974	40	Pediatrics	0	In state provider	None	5800 HANNUM AVE	None	CULVER CITY	CA	90230	6502	19	06037	33.98724995	-118.3858338	Los Angeles County
106575	Fee-for-Service	1669431318	1669431318	1	1	RAMOS, MADELEINE S MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101471	03	Allergy	0	In state provider	None	2773 HARRIS STREET	SUITE D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
106594	Fee-for-Service	1336397389	1336397389	1	1	REDDING-STEWART, DEBORAH L	1/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1125 E CLARK AVE	STE A3	SANTA BARBARA	CA	93455	5106	42	06083	34.8650853	-120.4175195	Santa Barbara
106633	Fee-for-Service	1275150955	1275150955	1	1	RED OAK PSYCHOLOGY GROUP COR	6/1/2021	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PORATION	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
106661	Fee-for-Service	1841257391	1841257391	1	1	REMSA	6/1/1992	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	450 EDISON WAY	None	RENO	NV	89502	4117	00	None	39.50518864	-119.756467	Washoe County
106667	Fee-for-Service	1376645911	1376645911	1	1	RANDALL, RISSMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	404 ZENA RD	None	WOODSTOCK	NY	12498	2626	00	None	42.015852	-74.0762415	Ulster County
106673	Fee-for-Service	1720421076	1720421076	1	1	RABAGO, MAURELLEN B MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146307	01	General Practice	0	In state provider	None	480 4TH AVE	STE 202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
106688	Fee-for-Service	1306017983	1306017983	1	1	RAZI, MARIAM MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101725	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
106691	Fee-for-Service	1336464262	1336464262	1	1	ROESCH, ERIN E MD	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144286	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106722	Fee-for-Service	1811985120	1811985120	1	1	ROBERTS, WALTER C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27442	18	Ophthalmology	0	In state provider	None	201 S ALVARADO ST	STE 406	LOS ANGELES	CA	90057	2353	19	06037	34.06417777	-118.2719543	Los Angeles County
106744	Fee-for-Service	1154529550	1154529550	1	1	ROTHSCHILD-DUNST, KAREN CRNA	9/30/1993	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
106750	Fee-for-Service	1932306677	1932306677	1	1	RUIZ, JUAN-CARLOS LCSW	8/13/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
106780	Fee-for-Service	1376624718	1376624718	1	1	ROBINSON, JEROME A MD	10/27/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	30815	41	Internal Medicine	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
106787	Fee-for-Service	1639517675	1639517675	1	1	ROH, JENNIFER S MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149256	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
106791	Fee-for-Service	1053748772	1053748772	1	1	RX CONSULTANTS GROUP INC	2/14/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8116 CALIFORNIA AVE	STE A	SOUTH GATE	CA	90280	2400	19	06037	33.96192232	-118.2048611	Los Angeles County
106873	Fee-for-Service	1467887000	1467887000	1	1	RELIANCE BEST PHARMACY LLC	12/24/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	653 MAIN ST	None	BRAWLEY	CA	92227	2547	13	06025	32.97866147	-115.5309435	Imperial County
106890	Fee-for-Service	1376899310	1376899310	1	1	ROISMAN, DEVORAH C CNM	5/2/2017	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
106896	Fee-for-Service	1699703504	1699703504	1	1	RICHARDSON, JOSEPH MD	9/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81303	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
106898	Fee-for-Service	1295239127	1295239127	1	1	RESTORE MEDICAL, INC.	5/18/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	475 CENTURY PARK	SUITE A	YUBA CITY	CA	95991	5774	51	06101	39.12057646	-121.6336572	Sutter County
106909	Fee-for-Service	1588044770	1588044770	1	1	ROUSEK, HAYLEY MD	12/15/2022	208M00000X	NA	Other	026	PHYSICIANS	165727	None	None	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
106915	Fee-for-Service	1447215108	1447215108	1	1	RILEY, AMY R MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86910	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
106924	Fee-for-Service	1275150955	1275150955	1	1	RED OAK PSYCHOLOGY GROUP COR	6/1/2021	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PORATION	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
106932	Fee-for-Service	1760541569	1760541569	1	11	RETINA INSTITUTE OF CALIFORN	11/14/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1640 NEWPORT BLVD	STE 220	COSTA MESA	CA	92627	3786	30	06059	33.63437128	-117.9221659	Orange County
106935	Fee-for-Service	1659394575	1659394575	1	1	REGAN, RAYMOND F MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	50745	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15891 LOS GATOS BLVD	None	LOS GATOS	CA	95032	3316	43	06085	37.23753965	-121.9623336	Santa Clara County
106955	Fee-for-Service	1619997939	1619997939	1	1	REDDY, GADDAM N MD	7/31/1985	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	42252	10	Gastroenterology (M.D. only)	0	In state provider	None	2510 AIRPARK DR	None	REDDING	CA	96001	2449	45	06089	40.57119566	-122.4016582	Shasta County
106959	Fee-for-Service	1699084772	1699084772	1	1	RATAUL. MANJOT S MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127439	None	None	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
106960	Fee-for-Service	1891303871	1891303871	1	1	ROLDAN, ALICIA DO	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22464	41	Internal Medicine	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
106971	Fee-for-Service	1982642179	1982642179	1	1	RICHARDSON, ROBERT A MD	8/20/2014	207P00000X	NA	Other	026	PHYSICIANS	34155	01	General Practice	0	In state provider	None	1402 BAILEY AVENUE	None	NEEDLES	CA	92363	3104	36	06071	34.832781	-114.618349	San Bernardino County
106979	Fee-for-Service	1336464262	1336464262	1	1	ROESCH, ERIN E MD	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144286	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106981	Fee-for-Service	1639426067	1639426067	1	1	RODRIGUEZ, FRANCISCO DO AMC	6/12/2013	261QP2300X	NA	Other	026	PHYSICIANS	10175	01	General Practice	0	In state provider	None	330 W LAS TUNAS DRIVE	STE 1	SAN GABRIEL	CA	91776	1213	19	06037	34.10244566	-118.1035965	Los Angeles County
107039	Fee-for-Service	1376646489	1376646489	1	1	RISHON, ANNE D CNP	4/16/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107158	Fee-for-Service	1528090701	1528090701	1	1	RANGEL, ROSA L MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43297	41	Internal Medicine	0	In state provider	REDWOOD INTERNAL	3304 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239308	-124.1360417	Humboldt County
107162	Fee-for-Service	1205084787	1205084787	1	1	RAMOLIA, ANIKA OD	9/9/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
107184	Fee-for-Service	1851850473	1851850473	1	1	RAM'S ROOF	3/14/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12861 MEDITERRANEAN DR	None	RANCHO CUCAMONGA	CA	91739	8954	36	06071	34.16011247	-117.5240539	San Bernardino County
107210	Fee-for-Service	1275150955	1275150955	1	1	RED OAK PSYCHOLOGY GROUP COR	8/11/2022	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PORATION	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
107212	Fee-for-Service	1578690400	1578690400	1	1	RAMIREZ, DANIEL LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
107220	Fee-for-Service	1760541569	1760541569	1	11	RETINA INSTITUTE OF CALIFORN	11/14/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 NEWPORT BLVD	STE 220	COSTA MESA	CA	92627	3786	30	06059	33.63437128	-117.9221659	Orange County
107267	Fee-for-Service	1336464262	1336464262	1	1	ROESCH, ERIN E MD	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144286	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
107286	Fee-for-Service	1639171317	1639171317	1	1	RELIABLE REXALL PHCY	2/5/1980	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18350 ROSCOE BLVD	SUITE 102	NORTHRIDGE	CA	91325	4109	19	06037	34.22071855	-118.5341175	Los Angeles County
107333	Fee-for-Service	1851930291	1851930291	1	1	RAMIREZ, CRISTINA LCSW	8/30/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124557	-	NOT APPLICABLE	0	In state provider	None	320 E PALMDALE BLVD	None	PALMDALE	CA	93550	4598	19	06037	34.57983613	-118.1240079	Los Angeles County
107343	Fee-for-Service	1093787038	1093787038	1	1	RUBENSTEIN, EMILY J MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71129	13	Neurology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
107347	Fee-for-Service	1437318573	1437318573	1	1	ROBERT FEKETE M.D.	9/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19 BRADHURST AVE	STE 2850	HAWTHORNE	NY	10532	2183	00	None	41.087934	-73.8015165	Westchester County
107356	Fee-for-Service	1821014309	1821014309	1	1	RAJ LUNAGARIA INC	8/1/2002	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1222 W 5TH ST	None	SAN BERNARDINO	CA	92411	2759	36	06071	34.10835647	-117.3121785	San Bernardino County
107357	Fee-for-Service	1578815213	1578815213	1	1	RODRIGUEZ, CARLOS MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127031	41	Internal Medicine	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
107365	Fee-for-Service	1982256574	1982256574	1	1	ROBERTSON OPTOMETRY, A PROF	12/18/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1421 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3401	19	06037	34.05409489	-118.3838638	Los Angeles County
107391	Fee-for-Service	1215249362	1215249362	1	1	RUSSELL, ERIC A MD	8/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
107457	Fee-for-Service	1932332418	1932332418	1	1	RAMER, CYRIL MD INC	5/16/2011	305R00000X	NA	Other	026	PHYSICIANS	14293	40	Pediatrics	0	In state provider	None	3801 SACRAMENTO ST	STE 432	SAN FRANCISCO	CA	94118	1663	38	06075	37.78707021	-122.4555217	San Francisco County
107460	Fee-for-Service	1578934675	1578934675	1	1	RAUDA-TROUT, REYNA M LCSW	1/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
107473	Fee-for-Service	1730947276	1730947276	1	1	RESTORE PSYCHIATRY AND WELLN	3/25/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ESS, A PROFESSIONAL NU	3200 E GUASTI RD	STE 100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
107509	Fee-for-Service	1114432317	1114432317	1	1	ROTH SHOFRON, LAURA J PSYD	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 LONG BEACH BLVD	STE 340	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
107535	Fee-for-Service	1225490659	1225490659	1	1	RUBERMAN, SARAH MD	7/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162392	None	None	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
107558	Fee-for-Service	1770774960	1770774960	1	1	ROUCE, RAYNE H MD	10/12/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
107577	Fee-for-Service	1053451104	1053451104	1	1	RATNER, EMILY F MD	10/31/1990	207L00000X	NA	Other	026	PHYSICIANS	46114	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
107581	Fee-for-Service	1578532545	1578532545	2	1	REIMAN, PAUL R MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	48380	20	Orthopedic Surgery	0	In state provider	None	341 MAGNOLIA AVE	SUITE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
107596	Fee-for-Service	1164037321	1164037321	1	1	REJUVENATE HOME HEALTH INC	5/26/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W. BURBANK BLVD	SUITE 184	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
107611	Fee-for-Service	1699352468	1699352468	1	1	REARDON, BRENNAN K DPM	7/11/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
107792	Fee-for-Service	1679645444	1679645444	1	1	ROSS, DOUGLAS B MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
107808	Fee-for-Service	1326196304	1326196304	1	1	ROBBINS, ANDREW N MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68171	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
107818	Fee-for-Service	1013425842	1013425842	1	1	RAZZAQ, SULMAN MD	6/4/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	152763	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
107819	Fee-for-Service	1417118589	1417118589	1	1	RUDY ALVAREZ M.D.	1/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 W EXPRESSWAY 83	None	MCALLEN	TX	78503	3045	00	None	26.1881123	-98.22555243	Hidalgo County
107861	Fee-for-Service	1053451104	1053451104	1	1	RATNER, EMILY F MD	10/31/1990	207L00000X	NA	Other	026	PHYSICIANS	46114	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
107867	Fee-for-Service	1235130808	1235130808	1	1	RAO S MIKKILINENI, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	483 UPPER RIVERDALE RD	None	RIVERDALE	GA	30274	2584	00	None	33.57231848	-84.406077	Clayton County
107881	Fee-for-Service	1265637698	1265637698	1	1	RODRIGUEZ, RICARDO A MD	9/18/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	136989	70	Clinic (mixed specialty)	0	In state provider	None	9917 OLIVE DR	None	BAKERSFIELD	CA	93312	9729	15	06029	35.41293571	-119.1123208	Kern County
107952	Fee-for-Service	1255845780	1255845780	1	1	REVESTIR, SHERRI LYNN PT	3/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
107960	Fee-for-Service	1750475562	1750475562	1	1	ROTH, KENNETH J	4/21/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52650	41	Internal Medicine	0	In state provider	None	3405 KENYON ST	STE 411	SAN DIEGO	CA	92110	5007	37	06073	32.74866031	-117.2135544	San Diego County
108061	Fee-for-Service	1689869976	1689869976	1	1	RINGEL, BRENDA L MD	12/31/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	65800	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
108069	Fee-for-Service	1942444310	1942444310	1	1	RAVINDRANATH, KRITHI MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107328	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
108071	Fee-for-Service	1669755153	1669755153	1	1	RAHNAVARD, AMIR DO	8/16/2018	207R00000X	NA	Other	026	PHYSICIANS	15779	41	Internal Medicine	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
108096	Fee-for-Service	1871010413	1871010413	1	1	RICO, ERICA M LMFT	1/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
108110	Fee-for-Service	1023484557	1023484557	1	1	RIVERA, EDWARD M	1/14/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
108113	Fee-for-Service	1386429108	1386429108	1	1	ROMAN, MIRIAM	1/31/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
108119	Fee-for-Service	1205283553	1205283553	1	1	REDDY, RADHIKA M PHD	6/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
108131	Fee-for-Service	1932380136	1932380136	1	1	ROSS A. HARPER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
108152	Fee-for-Service	1437442167	1437442167	1	1	ROTHSCHILD, DEBORAH C LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
108156	Fee-for-Service	1346345493	1346345493	1	1	RIPPLE, RICHARD W JR MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	27766	40	Pediatrics	0	In state provider	None	2416 CASTILLO ST	STE B	SANTA BARBARA	CA	93105	5304	42	06083	34.43092329	-119.7247028	Santa Barbara County
108173	Fee-for-Service	1801847157	1801847157	1	1	ROCHA, RODRIGO J MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76036	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108199	Fee-for-Service	1154028934	1154028934	1	1	RICOSSA, KRISTINE A OT	8/11/2023	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
108213	Fee-for-Service	1497137921	1497137921	1	1	RIANGWIWAT, TANAWAN MD	8/3/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	178685	None	None	0	In state provider	None	374 E. VANDERBILT WAY	None	SAN BERNARDINO	CA	92408	3593	36	06071	34.06877142	-117.2770094	San Bernardino County
108231	Fee-for-Service	1427690437	1427690437	1	1	RUBIO, MICHELLE NP	2/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
108233	Fee-for-Service	1477711091	1477711091	1	1	RAO, VINOD B MD	7/29/2022	2080C0008X	NA	Psychiatry	026	PHYSICIANS	169640	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
108291	Fee-for-Service	1609446459	1609446459	1	1	ROYAL A&V HOME HEALTH CARE	9/15/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	121 W LEXINGTON DR	UNIT 307B	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
108319	Fee-for-Service	1356451025	1356451025	1	1	RALEY'S	11/14/1988	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5420 SUNOL BLVD	None	PLEASANTON	CA	94566	7701	01	06001	37.6516457	-121.8801915	Alameda County
108320	Fee-for-Service	1003033374	1003033374	1	1	RANASINGHE, MOKSHA G MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129389	14	Neurological Surgery	0	In state provider	None	1105 E SPRUCE	SUITE 201	FRESNO	CA	93720	3313	10	06019	36.839466	-119.762685	Fresno County
108375	Fee-for-Service	1487608931	1487608931	1	6	RENAISSANCE IMAGING MED	4/30/2012	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	38925 TRADE CENTER DR	STE E	PALMDALE	CA	93551	3655	19	06037	34.59028112	-118.1433053	Los Angeles County
108435	Fee-for-Service	1851078356	1851078356	1	1	RAM, SHEENA PSYD	9/15/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
108443	Fee-for-Service	1609839067	1609839067	1	1	REGENTS OF THE UNIVERSITY OF	1/1/2000	207VX0201X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SOC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
108455	Fee-for-Service	1326124835	1326124835	1	1	RUDOMINER, ANDREA M MD	4/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79789	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
108512	Fee-for-Service	1902196454	1902196454	1	1	RAYMOND, AMANDA K MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123140	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108520	Fee-for-Service	1578165734	1578165734	1	1	RIDER MOBILITY INC.	1/27/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5735 KEARNY VILLA	SUITE 111	SAN DIEGO	CA	92123	1135	37	06073	32.83606923	-117.1342158	San Diego County
108540	Fee-for-Service	1003437385	1003437385	1	1	RUNKE, STEPHANIE MD	11/5/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
108567	Fee-for-Service	1770661712	1770661712	1	1	RASMUSSEN, JAMES A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 PIONEER PKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
108574	Fee-for-Service	1255563938	1255563938	1	1	RAUF, MUHAMMAD A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129065	02	General Surgery	0	In state provider	None	1510 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
108579	Fee-for-Service	1194705731	1194705731	1	1	REGENTS OF THE UNIV CA	6/25/1995	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	10044 WOLF RD	None	GRASS VALLEY	CA	95949	8193	29	06057	39.04265452	-121.0952182	Nevada County
108587	Fee-for-Service	1952396434	1952396434	1	1	REBECCA L WYSOSKE MD	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
108592	Fee-for-Service	1487949533	1487949533	1	1	RICARDO GONZALEZ, ROBERTO R	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123884	07	Dermatology	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108641	Fee-for-Service	1841610136	1841610136	1	1	ROSA, JOSE D B JR MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149316	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
108680	Fee-for-Service	1578639308	1578639308	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1966	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARMACY	3575 BUSINESS DRIVE	SUITE 1702	SACRAMENTO	CA	95820	2160	34	06067	38.541465	-121.4175285	Sacramento County
108688	Fee-for-Service	1700974813	1700974813	1	1	RIEMER, LAWRENCE S MD	4/17/2023	207R00000X	NA	Other	026	PHYSICIANS	26067	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
108712	Fee-for-Service	1023528627	1023528627	1	1	RAJAN, RESHMI PT	8/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18181 BUTTERFIELD BLVD	SUITE 170	MORGAN HILL	CA	95037	8108	43	06085	37.13904584	-121.6547035	Santa Clara County
108770	Fee-for-Service	1801889068	1801889068	1	1	REGENTS/UCDPBG/SUR ONCOL	5/1/1983	2086X0206X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
108774	Fee-for-Service	1750432779	1750432779	1	1	ROLNICK, MAUREEN A LCSW	12/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
108777	Fee-for-Service	1760541569	1760541569	1	33	RETINA INSTITUTE OF CALIFORN	2/26/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	116 N PLAZA ST	None	BRAWLEY	CA	92227	2426	13	06025	32.97891061	-115.5338678	Imperial County
108837	Fee-for-Service	1821049511	1821049511	1	1	ROUND, RALPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4545 E 9TH AVE	STE 510	DENVER	CO	80220	3910	00	None	39.73105686	-104.9346616	Denver County
108868	Fee-for-Service	1467956524	1467956524	1	1	RUSH, CHIZELLE D MD	10/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175003	None	None	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
108932	Fee-for-Service	1841941028	1841941028	1	1	RG HOME HEALTH INC	10/5/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	STE 355	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
108953	Fee-for-Service	1811962244	1811962244	1	1	RIDGWAY, WILLIAM M MD	1/1/2020	207RR0500X	NA	Other	026	PHYSICIANS	48862	83	Rheumatology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
108956	Fee-for-Service	1174532006	1174532006	1	1	RENGIFO,ALBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2300 N COMMERCE PKWY	STE 315	WESTON	FL	33326	0000	00	None	26.091502	-80.36938136	Broward County
108977	Fee-for-Service	1730132457	1730132457	1	1	REDDY, ARJUN N MD	11/8/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61204	41	Internal Medicine	0	In state provider	None	5129 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77203706	-117.0059214	San Diego County
108982	Fee-for-Service	1114501178	1114501178	1	1	ROADMAN, KEENE A CRNA	1/27/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
108994	Fee-for-Service	1013368687	1013368687	1	1	ROBLES, JULIE N MD	10/25/2021	207L00000X	NA	Other	026	PHYSICIANS	153269	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
109006	Fee-for-Service	1033282256	1033282256	1	1	RAMIREZ, ARCHIMEDES MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37515	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
109027	Fee-for-Service	1780782557	1780782557	1	1	RIVERSIDE MEDICAL CLINIC	12/31/1996	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CANYON SPRINGS PLAZA	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
109041	Fee-for-Service	1992850317	1992850317	1	1	RE, SEAN A LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	215 W STANDLEY ST	#8	UKIAH	CA	95482	4860	23	06045	39.1503267	-123.2094829	Mendocino County
109068	Fee-for-Service	1760541569	1760541569	1	33	RETINA INSTITUTE OF CALIFORN	2/26/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	116 N PLAZA ST	None	BRAWLEY	CA	92227	2426	13	06025	32.97891061	-115.5338678	Imperial County
109082	Fee-for-Service	1215443858	1215443858	1	1	RAFFERTY, JUSTIN M CCC-SLP	4/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
109104	Fee-for-Service	1205914801	1205914801	1	1	ROBBINS, DARREL A MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	63077	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
109135	Fee-for-Service	1023339496	1023339496	1	1	RAHNEMAI AZAR, AMIR ALI MD	1/22/2020	208600000X	NA	General Surgery	026	PHYSICIANS	163254	02	General Surgery	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
109190	Fee-for-Service	1720057136	1720057136	1	1	RADJABIAN, SHIMA MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54979	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109194	Fee-for-Service	1093889313	1093889313	1	1	ROBERTS, ANDREA G MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72070	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
109208	Fee-for-Service	1346901311	1346901311	1	1	REVIVE RENO LLC	2/21/2025	2278S1500X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	1	Border provider	EHABILITATION	3101 PLUMAS ST	None	RENO	NV	89509	4515	00	None	39.49410089	-119.8126357	Washoe County
109245	Fee-for-Service	1811962244	1811962244	1	1	RIDGWAY, WILLIAM M MD	1/1/2020	207RR0500X	NA	Other	026	PHYSICIANS	48862	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
109302	Fee-for-Service	1871634014	1871634014	1	1	ROWE, FREDERIC LEE II MD	6/25/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	65546	-	NOT APPLICABLE	0	In state provider	None	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	15	06029	35.35426453	-119.045007	Kern County
109313	Fee-for-Service	1780782557	1780782557	1	1	RIVERSIDE MEDICAL CLINIC	1/16/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CANYON SPRINGS PLAZA	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
109396	Fee-for-Service	1831378637	1831378637	1	1	RO, KYUNG K MD PROFESSIONAL	4/28/2008	207L00000X	NA	Other	026	PHYSICIANS	51432	05	Anesthesiology	0	In state provider	CORPORATION	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
109404	Fee-for-Service	1851601488	1851601488	1	1	RAHMAN, AMBAR MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119537	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
109432	Fee-for-Service	1750572277	1750572277	1	1	RUSSELL ROBERSON	11/24/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	7202	00	None	34.744437	-92.3813595	Pulaski County
109434	Fee-for-Service	1982709093	1982709093	1	1	ROEY, STEVEN C MD	10/4/1995	207R00000X	NA	Other	026	PHYSICIANS	54912	41	Internal Medicine	0	In state provider	None	710 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37717716	-122.0645687	Santa Clara County
109479	Fee-for-Service	1124093000	1124093000	2	1	RAMBERG, DONALD A MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	56939	14	Neurological Surgery	0	In state provider	None	699 CALIFORNIA BLVD	SUITE B	SAN LUIS OBISPO	CA	93401	2507	40	06079	35.28853572	-120.6568105	San Luis Obispo County
109491	Fee-for-Service	1609929561	1609929561	1	1	ROBIN WOODLAND MD	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
109504	Fee-for-Service	1225175581	1225175581	1	1	ROHINI SHARMA MD	3/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9191 GRANT ST	None	THORNTON	CO	80229	4361	00	None	39.86420881	-104.9846155	Adams County
109522	Fee-for-Service	1477689396	1477689396	1	1	RES-CARE CALIFORNIA, INC	4/28/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3315 GREEN PARK LN	None	CARMICHAEL	CA	95608	3712	34	06067	38.625156	-121.330881	Sacramento County
109538	Fee-for-Service	1760541569	1760541569	1	30	RETINA INSTITUTE OF CALIFORN	2/25/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9850 GENESEE AVE	310	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
109561	Fee-for-Service	1336438852	1336438852	1	1	RICHTER, KRISTOFER M DO	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12603	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	SUITE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
109566	Fee-for-Service	1447830187	1447830187	1	1	RIVAS, MADALYN R MD	9/4/2024	208M00000X	NA	Other	026	PHYSICIANS	191983	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
109567	Fee-for-Service	1003171604	1003171604	1	1	ROMERO DE MONTERO, CRISTINA	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137934	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
109607	Fee-for-Service	1831123868	1831123868	1	2	RADIOLOGY MEDICAL GROUP OF	11/9/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	WMMC	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
109648	Fee-for-Service	1245479633	1245479633	1	1	REID, JESSICA CRNA	3/10/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
109649	Fee-for-Service	1013052042	1013052042	1	1	RODRIGUEZ, CYNTHIA LMFT	7/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
109676	Fee-for-Service	1427717313	1427717313	1	1	RUBY HEARTS HEALTHCARE	7/2/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19626 VENTURA BLVD	UNIT 220	TARZANA	CA	91356	6026	19	06037	34.17266732	-118.5610251	Los Angeles County
109694	Fee-for-Service	1487608931	1487608931	1	8	RENAISSANCE IMAGING MED	7/10/2014	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
109735	Fee-for-Service	1073851341	1073851341	1	1	ROBIN, LINDSEY LCSW	11/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
109751	Fee-for-Service	1457436198	1457436198	1	1	ROOSEVELT, GENIE E MD	11/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
109795	Fee-for-Service	1164433314	1164433314	1	1	RAANA, ZAKIA MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95782	08	Family Practice	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
109826	Fee-for-Service	1760541569	1760541569	1	30	RETINA INSTITUTE OF CALIFORN	2/25/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	9850 GENESEE AVE	310	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
109882	Fee-for-Service	1730684234	1730684234	1	1	REJALI, NIMA A DO	5/3/2023	207P00000X	NA	Other	026	PHYSICIANS	20661	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
109925	Fee-for-Service	1710913231	1710913231	1	1	REDWOOD FAM DERMATOLOGY MEDI	3/2/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	DERMATOLOGY MEDICAL ASSO	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	49	06097	38.46672	-122.720724	Sonoma County
109937	Fee-for-Service	1225090194	1225090194	1	1	RAY, ROBERT R CRNA	3/26/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
109949	Fee-for-Service	1003996257	1003996257	1	1	RUDKIN, SCOTT E MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69403	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
109970	Fee-for-Service	1689376956	1689376956	1	1	RAMIREZ, LINDA R	2/1/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
109990	Fee-for-Service	1326300245	1326300245	1	1	RUSSO, CHRISTOPHER A DO	10/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12554	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
110052	Fee-for-Service	1073086765	1073086765	1	1	ROSILEZ, ANGEL	12/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
110073	Fee-for-Service	1790060473	1790060473	2	1	REJUVENATE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9087 ARROW ROUTE	SUITE 284	RANCHO CUCAMONGA	CA	91730	4478	36	06071	34.09931154	-117.6069482	San Bernardino County
110082	Fee-for-Service	1306813167	1306813167	2	1	ROBILIO, PETER A MD	11/13/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84527	15	Obstetrics (D.O. only)	0	In state provider	None	2901 N VENTURA RD STE 11	None	OXNARD	CA	93036	1150	56	06111	34.24479149	-119.1814409	Ventura County
110089	Fee-for-Service	1922199959	1922199959	1	1	ROSSINI, MICHAEL JR MD	12/1/2000	174400000X	NA	Other	026	PHYSICIANS	45121	02	General Surgery	0	In state provider	None	1421 OAKDALE RD	STE B	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
110090	Fee-for-Service	1922377738	1922377738	1	1	RACELA, CATHERINE P PT	10/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
110100	Fee-for-Service	1144391376	1144391376	1	1	REN, JIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	97030	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
110112	Fee-for-Service	1831783570	1831783570	1	1	ROSARIO, JULIUS V PT	2/15/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
110139	Fee-for-Service	1023122579	1023122579	1	1	RESNICK, CECILY A PHD	8/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	135 E 3RD AVE	STE B	ESCONDIDO	CA	92025	4252	37	06073	33.12022391	-117.0793824	San Diego County
110141	Fee-for-Service	1437197233	1437197233	1	1	REED, FRANK A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
110153	Fee-for-Service	1780039016	1780039016	1	1	RINGQVIST, JENNY R MD	3/4/2024	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
110156	Fee-for-Service	1386895977	1386895977	1	1	ROSE, JESSICA C LAC	3/16/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	44850 COMPTCHE UKIAH RD	None	MENDOCINO	CA	95460	9007	23	06045	39.29941857	-123.7906466	Mendocino County
110169	Fee-for-Service	1952951113	1952951113	1	1	RAJU, JENNIFER PSYD	3/12/2025	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
110175	Fee-for-Service	1386609618	1386609618	1	1	RUDOLPH, ROSS MD INC	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	29569	24	Plastic Surgery	0	In state provider	None	4060 4TH AVE	STE 120	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
110179	Fee-for-Service	1508246786	1508246786	1	1	ROSENBLUM, JILLIAN L MD	9/8/2019	207P00000X	NA	Other	026	PHYSICIANS	156825	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
110187	Fee-for-Service	1811192024	1811192024	1	1	REDDY, PREETHI MD	7/12/2023	207R00000X	NA	Other	026	PHYSICIANS	175771	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
110190	Fee-for-Service	1699939116	1699939116	1	1	ROBERT HADFIELD DPM	7/11/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1505 HARROUN AVE	STE H	MCKINNEY	TX	75069	3433	00	None	33.21455074	-96.62771376	Collin County
110299	Fee-for-Service	1245270966	1245270966	1	1	ROGOVE, HERBERT J MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	4103	01	General Practice	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
110307	Fee-for-Service	1992813190	1992813190	1	1	REHMAN, ASIF MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 PORT WASHINGTON BLVD	None	ROSLYN	NY	11576	1353	00	None	40.804308	-73.670589	Nassau County
110310	Fee-for-Service	1245650951	1245650951	1	1	RONA, KAIS A MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129546	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
110360	Fee-for-Service	1790060473	1790060473	2	1	REJUVENATE HOSPICE CARE INC	1/7/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9087 ARROW ROUTE	SUITE 284	RANCHO CUCAMONGA	CA	91730	4478	36	06071	34.09931154	-117.6069482	San Bernardino County
110368	Fee-for-Service	1306813167	1306813167	2	1	ROBILIO, PETER A MD	11/13/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84527	09	Gynecology (D.O. only)	0	In state provider	None	2901 N VENTURA RD STE 11	None	OXNARD	CA	93036	1150	56	06111	34.24479149	-119.1814409	Ventura County
110374	Fee-for-Service	1972799625	1972799625	1	1	ROSE, EMILY MD	2/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93596	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
110405	Fee-for-Service	1689642340	1689642340	1	1	RODRICK STEVENSON	4/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE DOCTORS LN	None	CLARION	PA	16214	0000	00	None	41.19015066	-79.39814017	Clarion County
110407	Fee-for-Service	1700059698	1700059698	1	1	REISBORD-ROJANY, JODIE D MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71549	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93303	7303	56	06111	34.27623479	-119.2520218	Ventura County
110442	Fee-for-Service	1841727633	1841727633	1	1	RAM, DEEPIKA DO	5/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19290	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
110451	Fee-for-Service	1821089129	1821089129	1	1	RUIZ, RAHEL T MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64304	41	Internal Medicine	0	In state provider	None	18675 BUREN PLACE	None	CASTRO VALLEY	CA	94552	5281	01	06001	37.72154215	-122.0285122	Alameda County
110454	Fee-for-Service	1154809978	1154809978	1	1	ROBERTS, CASSANDRA E RCP	8/31/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
110463	Fee-for-Service	1386609618	1386609618	1	1	RUDOLPH, ROSS MD INC	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	29569	02	General Surgery	0	In state provider	None	4060 4TH AVE	STE 120	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
110497	Fee-for-Service	1588691406	1588691406	1	1	RAVAGE, CHRISTOPHER K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 STEVENS DR	None	RICHLAND	WA	99352	3508	00	None	46.27960394	-119.2827934	Benton County
110522	Fee-for-Service	1497149645	1497149645	1	1	RICE, JONATHAN D MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
110525	Fee-for-Service	1487609384	1487609384	1	1	RENAL TREATMENT CTRS-CA, INC	10/19/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	15736 WOODRUFF AVE	None	BELLFLOWER	CA	90706	4018	19	06037	33.890481	-118.117362	Los Angeles County
110554	Fee-for-Service	1891937785	1891937785	1	1	RAISONI, SANJAY J MD	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128639	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
110567	Fee-for-Service	1649830654	1649830654	1	1	RAND, KATHERINE M MD	6/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178426	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
110620	Fee-for-Service	1417308693	1417308693	1	1	RIMMALAPUDI, DEEPTHI MD	12/2/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	162902	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
110623	Fee-for-Service	1710065933	1710065933	1	8	RADYS CHILDRENS HOSPITAL	7/1/2014	261Q00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3665 KEARNY VILLA RD	STE 440	SAN DIEGO	CA	92123	1953	37	06073	32.80816826	-117.1510112	San Diego County
110641	Fee-for-Service	1861564684	1861564684	1	1	RAJPUT, SALILA MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65507	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
110649	Fee-for-Service	1952557951	1952557951	1	1	RANJBARAN, ZIBA MD	8/20/2009	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	106970	25	Physical Medicine and Rehabilitation	0	In state provider	None	23512 MADERO RD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
110689	Fee-for-Service	1164695409	1164695409	1	1	ROELANDS, JENNIFER J MD	7/19/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169554	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110692	Fee-for-Service	1194327577	1194327577	1	1	RELIACARE HOSPICE INC	9/2/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 145	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
110730	Fee-for-Service	1477620284	1477620284	1	1	REYNA, ROBERT M MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64994	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
110764	Fee-for-Service	1851314520	1851314520	1	1	ROSALES, TERESA O MD	8/31/1985	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34354	18	Ophthalmology	0	In state provider	None	2840 LONG BEACH BLVD	# 308	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
110770	Fee-for-Service	1528463544	1528463544	1	1	ROMO, ALEJANDRA LCSW	2/12/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
110829	Fee-for-Service	1689768459	1689768459	1	1	RATNIEWSKI, ALFREDOQMD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	42220	41	Internal Medicine	0	In state provider	050622	835 3RD AVE	STE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
110850	Fee-for-Service	1659442416	1659442416	1	1	RAJASINGHAM, CHRISTIANA	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96326	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
110872	Fee-for-Service	1619033925	1619033925	1	1	ROBERTSON, KEITH MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70336	20	Orthopedic Surgery	0	In state provider	None	168 N BRENT ST	STE 505	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
110981	Fee-for-Service	1194327577	1194327577	1	1	RELIACARE HOSPICE INC	9/2/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 145	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
111017	Fee-for-Service	1083953830	1083953830	1	1	RODRIGUEZ, DEBORAH LMFT	11/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE	SUITE 212	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
111018	Fee-for-Service	1477620284	1477620284	1	1	REYNA, ROBERT M MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64994	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
111064	Fee-for-Service	1407950090	1407950090	1	1	RUCKER, LLOYD MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	37040	41	Internal Medicine	0	In state provider	None	101 CITY DR S	# 81	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
111100	Fee-for-Service	1114019015	1114019015	1	1	ROSE AVENUE FAMILY MEDICAL	5/1/1987	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP APC	451 W GONZALES RD	STE 230	OXNARD	CA	93036	0719	56	06111	34.21921445	-119.1816945	Ventura County
111137	Fee-for-Service	1659442416	1659442416	1	1	RAJASINGHAM, CHRISTIANA	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96326	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
111159	Fee-for-Service	1821104563	1821104563	1	1	REID, RICHARD R MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89177	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
111200	Fee-for-Service	1295049732	1295049732	1	1	RAHAL, RIMA MD	9/16/2020	207L00000X	NA	Other	026	PHYSICIANS	169291	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
111215	Fee-for-Service	1144308867	1144308867	1	1	ROMERO, MARY-BARBARA MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63495	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
111241	Fee-for-Service	1396910097	1396910097	1	1	RESTEL, BRADLEY H MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114744	30	Radiology	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4803	49	06097	38.44224	-122.70195	Sonoma County
111279	Fee-for-Service	1730682394	1730682394	1	13	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
111282	Fee-for-Service	1003870718	1003870718	1	1	ROBERT J DIMEFF, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
111376	Fee-for-Service	1356584312	1356584312	1	1	REED, KAROLIN O MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137092	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
111415	Fee-for-Service	1457694374	1457694374	1	1	REHMAN, SHAFIQUE LMFT	10/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
111432	Fee-for-Service	1710367420	1710367420	1	1	RUSSELL, CHRISTINE J MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	146732	01	General Practice	0	In state provider	None	915 HILBY AVE	STE 22	SEASIDE	CA	93955	5359	27	06053	36.60264439	-121.8478029	Monterey County
111443	Fee-for-Service	1821044017	1821044017	1	1	RAHMAN, PARIZA MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81942	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
111456	Fee-for-Service	1518240530	1518240530	1	1	ROBERTS, GENIVA A LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
111522	Fee-for-Service	1427056357	1427056357	1	1	RYNOLDS, BRANDEN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	44 W SIXTH AVE	STE 115	SPOKANE	WA	99204	2306	00	None	47.650626	-117.412794	Spokane County
111525	Fee-for-Service	1205892825	1205892825	1	1	RIEDEL, JOHN F MD INC	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	23985	18	Ophthalmology	0	In state provider	None	112 LA CASA VIA	STE 260	WALNUT CREEK	CA	94598	3068	07	06013	37.91229899	-122.0423696	Contra Costa County
111567	Fee-for-Service	1730682394	1730682394	1	13	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
111595	Fee-for-Service	1538547161	1538547161	1	1	RASTEGARPOUR, ALI MD	4/13/2020	111NR0200X	NA	Other	026	PHYSICIANS	164479	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
111630	Fee-for-Service	1578955852	1578955852	1	1	RAMAN, MAYA MD	6/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163472	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
111651	Fee-for-Service	1356785281	1356785281	1	1	REPOSAR, AARON L MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	143712	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
111700	Fee-for-Service	1851021653	1851021653	1	1	RODMAN, DEBORAH LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
111729	Fee-for-Service	1942395801	1942395801	1	1	RAY, JASON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 17TH ST	None	WOODWARD	OK	73801	2448	00	None	36.43669151	-99.40095701	Woodward County
111741	Fee-for-Service	1194257162	1194257162	1	1	RANJIT, ANJU MD	7/22/2021	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171423	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111811	Fee-for-Service	1558636142	1558636142	1	1	ROBERTS, ANDREW S MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142004	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111822	Fee-for-Service	1407339591	1407339591	1	1	RELATIONSHIP AND MARRIAGE TH	4/18/2024	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10940 FAIR OAKS BLVD STE	None	FAIR OAKS	CA	95628	5958	34	06067	38.650077	-121.263678	Sacramento County
111880	Fee-for-Service	1689178188	1689178188	1	1	RALBOVSKY, AMARIEL MD	6/5/2024	390200000X	NA	Other	026	PHYSICIANS	166253	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
111920	Fee-for-Service	1497792436	1497792436	2	1	RENARD, RONALD L MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	36415	None	None	0	In state provider	None	1505 VICTOR AVE	None	REDDING	CA	96003	4031	45	06089	40.58541565	-122.3388174	Shasta County
111962	Fee-for-Service	1316365794	1316365794	1	1	RAY, DIVYA T MD	3/15/2019	207P00000X	NA	Other	026	PHYSICIANS	139813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
112031	Fee-for-Service	1447579487	1447579487	1	1	ROBERTS MEDICAL PSYCHOLOGY,	10/1/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1534 REEVES ST	None	LOS ANGELES	CA	90035	2929	19	06037	34.05146232	-118.3964331	Los Angeles County
112050	Fee-for-Service	1992258008	1992258008	1	1	ROTENSTEIN, MARK DPM	9/12/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
112061	Fee-for-Service	1386785657	1386785657	1	1	ROSS, CAROLYN C MD MPH	8/13/2019	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	37347	36	Psychiatry	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
112089	Fee-for-Service	1669759148	1669759148	1	1	RISMANCHI, NEGGY MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118427	13	Neurology (M.D. only)	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
112094	Fee-for-Service	1306322862	1306322862	1	1	RODRIGUES, AGNES CNP	1/26/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8831 VILLA LA JOLLA DR	None	LA JOLLA	CA	92037	1949	37	06073	32.869242	-117.230535	San Diego County
112098	Fee-for-Service	1831170877	1831170877	1	2	REECE, JAMES M JR MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	44786	18	Ophthalmology	0	In state provider	None	1700 ALHAMBRA BLVD	SUITE 202	SACRAMENTO	CA	95816	7050	34	06067	38.564847	-121.469121	Sacramento County
112113	Fee-for-Service	1407339591	1407339591	1	1	RELATIONSHIP AND MARRIAGE TH	4/18/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10940 FAIR OAKS BLVD STE	None	FAIR OAKS	CA	95628	5958	34	06067	38.650077	-121.263678	Sacramento County
112114	Fee-for-Service	1508211012	1508211012	1	2	RODRIGUES VACAS, SUSANA MD	12/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	156820	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
112124	Fee-for-Service	1295717163	1295717163	1	1	ROGERS, JASON H MD	7/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82748	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112131	Fee-for-Service	1770933319	1770933319	1	1	RUTH BENZAR MD	5/4/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
112135	Fee-for-Service	1073045191	1073045191	1	1	RAMIREZ, SYDNEY	5/24/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	159271	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
112136	Fee-for-Service	1093823221	1093823221	1	2	ROOK, RONALD PHD	12/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	485 JOHNSTON	None	HEMET	CA	92543	7012	33	06065	33.73295787	-116.9752937	Riverside County
112147	Fee-for-Service	1629090006	1629090006	1	1	ROBERT EDWARD O'DONNELL JR.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
112158	Fee-for-Service	1073000105	1073000105	1	6	RADIOLOGICA INC.	6/23/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
112207	Fee-for-Service	1891244471	1891244471	1	1	ROJAS, JANELLE LMFT	3/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
112254	Fee-for-Service	1104847110	1104847110	1	1	R RIEMERSMA MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	417 STATE ST SUITE 440	None	BANGOR	ME	04401	0000	00	None	44.807409	-68.7524445	Penobscot County
112356	Fee-for-Service	1750306189	1750306189	1	1	REDDY, MANJULA K MD	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93135	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
112360	Fee-for-Service	1124730155	1124730155	1	1	REMY, ALEXIS LCSW	3/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
112375	Fee-for-Service	1669759148	1669759148	1	1	RISMANCHI, NEGGY MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118427	79	Neurology-Child	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
112411	Fee-for-Service	1295717163	1295717163	1	1	ROGERS, JASON H MD	7/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82748	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112455	Fee-for-Service	1306094453	1306094453	1	1	RHOADS BAEZA, MARIA E MD	12/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121345	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
112535	Fee-for-Service	1992922306	1992922306	1	1	ROBERTS, RONALD A	2/8/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2412 PONDEROSA N DR	STE B 101	CAMARILLO	CA	93010	2380	56	06111	34.24223352	-119.0227101	Ventura County
112536	Fee-for-Service	1194383737	1194383737	1	1	RAMIREZ, CARLOS E MD	6/1/2022	208M00000X	NA	Other	026	PHYSICIANS	178524	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
112575	Fee-for-Service	1144581844	1144581844	1	1	ROB, FARHANA DO	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13990	01	General Practice	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
112606	Fee-for-Service	1912678053	1912678053	1	1	RIVERA, VANESSA E OT	2/23/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
112619	Fee-for-Service	1134220601	1134220601	1	1	ROE, CYNTHIA E LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
112631	Fee-for-Service	1306900832	1306900832	1	1	ROY, RITA MD	10/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	31632	40	Pediatrics	0	In state provider	None	11480 BROOKSHIRE AVE	STE 105	DOWNEY	CA	90241	5020	19	06037	33.93622932	-118.1311752	Los Angeles County
112665	Fee-for-Service	1861473209	1861473209	1	1	RASHEED, SHABANA MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	53091	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
112694	Fee-for-Service	1417903147	1417903147	1	1	RESSLER, JULIE A MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	73507	30	Radiology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
112723	Fee-for-Service	1730682394	1730682394	1	8	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1375 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3382	49	06097	38.6272407	-122.8638253	Sonoma County
112766	Fee-for-Service	1962413625	1962413625	1	1	RABER, DUSTIN A MD	11/13/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94854	08	Family Practice	0	In state provider	None	1524 W LACEY BLVD	None	HANFORD	CA	93230	5965	16	06031	36.32816338	-119.6690189	Kings County
112791	Fee-for-Service	1043217268	1043217268	1	1	ROGER SMITH MD	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1109 N 100 W	None	BEAVER	UT	84713	7746	00	None	38.28916369	-112.6431749	Beaver County
112792	Fee-for-Service	1639371818	1639371818	1	1	ROBIN T HAPE MD	11/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY ST	None	MISSOULA	MT	59802	4008	00	None	46.87419951	-114.0007525	Missoula County
112828	Fee-for-Service	1336177930	1336177930	1	1	RASI, ALFREDO L MD	3/31/1986	208G00000X	NA	General Surgery	026	PHYSICIANS	26200	33	Thoracic Surgery	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
112837	Fee-for-Service	1073893285	1073893285	1	1	ROMEO, SUZANNE OD	3/7/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 E STOWELL RD	None	SANTA MARIA	CA	93454	7001	42	06083	34.93834649	-120.422502	Santa Barbara County
112920	Fee-for-Service	1134256944	1134256944	1	1	ROSEN, ERICA M MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98170	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
112947	Fee-for-Service	1326272956	1326272956	1	1	ROSS, CHARMAYNE G	2/8/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50 E FOOTHILL BLVD	STE 100	ARCADIA	CA	91006	2314	19	06037	34.15096965	-118.0295442	Los Angeles County
112948	Fee-for-Service	1780410167	1780410167	1	1	REFLECT CHRISTIAN COUNSELING	12/24/2024	No Taxonomy Provided	NA	None	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC	4550 CALIFORNIA AVE	SUITE 670	BAKERSFIELD	CA	93309	7012	15	06029	35.367903	-119.0537145	Kern County
112959	Fee-for-Service	1982711974	1982711974	1	1	RUHLIN, CHARLES J MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92107	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
112973	Fee-for-Service	1699263053	1699263053	1	1	RODRIGUEZ MELGOZA, GABRIELA	6/11/2021	207R00000X	NA	Other	026	PHYSICIANS	165081	None	None	0	In state provider	MD	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
112974	Fee-for-Service	1841354164	1841354164	1	1	RIOS, CLARITZA L MD	9/13/2019	207P00000X	NA	Other	026	PHYSICIANS	56057	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113007	Fee-for-Service	1023151065	1023151065	1	1	REHBERG, KATHRYN L PSYD	8/30/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	353 PARK MARINA CIR	None	REDDING	CA	96001	0965	45	06089	40.57650059	-122.3737972	Shasta County
113012	Fee-for-Service	1730682394	1730682394	1	8	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1375 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3382	49	06097	38.6272407	-122.8638253	Sonoma County
113032	Fee-for-Service	1538230438	1538230438	1	1	RAMOS, RICARDO A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63720	08	Family Practice	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	#230	LOS ANGELES	CA	90042	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
113051	Fee-for-Service	1265725725	1265725725	1	1	REDWOOD SLEEP AND	4/12/2016	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	PULMONARY CARE INC	202 WEST WILLOW STREET	STE 103	VISALIA	CA	93291	6238	54	06107	36.3283683	-119.29356	Tulare County
113092	Fee-for-Service	1902399751	1902399751	1	1	RIGO, RACHEL S MD	5/15/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	177012	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
113114	Fee-for-Service	1215103056	1215103056	1	1	RUBIO, ROSALIO O MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110598	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
113154	Fee-for-Service	1568641843	1568641843	1	1	RISO, DENA J	11/14/2007	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1767 E MAIN ST	None	EL CAJON	CA	92021	5219	37	06073	32.81439596	-116.9170171	San Diego County
113166	Fee-for-Service	1881292928	1881292928	1	1	RASHIDI, AMBER M CPO	10/12/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1849 W REDLANDS BLVD	STE 103	REDLANDS	CA	92373	3127	36	06071	34.06287354	-117.2162115	San Bernardino County
113238	Fee-for-Service	1780410167	1780410167	1	1	REFLECT CHRISTIAN COUNSELING	12/24/2024	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC	4550 CALIFORNIA AVE	SUITE 670	BAKERSFIELD	CA	93309	7012	15	06029	35.367903	-119.0537145	Kern County
113258	Fee-for-Service	1841354164	1841354164	1	1	RIOS, CLARITZA L MD	9/13/2019	207P00000X	NA	Other	026	PHYSICIANS	56057	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113352	Fee-for-Service	1144985532	1144985532	1	1	RESPONSIVE MEDICAL SERVICES,	8/31/2023	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3954 MURPHY CANYON RD	D104	SAN DIEGO	CA	92123	4418	37	06073	32.81682151	-117.1169852	San Diego County
113371	Fee-for-Service	1407819485	1407819485	1	1	RENAL TREATMENT CENTERS	12/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	26900 CACTUS AVE	None	MORENO VALLEY	CA	92555	3912	33	06065	33.91013953	-117.193383	Riverside County
113376	Fee-for-Service	1902399751	1902399751	1	1	RIGO, RACHEL S MD	5/15/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	177012	07	Dermatology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
113391	Fee-for-Service	1235306077	1235306077	1	1	RUCHALSKI, KATHLEEN L MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110019	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
113433	Fee-for-Service	1700111689	1700111689	1	1	RACHEL LEVITAN MD	1/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
113457	Fee-for-Service	1255471637	1255471637	1	1	RODRIGUEZ, MARIBEL LCSW	2/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 W FLORIDA AVE	SUITE C	HEMET	CA	92543	4628	33	06065	33.74755149	-116.98533	Riverside County
113492	Fee-for-Service	1245672815	1245672815	1	1	RAIF JAWID, ABDUL W MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
113548	Fee-for-Service	1841354164	1841354164	1	1	RIOS, CLARITZA L MD	9/13/2019	207P00000X	NA	Other	026	PHYSICIANS	56057	38	Geriatrics	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113601	Fee-for-Service	1538301064	1538301064	1	1	REV VASCULAR INC	12/18/2017	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	6401 COYLE AVE	SUITE 311	CARMICHAEL	CA	95608	0310	34	06067	38.668698	-121.3148745	Sacramento County
113607	Fee-for-Service	1033283395	1033283395	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF II LLC	2710 TELEGRAPH AVE	STE 100	OAKLAND	CA	94612	1771	01	06001	37.81647593	-122.2677965	Alameda County
113613	Fee-for-Service	1760541569	1760541569	1	36	RETINA INSTITUTE OF CALIFORN	5/8/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	700 W EL NORTE PKWY	200	ESCONDIDO	CA	92026	3923	37	06073	33.14611822	-117.1023285	San Diego County
113624	Fee-for-Service	1013963594	1013963594	1	1	REDOR, MARK WILLIAM MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56411	10	Gastroenterology (M.D. only)	0	In state provider	None	1006 MARSHALL WAY	None	PLACERVILLE	CA	95667	5706	09	06017	38.7261417	-120.7925328	El Dorado County
113669	Fee-for-Service	1780734491	1780734491	1	1	ROYBAL, GREGORY M MD	10/31/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	55881	-	NOT APPLICABLE	0	In state provider	None	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
113712	Fee-for-Service	1497081582	1497081582	1	1	RYDFORS, JAN T MD INC	4/27/2010	193400000X	NA	Other	026	PHYSICIANS	65169	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 WARREN STREET	SUITE 300	REDWOOD CITY	CA	94063	1536	41	06081	37.48729928	-122.2318924	San Mateo County
113743	Fee-for-Service	1003078601	1003078601	1	1	RYOU, THOMAS K MD	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108793	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
113844	Fee-for-Service	1063041630	1063041630	1	1	RANI, MONICA OD	12/22/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
113868	Fee-for-Service	1417978644	1417978644	1	1	RUBALCAVA, RAFAEL	8/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61645	08	Family Practice	0	In state provider	None	15625 IMPERIAL HWY	None	LA MIRADA	CA	90638	1627	19	06037	33.91736145	-117.9981225	Los Angeles County
113874	Fee-for-Service	1447441092	1447441092	1	1	RUELAS, GREGORIO A MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95991	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
113889	Fee-for-Service	1083894075	1083894075	1	1	ROCCO, GOWRI R MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52555	08	Family Practice	0	In state provider	None	11705 SLATE AVE	STE 200	RIVERSIDE	CA	92505	5199	33	06065	33.9027276	-117.4928061	Riverside County
113897	Fee-for-Service	1396804977	1396804977	1	1	RAO, RAMAMOHAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32226	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
113902	Fee-for-Service	1760541569	1760541569	1	36	RETINA INSTITUTE OF CALIFORN	5/8/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 W EL NORTE PKWY	200	ESCONDIDO	CA	92026	3923	37	06073	33.14611822	-117.1023285	San Diego County
113952	Fee-for-Service	1104016351	1104016351	1	1	RICHARDS, LAWRENCE T MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114003	Fee-for-Service	1497081582	1497081582	1	1	RYDFORS, JAN T MD INC	4/27/2010	193400000X	NA	Other	026	PHYSICIANS	65169	67	Endocrinology	0	In state provider	None	401 WARREN STREET	SUITE 300	REDWOOD CITY	CA	94063	1536	41	06081	37.48729928	-122.2318924	San Mateo County
114038	Fee-for-Service	1558346130	1558346130	1	1	RAVIN, PAULA D MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45656	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
114042	Fee-for-Service	1851802052	1851802052	1	1	RACHEL HAYNES	5/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPIST, PC	21700 REDWOOD RD	SUITE B	CASTRO VALLEY	CA	94546	6434	01	06001	37.68919396	-122.0735402	Alameda County
114075	Fee-for-Service	1487950333	1487950333	1	1	REDDEN, DANIEL D LMFT	12/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
114088	Fee-for-Service	1881912988	1881912988	1	1	RABIZADEH, RASHEL DO	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13357	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
114099	Fee-for-Service	1760986715	1760986715	1	1	RIVERA, KEVIN JOHN R MD	7/16/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
114111	Fee-for-Service	1649609355	1649609355	1	1	RAMOS, MENA C MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131689	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
114190	Fee-for-Service	1760541569	1760541569	1	8	RETINA INSTITUTE OF CALIFORN	6/22/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	29950 HAUN ROAD	202	MENIFEE	CA	92856	6526	33	06065	33.68584881	-117.1754214	Riverside County
114259	Fee-for-Service	1104252147	1104252147	1	2	RIGGIO, THOMAS OD	4/2/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5020 ELLINGHOUSE DR	SUITE A	COOL	CA	95614	9569	09	06017	38.88643939	-121.0137037	El Dorado County
114279	Fee-for-Service	1427568088	1427568088	1	1	RYKER, KARA CCC-SLP	8/26/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
114287	Fee-for-Service	1477895597	1477895597	1	1	RICHARDSON, SHAWN S MD	11/17/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	159098	20	Orthopedic Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
114297	Fee-for-Service	1699704742	1699704742	1	1	ROGALSKI, GREGORY MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82124	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
114319	Fee-for-Service	1497942106	1497942106	1	1	ROUMANIS, PANAYOTA S MD	5/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121083	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
114347	Fee-for-Service	1336283902	1336283902	1	1	RAINES-HEPPLE, ROBERT P MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120069	30	Radiology	0	In state provider	None	1504 N WISHON AVE	None	FRESNO	CA	93728	1827	10	06019	36.763497	-119.8010405	Fresno County
114370	Fee-for-Service	1992487714	1992487714	1	1	RODRIGUEZ HERNANDEZ, NAYELI	12/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CCC-SLP	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
114403	Fee-for-Service	1679599393	1679599393	1	1	ROBERTSON, MARILYN M MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69580	13	Neurology (M.D. only)	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
114430	Fee-for-Service	1003911124	1003911124	1	1	ROMAN-CLIFTON, MARIE PHD	3/13/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
114460	Fee-for-Service	1073000105	1073000105	1	3	RADIOLOGICA INC.	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	80 IRON POINT CIRCLE	#118	FOLSOM	CA	95630	8593	34	06067	38.645253	-121.1416425	Sacramento County
114478	Fee-for-Service	1760541569	1760541569	1	8	RETINA INSTITUTE OF CALIFORN	10/30/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	29950 HAUN ROAD	202	MENIFEE	CA	92856	6526	33	06065	33.68584881	-117.1754214	Riverside County
114517	Fee-for-Service	1659309425	1659309425	1	1	ROSS, DENNIS L MD	5/30/1983	193400000X	NA	Other	026	PHYSICIANS	36200	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
114519	Fee-for-Service	1760541569	1760541569	1	25	RETINA INSTITUTE OF CALIFORN	2/18/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	300 S PIERCE ST	200	EL CAJON	CA	92020	4165	37	06073	32.79286035	-116.9780352	San Diego County
114538	Fee-for-Service	1265559694	1265559694	1	1	RAO, SHYAM S MD	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129053	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
114563	Fee-for-Service	1215948997	1215948997	1	1	RAO, RAMINENI V MD	6/14/1982	208600000X	NA	General Surgery	026	PHYSICIANS	38532	02	General Surgery	0	In state provider	None	1895 MOWRY AVE	STE 118B	FREMONT	CA	94538	1766	01	06001	37.55909066	-121.9799265	Alameda County
114571	Fee-for-Service	1861066987	1861066987	1	1	RIMMER, TERESA A LMFT	6/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5790 MAGNOLIA AVE	STE 202	RIVERSIDE	CA	92506	1874	33	06065	33.96267292	-117.3905848	Riverside County
114586	Fee-for-Service	1609972777	1609972777	1	1	RIO HONDO MEDICAL GROUP	2/21/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	12444 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96757592	-118.046351	Los Angeles County
114597	Fee-for-Service	1184219230	1184219230	1	1	ROLLERSON, ASHLEY	4/14/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
114615	Fee-for-Service	1871970335	1871970335	1	1	RIOS, TRAVIS L LMFT	6/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1918 BONITA AVE	200	BERKELEY	CA	94704	1014	01	06001	37.87279926	-122.2720479	Alameda County
114620	Fee-for-Service	1174692552	1174692552	1	1	ROBERTSON, VALERIE J	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
114704	Fee-for-Service	1982089314	1982089314	1	1	ROGERS, THULI	7/30/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	26265 PRIMA WAY	None	SANTA CLARITA	CA	91350	8554	19	06037	34.41666314	-118.5171015	Los Angeles County
114723	Fee-for-Service	1881784981	1881784981	1	1	RICHTER, LISA LMFT	7/1/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6609 FOLSOM AUBURN RD	BLDG B STE 100	FOLSOM	CA	95630	2101	34	06067	38.684619	-121.1778135	Sacramento County
114727	Fee-for-Service	1386998383	1386998383	1	1	ROMANUCCI, ROBYN	11/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
114734	Fee-for-Service	1467418327	1467418327	1	1	RICE, KEVIN MD	5/4/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53057	30	Radiology	0	In state provider	None	44105 15TH ST W	None	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
114742	Fee-for-Service	1578844973	1578844973	2	1	RAD PHYSICIANS MEDICAL	3/19/2015	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
114795	Fee-for-Service	1578786943	1578786943	1	1	RANJAN, SUMIT MD	12/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142427	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114805	Fee-for-Service	1760541569	1760541569	1	25	RETINA INSTITUTE OF CALIFORN	2/18/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 S PIERCE ST	200	EL CAJON	CA	92020	4165	37	06073	32.79286035	-116.9780352	San Diego County
114808	Fee-for-Service	1508927914	1508927914	1	2	RANAVAT, AMRITLAL C	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35341	None	None	0	In state provider	None	201 S ALVARADO ST	STE 824	LOS ANGELES	CA	90057	2391	19	06037	34.06417777	-118.2719543	Los Angeles County
114824	Fee-for-Service	1265559694	1265559694	1	1	RAO, SHYAM S MD	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129053	30	Radiology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
114839	Fee-for-Service	1730682394	1730682394	1	9	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
114854	Fee-for-Service	1720155682	1720155682	1	1	RODRIGUEZ, OSVALDO MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70011	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
114878	Fee-for-Service	1760541569	1760541569	1	29	RETINA INSTITUTE OF CALIFORN	2/24/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1420 OCOTILLO DR	C & D	EL CENTRO	CA	92243	4254	13	06025	32.77671804	-115.5683943	Imperial County
114879	Fee-for-Service	1689827776	1689827776	1	1	ROSS, ALLISON M MD	1/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76896	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114919	Fee-for-Service	1063443497	1063443497	1	1	RAFIEE, SHAHRZAD MD	5/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74643	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
114934	Fee-for-Service	1346772142	1346772142	1	1	ROTHENBERG, EDWARD S MD	8/10/2020	390200000X	NA	Other	026	PHYSICIANS	162141	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
114936	Fee-for-Service	1437548716	1437548716	1	1	RUBIN, LESLIE F CRNA	1/27/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
114947	Fee-for-Service	1962482513	1962482513	1	2	REGENTS OF THE UNIVERSITY OF	3/31/2021	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
114975	Fee-for-Service	1700357308	1700357308	1	1	REVIVE HEALTH SENIOR CARE LL	2/20/2025	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	1	Border provider	ABILITATION CENTER	555 HAMMILL LN	None	RENO	NV	89511	1004	00	None	39.47214937	-119.7943301	Washoe County
114992	Fee-for-Service	1982089314	1982089314	1	1	ROGERS, THULI	7/30/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	26265 PRIMA WAY	None	SANTA CLARITA	CA	91350	8554	19	06037	34.41666314	-118.5171015	Los Angeles County
114998	Fee-for-Service	1235169038	1235169038	1	1	RATICO, HELEN MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	29217	36	Psychiatry	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
115008	Fee-for-Service	1376998849	1376998849	1	1	ROLL, RANDALL DO	9/9/2019	207P00000X	NA	Other	026	PHYSICIANS	17512	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
115012	Fee-for-Service	1275647737	1275647737	1	1	ROSEVILLE PEDIATRIC	11/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4420	31	06061	38.7294585	-121.2763095	Placer County
115064	Fee-for-Service	1477560126	1477560126	1	1	RAFE M HENG, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 W WASHINGTON ST	None	PITTSFIELD	IL	62363	1350	00	None	39.60681647	-90.8148915	Pike County
115073	Fee-for-Service	1700176740	1700176740	1	1	RUCKER, ADAM N MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141753	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115076	Fee-for-Service	1063526747	1063526747	1	1	RHEE, PAUL C MD	1/1/1999	207P00000X	NA	Other	026	PHYSICIANS	65713	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
115085	Fee-for-Service	1760541569	1760541569	1	32	RETINA INSTITUTE OF CALIFORN	2/25/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	81893 DOCTOR CARREON BLV	2	INDIO	CA	92201	0604	33	06065	33.7073755	-116.2355895	Riverside County
115092	Fee-for-Service	1508347543	1508347543	1	1	RODRIGUEZ, KAYLA	9/12/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
115094	Fee-for-Service	1679624282	1679624282	1	1	RASKIN, NEIL H MD	1/31/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	15494	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115095	Fee-for-Service	1760541569	1760541569	1	17	RETINA INSTITUTE OF CALIFORN	10/31/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
115122	Fee-for-Service	1730682394	1730682394	1	9	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
115142	Fee-for-Service	1437322203	1437322203	1	1	RATANASIT, ARLENE MD	10/26/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	113079	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	91188	0001	19	06037	34.03781261	-118.3755101	Los Angeles County
115165	Fee-for-Service	1760541569	1760541569	1	29	RETINA INSTITUTE OF CALIFORN	2/24/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1420 OCOTILLO DR	C & D	EL CENTRO	CA	92243	4254	13	06025	32.77671804	-115.5683943	Imperial County
115175	Fee-for-Service	1861883811	1861883811	1	1	RAMBACHAN, AKSHARANANDA MD	8/21/2019	207R00000X	NA	Other	026	PHYSICIANS	161155	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115222	Fee-for-Service	1417105156	1417105156	1	1	RASMUSSEN, AMMON G MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124902	02	General Surgery	0	In state provider	None	5400 W HILLSDALE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
115224	Fee-for-Service	1518672716	1518672716	1	3	R Y WILLIAMS MD MEDICAL CORP	8/23/2024	261QM2500X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	ORATION	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
115233	Fee-for-Service	1962482513	1962482513	1	2	REGENTS OF THE UNIVERSITY OF	2/12/2021	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
115236	Fee-for-Service	1578647988	1578647988	1	1	RAGSDALE, VINCENT K OD	6/30/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6690 ALESSANDRO BLVD	STE B	RIVERSIDE	CA	92506	5355	33	06065	33.93004099	-117.3458288	Riverside County
115288	Fee-for-Service	1992236871	1992236871	1	1	REACH PROJECT	8/20/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1750 HARBOR STREET	None	PITTSBURG	CA	94565	4615	07	06013	38.019141	-121.8843135	Contra Costa County
115298	Fee-for-Service	1609656339	1609656339	1	1	RESILIENCE COLLECTIVE PSYCHO	8/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LOGY GROUP	1306 ROUNDHOUSE ST	None	TULARE	CA	93274	7777	54	06107	36.19293136	-119.3029319	Tulare County
115316	Fee-for-Service	1477714624	1477714624	2	1	RODRIGUEZ GONZALEZ, YRIDIANA	10/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MARRIAGE AND FAMILY THER	5055 CANYON CREST DR	STE 223	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
115334	Fee-for-Service	1376108340	1376108340	1	1	RABBANI, BAHRAM DO	7/29/2024	2081N0008X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	21318	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
115343	Fee-for-Service	1871681072	1871681072	1	1	REED, ALISON S MD	8/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84595	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
115359	Fee-for-Service	1356343396	1356343396	2	1	RENAISSANCE HOME HEALTH CARE	1/22/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3160 CAMINO DEL RIO S	STE 312	SAN DIEGO	CA	92108	3835	37	06073	32.77320652	-117.1256888	San Diego County
115362	Fee-for-Service	1851312391	1851312391	1	1	REDDY, VADIYALA M MD	6/20/1997	208G00000X	NA	General Surgery	026	PHYSICIANS	62821	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
115372	Fee-for-Service	1760541569	1760541569	1	32	RETINA INSTITUTE OF CALIFORN	2/25/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	81893 DOCTOR CARREON BLV	2	INDIO	CA	92201	0604	33	06065	33.7073755	-116.2355895	Riverside County
115381	Fee-for-Service	1679624282	1679624282	1	1	RASKIN, NEIL H MD	1/31/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	15494	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115383	Fee-for-Service	1760541569	1760541569	1	17	RETINA INSTITUTE OF CALIFORN	10/31/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
115485	Fee-for-Service	1629314869	1629314869	1	1	RELIANCE FB RX LLC	11/20/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11333 SEPULVEDA BLVD	SUITE 1200	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
115493	Fee-for-Service	1740220995	1740220995	1	1	RUIZ, CYNTHIA MD	7/31/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	48844	01	General Practice	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
115520	Fee-for-Service	1962482513	1962482513	1	2	REGENTS OF THE UNIVERSITY OF	3/23/2022	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
115522	Fee-for-Service	1477260859	1477260859	1	1	RIVERSIDE OPERATIONS, LP	2/16/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17050 ARNOLD DRIVE	None	RIVERSIDE	CA	92518	2086	33	06065	33.8730097	-117.2923955	Riverside County
115542	Fee-for-Service	1013572932	1013572932	1	1	ROMERO-GUTIERREZ, ERIKA D	3/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180004	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
115556	Fee-for-Service	1124462635	1124462635	1	1	RUSSELL, JEAN L MD	7/12/2017	390200000X	NA	Other	026	PHYSICIANS	143458	40	Pediatrics	0	In state provider	None	7720 N FRESNO ST	STE 104	FRESNO	CA	93720	2407	10	06019	36.85068226	-119.7836282	Fresno County
115561	Fee-for-Service	1134309495	1134309495	1	1	RHEE, DAVID M MD	10/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101726	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
115562	Fee-for-Service	1013028190	1013028190	1	1	RAPAPORT, VICKI MD A	10/1/2012	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	436 N BEDFORD DR	#306	BEVERLY HILLS	CA	90210	4320	19	06037	34.0685329	-118.4056227	Los Angeles County
115593	Fee-for-Service	1134778012	1134778012	1	1	RAHMAN, OLAYINKA PSYD	5/18/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
115625	Fee-for-Service	1376831289	1376831289	1	1	ROBLEDO, DAMIAN LCSW	2/18/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
115639	Fee-for-Service	1841459732	1841459732	1	1	RANASINGHE, NALIN E MD	11/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127659	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
115640	Fee-for-Service	1003829417	1003829417	1	1	RAMIREZ, ALFREDO R MD	3/9/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	101070	33	Thoracic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115648	Fee-for-Service	1851312391	1851312391	1	1	REDDY, VADIYALA M MD	6/20/1997	208G00000X	NA	General Surgery	026	PHYSICIANS	62821	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
115650	Fee-for-Service	1912901471	1912901471	1	1	RUIZ, RUBEN MD	4/23/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52245	41	Internal Medicine	0	In state provider	None	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
115654	Fee-for-Service	1760541569	1760541569	1	14	RETINA INSTITUTE OF CALIFORN	9/11/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 SANTA FE DRIVE	104	ENCINITAS	CA	92856	6526	37	06073	33.038847	-117.285579	San Diego County
115683	Fee-for-Service	1184906745	1184906745	1	1	RAI CARE CENTERS OF NORTHERN	4/20/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA I LLC	4600 MACK ROAD	STE 168	SACRAMENTO	CA	95823	8200	34	06067	38.47392	-121.4470395	Sacramento County
115694	Fee-for-Service	1134157639	1134157639	1	2	RYAN, LISA Y MD	12/3/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88086	01	General Practice	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
115702	Fee-for-Service	1346336567	1346336567	1	1	REITMAN, DAVID J MD	11/1/2000	207R00000X	NA	Other	026	PHYSICIANS	65980	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
115742	Fee-for-Service	1841589694	1841589694	1	1	RANCHES, GREGORY P MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122392	41	Internal Medicine	0	In state provider	None	4077 5TH AVENUE	MER 35	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
115760	Fee-for-Service	1841495595	1841495595	1	1	ROEDER, HILARY A MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115798	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
115764	Fee-for-Service	1033107495	1033107495	1	1	ROTHMAN, MARK C MD	5/7/2021	207L00000X	NA	Other	026	PHYSICIANS	83051	None	None	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
115767	Fee-for-Service	1124110192	1124110192	1	1	RIORDAN, NOLLI S MD	8/2/1995	208600000X	NA	General Surgery	026	PHYSICIANS	81855	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
115772	Fee-for-Service	1154479038	1154479038	1	1	ROSENBERG, CHI N MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85303	07	Dermatology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
115779	Fee-for-Service	1205162823	1205162823	1	1	ROOZROKH, AFSHID	10/3/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
115809	Fee-for-Service	1962482513	1962482513	1	2	REGENTS OF THE UNIVERSITY OF	8/19/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
115810	Fee-for-Service	1982763546	1982763546	1	1	RUSKIN, JOEL MD	7/4/1970	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	10326	None	None	0	In state provider	None	936 CLARA DR	None	PALO ALTO	CA	94303	4001	43	06085	37.43662215	-122.1196464	Santa Clara County
115817	Fee-for-Service	1386164580	1386164580	1	2	REDDING RANCHERIA	4/4/2022	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	81 ARBUCKLE COURT	None	WEAVERVILLE	CA	96093	0000	45	06089	40.71114015	-122.9256356	Trinity County
115825	Fee-for-Service	1740219104	1740219104	1	1	REYES, CARLO M MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70435	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
115840	Fee-for-Service	1023278314	1023278314	1	1	ROBERTS, POMAI MD	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103218	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
115860	Fee-for-Service	1629253471	1629253471	1	1	RICH, KEVIN W DO	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12701	41	Internal Medicine	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
115871	Fee-for-Service	1316944846	1316944846	1	2	RIVER MEDICAL, INC.	1/27/2023	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	None	415 EL CAMINO WAY	None	LAKE HAVASU CITY	AZ	86403	4628	00	None	34.484445	-114.3511155	Mohave County
115907	Fee-for-Service	1063903201	1063903201	1	1	ROY, NISHA A NP	9/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
115921	Fee-for-Service	1750861936	1750861936	1	1	ROSE, KAMERYN V LMFT	1/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
115936	Fee-for-Service	1053362624	1053362624	1	1	RIPON MEDICAL CENTER	9/19/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	933 NEWBURY ST	None	RIPON	WI	54971	1730	00	None	43.83465949	-88.83736461	Fond du Lac County
115940	Fee-for-Service	1225404015	1225404015	1	1	REMEDE, PC	10/11/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6553 E PACIFIC COAST HWY	None	LONG BEACH	CA	90803	4202	19	06037	33.75590219	-118.1091312	Los Angeles County
115941	Fee-for-Service	1760541569	1760541569	1	14	RETINA INSTITUTE OF CALIFORN	9/11/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	320 SANTA FE DRIVE	104	ENCINITAS	CA	92856	6526	37	06073	33.038847	-117.285579	San Diego County
115968	Fee-for-Service	1063454692	1063454692	1	1	RAVI, NANDAKUMAR B MD	9/29/2003	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	64007	10	Gastroenterology (M.D. only)	0	In state provider	None	9870 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2798	15	06029	35.36881694	-119.1119759	Kern County
115983	Fee-for-Service	1790736098	1790736098	1	1	RETINA CONSULTANTS	9/30/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12630 MONTE VISTA RD	STE 104	POWAY	CA	92064	2526	37	06073	32.99533582	-117.0560031	San Diego County
115989	Fee-for-Service	1982826236	1982826236	1	1	ROCCO, ROBERT T MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52627	08	Family Practice	0	In state provider	None	16465 SIERRA LAKES PRKWY	STE 250	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
116009	Fee-for-Service	1437142692	1437142692	1	2	REGENTS/UCDPBG/IM PULMON	5/1/1999	207RP1001X	NA	Pulmonology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
116042	Fee-for-Service	1659389740	1659389740	1	1	ROBINSON, DAISY A MD	4/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56278	01	General Practice	0	In state provider	None	321 E ALVARADO ST	None	FALLBROOK	CA	92028	2912	37	06073	33.38200789	-117.2493602	San Diego County
116050	Fee-for-Service	1609834936	1609834936	1	1	RIESENMAN,JOHN P MD	1/1/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	47918	36	Psychiatry	0	In state provider	None	1800 WESTERN AVE	STE 201	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
116054	Fee-for-Service	1124110192	1124110192	1	1	RIORDAN, NOLLI S MD	8/2/1995	208600000X	NA	General Surgery	026	PHYSICIANS	81855	33	Thoracic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
116092	Fee-for-Service	1891138293	1891138293	1	1	ROCHER, PATRICE J NP	5/22/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116097	Fee-for-Service	1962482513	1962482513	1	2	REGENTS OF THE UNIVERSITY OF	9/1/2022	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
116105	Fee-for-Service	1386164580	1386164580	1	2	REDDING RANCHERIA	4/4/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	81 ARBUCKLE COURT	None	WEAVERVILLE	CA	96093	0000	45	06089	40.71114015	-122.9256356	Trinity County
116127	Fee-for-Service	1124132246	1124132246	1	1	RAJAGOPAL, THIRU N MD	5/31/1988	208600000X	NA	General Surgery	026	PHYSICIANS	44837	02	General Surgery	0	In state provider	None	3939 J ST	SUITE 340	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
116153	Fee-for-Service	1407824170	1407824170	1	1	RANCHO PHYSICAL THERAPY, INC	12/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	29645 RANCHO CALIFORNIA	STE. 121	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
116163	Fee-for-Service	1598867608	1598867608	1	1	ROSWELL, KELLEY C MD	7/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
116199	Fee-for-Service	1538796941	1538796941	1	1	REDFIELD, SHAWN T LMFT	12/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
116217	Fee-for-Service	1760541569	1760541569	1	34	RETINA INSTITUTE OF CALIFORN	4/7/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	58471 29 PALMS HWY	203	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
116241	Fee-for-Service	1104815067	1104815067	1	1	REGENTS/UCDPBG/PED IC	1/1/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
116258	Fee-for-Service	1063454692	1063454692	1	1	RAVI, NANDAKUMAR B MD	9/29/2003	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	64007	41	Internal Medicine	0	In state provider	None	9870 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2798	15	06029	35.36881694	-119.1119759	Kern County
116263	Fee-for-Service	1891805545	1891805545	1	1	RALEY'S	10/5/1984	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1601 WEST CAPITOL AVE	None	WEST SACRAMENTO	CA	95691	3219	57	06113	38.58031783	-121.5292376	Yolo County
116269	Fee-for-Service	1770662116	1770662116	1	1	RONALD M WINTERS	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	# NORTH	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
116295	Fee-for-Service	1801921952	1801921952	1	4	ROY MEDICAL GROUP INC	7/12/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1543 E PALMDALE BLVD	SUITE F	PALMDALE	CA	93550	2030	19	06037	34.57966352	-118.101582	Los Angeles County
116296	Fee-for-Service	1437142692	1437142692	1	2	REGENTS/UCDPBG/IM PULMON	4/17/2020	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
116303	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	2/9/2021	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
116329	Fee-for-Service	1659389740	1659389740	1	1	ROBINSON, DAISY A MD	4/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56278	40	Pediatrics	0	In state provider	None	321 E ALVARADO ST	None	FALLBROOK	CA	92028	2912	37	06073	33.38200789	-117.2493602	San Diego County
116331	Fee-for-Service	1972508497	1972508497	1	1	ROBINSON,CHARITY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 CEDAR	None	OROFINO	ID	83544	0000	00	None	46.48694067	-116.2595042	Clearwater County
116348	Fee-for-Service	1508828963	1508828963	1	1	RIVERSIDE EYE SPECIALIST	4/11/1997	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	4605 BROCKTON AVENUE	100	RIVERSIDE	CA	92506	0106	33	06065	33.97611422	-117.3860257	Riverside County
116378	Fee-for-Service	1922018480	1922018480	1	1	RACHEL KORETH MD	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
116401	Fee-for-Service	1518021369	1518021369	1	1	RAISZDADEH, RAMIN MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88341	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
116412	Fee-for-Service	1316573363	1316573363	1	1	ROZICH, JACOB	8/9/2023	207R00000X	NA	Other	026	PHYSICIANS	176977	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
116417	Fee-for-Service	1740775568	1740775568	1	1	REYERSON-SLIFER, MELISSA LC	8/19/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	333 N PALM CANYON DR	215	PALM SPRINGS	CA	92262	5658	33	06065	33.827652	-116.5468485	Riverside County
116426	Fee-for-Service	1619278801	1619278801	1	1	REONIDA LLC	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	29679	None	None	0	In state provider	None	222 E PLAZA BLVD	None	NATIONAL CITY	CA	91950	3342	37	06073	32.67477045	-117.1037306	San Diego County
116468	Fee-for-Service	1841665676	1841665676	1	1	RAMBAYON, MARY LMFT	5/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
116491	Fee-for-Service	1457680738	1457680738	1	1	RUSKIN, RACHEL MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115368	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
116506	Fee-for-Service	1760541569	1760541569	1	34	RETINA INSTITUTE OF CALIFORN	4/7/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	58471 29 PALMS HWY	203	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
116517	Fee-for-Service	1245500958	1245500958	1	1	RAO, NIKHIL R MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126837	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
116521	Fee-for-Service	1588801054	1588801054	1	1	ROHE, LISA M PSYD	4/5/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1008 FIFTH STREET	None	SANTA ROSA	CA	95404	4307	49	06097	38.443941	-122.708187	Sonoma County
116527	Fee-for-Service	1437632973	1437632973	1	1	RIOS, RACHEL I LCSW	10/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	920 S. BROADWAY	STE. B	SANTA MARIA	CA	93454	6641	42	06083	34.942311	-120.4359745	Santa Barbara County
116531	Fee-for-Service	1104815067	1104815067	1	1	REGENTS/UCDPBG/PED IC	1/1/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
116545	Fee-for-Service	1710972815	1710972815	1	1	ROBERTS, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 DALLAS ST	None	SAN ANTONIO	TX	78205	1201	00	None	29.43317376	-98.49236007	Bexar County
116550	Fee-for-Service	1326201286	1326201286	1	1	RINCON, ANA M LCSW	11/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
116556	Fee-for-Service	1851375208	1851375208	1	1	RUN, FRANSCISCO D K MD	5/5/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37561	01	General Practice	0	In state provider	None	1730 S SAN GABRIEL BLVD	None	SAN GABRIEL	CA	91776	3928	19	06037	34.077654	-118.0907045	Los Angeles County
116579	Fee-for-Service	1376556035	1376556035	1	2	RIOS, GUILLERMO MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55049	40	Pediatrics	0	In state provider	None	200 SOUTH WELLS ROAD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
116591	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	2/9/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
116598	Fee-for-Service	1023031184	1023031184	1	1	ROMANO, THOMAS J MD	1/1/1998	207RR0500X	NA	Other	026	PHYSICIANS	31881	83	Rheumatology	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 510	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
116612	Fee-for-Service	1760541569	1760541569	1	16	RETINA INSTITUTE OF CALIFORN	11/22/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2240 PLAZA BLVD	F-G	NATIONAL CITY	CA	91950	5164	37	06073	32.67873894	-117.0818176	San Diego County
116636	Fee-for-Service	1508828963	1508828963	1	1	RIVERSIDE EYE SPECIALIST	9/2/2020	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4605 BROCKTON AVENUE	100	RIVERSIDE	CA	92506	0106	33	06065	33.97611422	-117.3860257	Riverside County
116687	Fee-for-Service	1518021369	1518021369	1	1	RAISZDADEH, RAMIN MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88341	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
116713	Fee-for-Service	1144419615	1144419615	1	1	RASKEY, WENDY B PHD	5/20/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
116746	Fee-for-Service	1720550056	1720550056	1	2	RENATO V. MUNGCAL, M.D., INC	12/27/2018	261QP2300X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	.	133 S VERMONT AVE	None	LOS ANGELES	CA	90004	5904	19	06037	34.071714	-118.2917085	Los Angeles County
116753	Fee-for-Service	1124106802	1124106802	1	1	RAMADOSS, INDIRA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76779	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
116766	Fee-for-Service	1245328053	1245328053	1	1	RICH, CHRISTOPHER C MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
116767	Fee-for-Service	1093007395	1093007395	1	1	ROBINSON, MAKEDA L MD	2/22/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	123911	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116780	Fee-for-Service	1457680738	1457680738	1	1	RUSKIN, RACHEL MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115368	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
116789	Fee-for-Service	1639270051	1639270051	1	1	REGULLANO, JOSE B MD	4/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41468	01	General Practice	0	In state provider	None	2101 W BEVERLY BLVD	STE 202	MONTEBELLO	CA	90640	3951	19	06037	34.02044497	-118.1217168	Los Angeles County
116811	Fee-for-Service	1710073697	1710073697	1	1	ROMERO, JUDITH B MD	6/14/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	73488	None	None	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
116850	Fee-for-Service	1396324596	1396324596	1	1	RAFFI, LIZA R MD	5/16/2024	207R00000X	NA	Other	026	PHYSICIANS	180752	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
116856	Fee-for-Service	1881184026	1881184026	1	1	R.W. WEBER, M.D., A MEDICAL	5/13/2019	193400000X	NA	Other	026	PHYSICIANS	None	68	Hematology	0	In state provider	CORPORATION	1800 SULLIVAN AVE	RM 603	DALY CITY	CA	94015	2226	41	06081	37.68077723	-122.4728941	San Mateo County
116864	Fee-for-Service	1952968323	1952968323	1	1	REDDY, HARIKA M MD	8/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175985	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
116871	Fee-for-Service	1053469072	1053469072	1	1	ROY, DOLLY B MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86956	13	Neurology (M.D. only)	0	In state provider	None	1328 16TH ST	SECOND FL	SANTA MONICA	CA	90404	1804	19	06037	34.02632404	-118.4846904	Los Angeles County
116878	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	6/21/2021	261QM1300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
116894	Fee-for-Service	1013965441	1013965441	1	1	ROSELLINI, MICHAEL D MD DO	6/8/2021	2085B0100X	NA	MRI Provider	026	PHYSICIANS	55002	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
116899	Fee-for-Service	1760541569	1760541569	1	16	RETINA INSTITUTE OF CALIFORN	11/22/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 PLAZA BLVD	F-G	NATIONAL CITY	CA	91950	5164	37	06073	32.67873894	-117.0818176	San Diego County
116939	Fee-for-Service	1801308663	1801308663	1	1	REYES, GINA M CRNA	5/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
116972	Fee-for-Service	1093823221	1093823221	1	3	ROOK, RONALD PHD	12/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1700 WASHINGTON	None	COLTON	CA	92324	4619	36	06071	34.04838255	-117.299052	San Bernardino County
116984	Fee-for-Service	1043203102	1043203102	1	1	REGENTS/UCDPBG/IM GASTRO	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
117036	Fee-for-Service	1821021981	1821021981	1	1	ROY, ROSALINDA A MD	2/14/1997	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	42697	01	General Practice	0	In state provider	None	16063 VANOWEN ST	None	VAN NUYS	CA	91406	4810	19	06037	34.1939643	-118.4831734	Los Angeles County
117054	Fee-for-Service	1245328053	1245328053	1	1	RICH, CHRISTOPHER C MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	26	Psychiatry (child)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
117067	Fee-for-Service	1790388486	1790388486	1	1	RUBIN, TESSA R NP	2/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117084	Fee-for-Service	1508063942	1508063942	1	1	ROSENFELD, SCOTT B MD	7/1/2021	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
117110	Fee-for-Service	1255805636	1255805636	1	1	REY, MICHELLE K CNM	8/28/2020	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1881 BUSINESS CENTER DR	SUITE 8A	SAN BERNARDINO	CA	92408	3448	36	06071	34.06846141	-117.2811029	San Bernardino County
117149	Fee-for-Service	1629001763	1629001763	1	1	REIMNITZ, JOEL D	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	42241	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
117154	Fee-for-Service	1811640980	1811640980	1	1	RAINBOW CHUNG-OU, MD, A PROF	3/5/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	ESSIONAL CORPORATION	4195 CHINO HILLS PKWY	STE H	CHINO HILLS	CA	91709	2618	36	06071	33.98254452	-117.713142	San Bernardino County
117164	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	3/11/2025	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
117167	Fee-for-Service	1629085964	1629085964	1	1	RILEY,REBECCA A MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56046	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
117178	Fee-for-Service	1568880136	1568880136	1	1	RHAYEM, WISSAM MD	11/10/2021	207P00000X	NA	Other	026	PHYSICIANS	173652	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
117182	Fee-for-Service	1225663008	1225663008	1	1	RAMSAY, STEPHANIE R	12/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
117212	Fee-for-Service	1073507018	1073507018	1	1	RUMERY, CHRISTOPHER G MD	6/30/1991	207L00000X	NA	Other	026	PHYSICIANS	71039	01	General Practice	0	In state provider	None	6608 MERCY CT	None	FAIR OAKS	CA	95628	3133	34	06067	38.665917	-121.3106895	Sacramento County
117260	Fee-for-Service	1992366579	1992366579	1	1	RIZZO, LUCIEN A MD	4/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176728	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
117282	Fee-for-Service	1801969829	1801969829	1	1	ROBACK, MARK T DO	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10324	08	Family Practice	0	In state provider	None	3306 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239845	-124.1360414	Humboldt County
117324	Fee-for-Service	1821021981	1821021981	1	1	ROY, ROSALINDA A MD	2/14/1997	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	42697	40	Pediatrics	0	In state provider	None	16063 VANOWEN ST	None	VAN NUYS	CA	91406	4810	19	06037	34.1939643	-118.4831734	Los Angeles County
117337	Fee-for-Service	1013361179	1013361179	1	1	RODRIGUEZ, JOSE D MD	7/1/2022	208200000X	NA	General Surgery	026	PHYSICIANS	178413	None	None	0	In state provider	None	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	37	06073	32.80027449	-117.153846	San Diego County
117356	Fee-for-Service	1689919722	1689919722	1	1	ROSENTHAL, MARC MD	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50235	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
117359	Fee-for-Service	1598875775	1598875775	1	1	RAFII, MICHAEL S MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94804	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
117368	Fee-for-Service	1578046173	1578046173	1	1	REINHOLT, ELIZABETH A CNM	1/30/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	NM	2760 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700542	-119.790868	Fresno County
117406	Fee-for-Service	1003975715	1003975715	1	1	REYES, TERESA C OD	5/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27350 IRIS AVE	MOB 1	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
117453	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	2/9/2021	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
117531	Fee-for-Service	1881004810	1881004810	1	1	RAMAKRISHNA, SATVIK MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141276	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117550	Fee-for-Service	1710065933	1710065933	1	11	RADYS CHILDRENS HOSPITAL	1/14/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
117553	Fee-for-Service	1184795007	1184795007	1	1	RAMIREZ, JORGE A MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61604	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
117559	Fee-for-Service	1588161178	1588161178	1	1	RYAN, JOSEPH S MD	10/16/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	164039	68	Hematology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
117608	Fee-for-Service	1275203101	1275203101	1	1	RAPID HOME HEALTH CARE, INC	7/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 311	GLENDALE	CA	91203	2656	19	06037	34.14652066	-118.2549229	Los Angeles County
117621	Fee-for-Service	1467530212	1467530212	1	1	RICHARDS, JACQUELINE MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	58115	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
117622	Fee-for-Service	1932223831	1932223831	1	1	RAHMAN, KAZI H MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86409	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
117632	Fee-for-Service	1871780445	1871780445	1	1	RIVERA, JENNIFER N MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115972	08	Family Practice	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
117634	Fee-for-Service	1366670515	1366670515	1	1	RAZMARA, ALI MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126467	13	Neurology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
117649	Fee-for-Service	1497788772	1497788772	1	1	ROZENDAL, FREDERICK G PHD	8/13/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	946 IRVING ST	SUITE D	SAN FRANCISCO	CA	94122	2207	38	06075	37.7640023	-122.4681781	San Francisco County
117720	Fee-for-Service	1235253576	1235253576	1	1	REECE, EDWARD A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20799	41	Internal Medicine	0	In state provider	None	8135 PAINTER AVE	STE 206	WHITTIER	CA	90602	3167	19	06037	33.965829	-118.032738	Los Angeles County
117742	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	4/8/2025	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
117821	Fee-for-Service	1154305977	1154305977	1	1	RICHARDSON, ALVIE C MD	3/26/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160063	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
117891	Fee-for-Service	1376527762	1376527762	1	1	RASMUSSEN, MARK D MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80885	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
117897	Fee-for-Service	1144213232	1144213232	1	1	REGENTS/UCDPBG/FAM PRACT	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
117930	Fee-for-Service	1083940522	1083940522	1	1	RAYA HOFFMAN, TERRY G CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	921 PACIFIC COAST HWY	None	SEAL BEACH	CA	90740	6244	30	06059	33.74418902	-118.1018883	Orange County
117938	Fee-for-Service	1285651745	1285651745	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2440 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54046763	-119.83553	Fresno County
117943	Fee-for-Service	1710913231	1710913231	1	5	REDWOOD FAM DERMATOLOGY MEDI	9/15/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	555 DORA ST	None	UKIAH	CA	95482	5424	23	06045	39.14592307	-123.211583	Mendocino County
117979	Fee-for-Service	1194827451	1194827451	1	1	ROSEBUD COMMUNITY HOSPITAL	6/29/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	383 N 17TH AVE	None	FORSYTH	MT	59327	7971	00	None	46.271907	-106.6704975	Rosebud County
117985	Fee-for-Service	1043253511	1043253511	1	1	ROBERT PARRIS	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
118030	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	10/4/2023	261QM1300X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
118086	Fee-for-Service	1760541569	1760541569	1	15	RETINA INSTITUTE OF CALIFORN	9/12/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1950 SUNNY CREST DR	3200	FULLERTON	CA	92856	3517	30	06059	33.89240507	-117.9313904	Orange County
118087	Fee-for-Service	1710065933	1710065933	1	4	RADYS CHILDRENS HOSPITAL	10/25/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	37	06073	32.74957853	-117.101439	San Diego County
118091	Fee-for-Service	1124407028	1124407028	1	1	RENELLA, KRISTA H LMFT	7/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9625 GULLO AVE	None	ARLETA	CA	91331	5253	19	06037	34.24549525	-118.4447791	Los Angeles County
118109	Fee-for-Service	1669595096	1669595096	1	1	ROUHE, HELENA L LMFT	7/31/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44238	-	NOT APPLICABLE	0	In state provider	None	2603 CAMINO RAMON	STE 200	SAN RAMON	CA	94583	9137	07	06013	37.76856551	-121.9609999	Contra Costa County
118151	Fee-for-Service	1629484811	1629484811	1	1	RAHEEMULLAH, AMER MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148450	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118209	Fee-for-Service	1083746259	1083746259	1	1	RESOURCE ANESTHESIOLOGY	6/10/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES OF CA AMC	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
118226	Fee-for-Service	1285651745	1285651745	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2440 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54046763	-119.83553	Fresno County
118231	Fee-for-Service	1932346301	1932346301	1	1	RAYCHEV, RADOSLAV I MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107959	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	6975	19	06037	34.06473399	-118.445865	Los Angeles County
118280	Fee-for-Service	1285834242	1285834242	1	1	REED, LYNDA L NP	11/24/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	347860	-	NOT APPLICABLE	0	In state provider	None	540 S EREMLAND DR	None	COVINA	CA	91763	3186	19	06037	34.079904	-117.8863235	Los Angeles County
118319	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	8/15/2023	261QM1300X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
118320	Fee-for-Service	1750743282	1750743282	1	1	REISCH, JAMIE DO	11/6/2019	207P00000X	NA	Other	026	PHYSICIANS	15945	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
118334	Fee-for-Service	1821403049	1821403049	1	1	RONG, JUAN MD	8/26/2020	207ZP0102X	NA	Other	026	PHYSICIANS	144144	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
118343	Fee-for-Service	1184729238	1184729238	1	1	RASMUSSEN, JOHN K MD	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	334 S PATTERSON AVE	STE 130	SANTA BARBARA	CA	93111	2400	42	06083	34.43376368	-119.8092445	Santa Barbara County
118367	Fee-for-Service	1609063957	1609063957	1	1	RASHID, IQBAL MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144648	36	Psychiatry	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
118373	Fee-for-Service	1760541569	1760541569	1	15	RETINA INSTITUTE OF CALIFORN	9/12/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1950 SUNNY CREST DR	3200	FULLERTON	CA	92856	3517	30	06059	33.89240507	-117.9313904	Orange County
118392	Fee-for-Service	1043317209	1043317209	1	1	REEVES, STUART G DPM	6/1/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	902 FLORIN RD	STE A	SACRAMENTO	CA	95831	3501	34	06067	38.49641384	-121.5265381	Sacramento County
118394	Fee-for-Service	1396784740	1396784740	1	1	RAOUFI, KAMBIZ MD FACP	9/14/2004	207R00000X	NA	Other	026	PHYSICIANS	80404	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
118409	Fee-for-Service	1497193585	1497193585	1	1	ROBERTS, ETHAN P PSYD	9/13/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
118425	Fee-for-Service	1285759738	1285759738	1	1	REDDY, PRASHANTI MD	8/30/2020	207ZP0101X	NA	Other	026	PHYSICIANS	98226	22	Pathology (M.D. only)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
118440	Fee-for-Service	1629484811	1629484811	1	1	RAHEEMULLAH, AMER MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148450	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118490	Fee-for-Service	1821418468	1821418468	1	1	RICHARDSON, CHRISTOPHER C DO	8/13/2020	207R00000X	NA	Other	026	PHYSICIANS	18177	41	Internal Medicine	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
118495	Fee-for-Service	1891899183	1891899183	1	1	RANDALL, ROBIN	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	54103	36	Psychiatry	0	In state provider	None	10850 MACARTHUR BLVD	STE 300	OAKLAND	CA	94605	5266	01	06001	37.7414325	-122.1498379	Alameda County
118515	Fee-for-Service	1285651745	1285651745	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2440 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54046763	-119.83553	Fresno County
118539	Fee-for-Service	1811075906	1811075906	1	1	RAFFEL, RICHARD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34351	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
118545	Fee-for-Service	1194958389	1194958389	1	1	REIMER, GRAHAM MD	5/21/2019	208VP0000X	NA	Other	026	PHYSICIANS	142466	05	Anesthesiology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
118555	Fee-for-Service	1518132067	1518132067	1	1	RIZAL, ABISHEK R MD	7/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143265	36	Psychiatry	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
118569	Fee-for-Service	1699869412	1699869412	1	1	RAO, MONISHA MD	10/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72862	40	Pediatrics	0	In state provider	None	2438 N PONDEROSA DR	STE C209	CAMARILLO	CA	93010	2374	56	06111	34.24219545	-119.0227012	Ventura County
118578	Fee-for-Service	1376970988	1376970988	1	1	RUFFIN, CHRISTOPHER O LCSW	6/17/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
118590	Fee-for-Service	1508982729	1508982729	1	1	RAFFETY SCHATZ, SHAUNA B	3/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
118606	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	2/9/2021	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
118632	Fee-for-Service	1184722183	1184722183	1	1	REDDY, MOHAN P MD FACP	5/24/2019	207K00000X	NA	Other	026	PHYSICIANS	26245	03	Allergy	0	In state provider	None	750 W OLIVE AVE	SUITE 103	MERCED	CA	95348	2436	24	06047	37.31917248	-120.480657	Merced County
118647	Fee-for-Service	1285492793	1285492793	1	1	ROBERT ASSIBEY MD APMC	10/2/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5924 KIM CT	None	LIVERMORE	CA	94550	8116	01	06001	37.69382896	-121.7194723	Alameda County
118676	Fee-for-Service	1093732554	1093732554	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	300 S LEON S PETERS BLVD	None	FOWLER	CA	93625	2439	10	06019	0	0	None
118684	Fee-for-Service	1184796922	1184796922	1	1	RIVERA, EDNA S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	39821	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
118752	Fee-for-Service	1336607688	1336607688	1	1	RAUCH, KELLY	3/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
118758	Fee-for-Service	1023310109	1023310109	1	1	RODRIGUEZ, JULIE LMFT	3/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	4645 E ANAHEIM ST	None	LONG BEACH	CA	90804	3122	19	06037	33.78261647	-118.1384685	Los Angeles County
118787	Fee-for-Service	1760541569	1760541569	1	28	RETINA INSTITUTE OF CALIFORN	2/21/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	3440 LOMITA BLVD	100	TORRANCE	CA	90505	4801	19	06037	33.81328127	-118.3452927	Los Angeles County
118792	Fee-for-Service	1467188201	1467188201	1	1	RAJAN GOYAL MD INC	2/5/2025	207RP1001X	NA	Pulmonology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5531 BUSINESS PARK S	201A	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
118798	Fee-for-Service	1891182903	1891182903	1	1	RODRIGUEZ RUIZ, CHRISTINA M	5/18/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161439	None	None	0	In state provider	D	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118802	Fee-for-Service	1285651745	1285651745	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2440 W TAHOE	None	CARUTHERS	CA	93609	9476	10	06019	36.54046763	-119.83553	Fresno County
118850	Fee-for-Service	1568748622	1568748622	1	1	ROTH, CHRISTINA T	4/22/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
118851	Fee-for-Service	1487036182	1487036182	1	1	REDNIKOV, VLADIMIR	5/2/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
118895	Fee-for-Service	1952998973	1952998973	1	1	REGENTS OF THE UNIVERSITY OF	2/9/2021	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
118907	Fee-for-Service	1134972110	1134972110	1	1	RAQUID, SWEET FAYE R NP	3/5/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118908	Fee-for-Service	1902281629	1902281629	1	1	RUDGE, DEREK MD	10/13/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	170836	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
118935	Fee-for-Service	1689114068	1689114068	1	1	RODRIGUEZ, JASMIN LMFT	11/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
118941	Fee-for-Service	1487608931	1487608931	1	9	RENAISSANCE IMAGING MED	9/1/2017	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1245 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90017	4812	19	06037	34.05362775	-118.2661889	Los Angeles County
118964	Fee-for-Service	1093732554	1093732554	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	300 S LEON S PETERS BLVD	None	FOWLER	CA	93625	2439	10	06019	0	0	None
119002	Fee-for-Service	1134294788	1134294788	1	1	RUIZ-RESTREPO, LUIS E M D	1/23/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41382	40	Pediatrics	0	In state provider	INC	116 WEST E ST	None	TEHACHAPI	CA	93561	1608	15	06029	35.1300316	-118.4487308	Kern County
119070	Fee-for-Service	1225371818	1225371818	1	1	RAJ, MARC A DO	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15518	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LANE	STE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
119076	Fee-for-Service	1760541569	1760541569	1	28	RETINA INSTITUTE OF CALIFORN	2/21/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3440 LOMITA BLVD	100	TORRANCE	CA	90505	4801	19	06037	33.81328127	-118.3452927	Los Angeles County
119078	Fee-for-Service	1467188201	1467188201	1	1	RAJAN GOYAL MD INC	2/5/2025	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5531 BUSINESS PARK S	201A	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
119090	Fee-for-Service	1730392887	1730392887	1	1	RANGAPPA, SUNIL MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93249	41	Internal Medicine	0	In state provider	None	3975 JACKSON STREET	SUITE 309	RIVERSIDE	CA	92503	3951	33	06065	33.92729721	-117.4413503	Riverside County
119128	Fee-for-Service	1801963467	1801963467	1	1	RIDGE, TAMARA	9/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
119129	Fee-for-Service	1578942207	1578942207	1	1	RAMIREZ, CLAUDIA LMFT	2/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
119204	Fee-for-Service	1508252206	1508252206	1	1	REYNOLDS, ALEXANDRA H MD	11/5/2019	207L00000X	NA	Other	026	PHYSICIANS	164428	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
119218	Fee-for-Service	1538172424	1538172424	1	1	REEVE, ROBERT B MD	4/30/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	59401	None	None	0	In state provider	None	6009 PENTZ RD	STE A	PARADISE	CA	95969	5542	04	06007	39.75746555	-121.5723505	Butte County
119239	Fee-for-Service	1003344615	1003344615	1	1	ROMANOV, REBECCA E MD	6/30/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161469	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
119241	Fee-for-Service	1356366959	1356366959	1	1	RALPHS GROCERY COMPANY	6/26/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #206	5429 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	3405	19	06037	34.10177197	-118.3082873	Los Angeles County
119249	Fee-for-Service	1093732554	1093732554	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	300 S LEON S PETERS BLVD	None	FOWLER	CA	93625	2439	10	06019	0	0	None
119271	Fee-for-Service	1306868252	1306868252	1	1	ROJTER, SERGIO E MD	2/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63254	None	None	0	In state provider	A PROFESSIONAL CORP	1245 WILSHIRE BLVD	STE 707	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
119279	Fee-for-Service	1235347188	1235347188	1	1	REEHAL, VICKRAM S MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87717	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
119365	Fee-for-Service	1760742357	1760742357	1	1	REES, GALYA MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127479	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
119367	Fee-for-Service	1467188201	1467188201	1	1	RAJAN GOYAL MD INC	2/5/2025	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5531 BUSINESS PARK S	201A	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
119371	Fee-for-Service	1225685563	1225685563	1	1	RAMIREZ, ALEJANDRO MD	8/23/2024	207P00000X	NA	Other	026	PHYSICIANS	184335	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
119412	Fee-for-Service	1629495148	1629495148	1	1	ROYAL HOSPICE CARE INC	8/10/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	412 W BROADWAY	SUITE 305	GLENDALE	CA	91204	1297	19	06037	34.14682413	-118.261622	Los Angeles County
119475	Fee-for-Service	1346988557	1346988557	1	1	RELIABLE MEDICAL TRANSPORT	9/2/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW RTE	218	RANCHO CUCAMONGA	CA	91730	4810	36	06071	34.09917725	-117.5708877	San Bernardino County
119491	Fee-for-Service	1407405673	1407405673	1	1	RAY, MICAELA C CNM	6/22/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
119509	Fee-for-Service	1215670716	1215670716	1	1	RADOMSKI, LENNY R MD	7/6/2022	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	177009	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119537	Fee-for-Service	1093732554	1093732554	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	300 S LEON S PETERS BLVD	None	FOWLER	CA	93625	2439	10	06019	0	0	None
119570	Fee-for-Service	1235347188	1235347188	1	1	REEHAL, VICKRAM S MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87717	83	Rheumatology	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
119607	Fee-for-Service	1528295789	1528295789	1	1	REDWOOD, MARCIA C MD	9/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107570	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
119684	Fee-for-Service	1578666509	1578666509	1	1	RAUSCH, DORI N MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96531	07	Dermatology	0	In state provider	None	230 PROSPECT PL	STE 260	CORONADO	CA	92118	1987	37	06073	32.69468235	-117.1677128	San Diego County
119688	Fee-for-Service	1982012316	1982012316	1	1	REYES, SONIA-MARIA MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	154933	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
119699	Fee-for-Service	1629495148	1629495148	1	1	ROYAL HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	412 W BROADWAY	SUITE 305	GLENDALE	CA	91204	1297	19	06037	34.14682413	-118.261622	Los Angeles County
119736	Fee-for-Service	1699718312	1699718312	1	1	ROSEVILLE CARDIOLOGY	9/23/2003	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL ASSOC INC	2 MEDICAL PLAZA DR	STE 175	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
119761	Fee-for-Service	1730180415	1730180415	1	2	RIVERSIDE MEDICAL CLINIC	12/16/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6250 CLAY ST	None	RIVERSIDE	CA	92509	6005	33	06065	33.974892	-117.462183	Riverside County
119820	Fee-for-Service	1477131969	1477131969	1	1	ROWSE, STEPHEN MD	8/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
119829	Fee-for-Service	1689100224	1689100224	1	1	REES, JEFFREY MD	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
119835	Fee-for-Service	1538184130	1538184130	1	1	RALPHS GORCERY COOMPANY	4/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #720	30019 HAWTHORNE BLVD	None	PALOS VERDES EST	CA	90275	5467	19	06037	33.76019434	-118.394138	Los Angeles County
119843	Fee-for-Service	1467524215	1467524215	1	1	RAY, COURTNEY J MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53223	18	Ophthalmology	0	In state provider	None	160 GREEN VALLEY ROAD	#202	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
119848	Fee-for-Service	1619280633	1619280633	1	1	ROMAN, JUULA M MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125205	41	Internal Medicine	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
119881	Fee-for-Service	1558706218	1558706218	1	1	ROBIN LENZ D.P.M	1/9/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 TRENTON RD	None	BROWNS MILLS	NJ	08015	1705	00	None	39.97694153	-74.58595059	Burlington County
119892	Fee-for-Service	1346937133	1346937133	1	1	RANCHO MIRAGE PEDIATRICS, IN	4/24/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	C.	35900 BOB HOPE DRIVE	SUITE 140	RANCHO MIRAGE	CA	92270	1767	33	06065	33.790311	-116.405864	Riverside County
119900	Fee-for-Service	1821124868	1821124868	1	1	RSCR CALIFORNIA, INC	3/4/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	604 S WASHINGTON AVE	None	FULLERTON	CA	92832	2635	30	06059	33.86526434	-117.9378552	Orange County
119948	Fee-for-Service	1205090842	1205090842	1	1	ROCHE, CASEY M MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
119953	Fee-for-Service	1851586499	1851586499	1	1	ROGERS, JOHN	11/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
119957	Fee-for-Service	1669962635	1669962635	1	1	ROEPKE, ABBEY N NP	4/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119967	Fee-for-Service	1548680192	1548680192	1	1	RANA, RAMNEEK K MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150640	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
119968	Fee-for-Service	1306301304	1306301304	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	504	LOS ANGELES	CA	90017	3906	19	06037	34.05270508	-118.2641005	Los Angeles County
119969	Fee-for-Service	1821279233	1821279233	1	1	REEHEL, PAUL S MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87834	08	Family Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
119982	Fee-for-Service	1376616151	1376616151	1	1	ROSENBLUM, CARLA S CRNA	6/9/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
119986	Fee-for-Service	1578904330	1578904330	1	1	RAO, KUMUDA P MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132331	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
120004	Fee-for-Service	1437647583	1437647583	1	1	REZA, MOHONA MD	9/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	186697	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
120032	Fee-for-Service	1336404128	1336404128	1	1	RAISZADEH,FARBOD	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVENUE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
120042	Fee-for-Service	1083786065	1083786065	1	1	ROMINES AND ROMINES DPM	11/20/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9121 FOLSOM BLVD	STE G	SACRAMENTO	CA	95826	2473	34	06067	38.559906	-121.3624125	Sacramento County
120049	Fee-for-Service	1730180415	1730180415	1	2	RIVERSIDE MEDICAL CLINIC	12/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6250 CLAY ST	None	RIVERSIDE	CA	92509	6005	33	06065	33.974892	-117.462183	Riverside County
120090	Fee-for-Service	1962030106	1962030106	1	1	ROSSI, JORDAN M MD	8/16/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180662	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
120117	Fee-for-Service	1629181730	1629181730	1	1	RAVIN, ROSS R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81544	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
120171	Fee-for-Service	1104264316	1104264316	1	1	ROGERS, MATTHEW T MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
120175	Fee-for-Service	1659415016	1659415016	1	1	RAMOS, CARLOS E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7426 SW 48TH ST	None	MIAMI	FL	33155	4415	00	None	25.72538283	-80.31468521	Miami-Dade County
120249	Fee-for-Service	1609936483	1609936483	1	1	RASTEGAR, JOHN H MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53847	08	Family Practice	0	In state provider	VERMNT FMLY CARE MED CLI	1300 N VERMONT AVE	STE 310	LOS ANGELES	CA	90029	1760	19	06037	34.0956033	-118.2916918	Los Angeles County
120257	Fee-for-Service	1306301304	1306301304	1	1	RETINA INSTITUTE OF CALIFORN	1/19/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	504	LOS ANGELES	CA	90017	3906	19	06037	34.05270508	-118.2641005	Los Angeles County
120301	Fee-for-Service	1881058410	1881058410	1	1	RANGWALA, MARIAM M MD	7/2/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	153006	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
120337	Fee-for-Service	1730180415	1730180415	1	2	RIVERSIDE MEDICAL CLINIC	8/22/2022	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6250 CLAY ST	None	RIVERSIDE	CA	92509	6005	33	06065	33.974892	-117.462183	Riverside County
120342	Fee-for-Service	1164412433	1164412433	1	1	REED, THOMAS D MD	3/31/1982	2080P0203X	NA	Other	026	PHYSICIANS	40686	40	Pediatrics	0	In state provider	None	51ST & GROVE STS	None	OAKLAND	CA	94609	0000	01	06001	37.83637691	-122.2678962	Alameda County
120352	Fee-for-Service	1043474695	1043474695	1	1	RAJARATNAM, CRISANJALI R MD	4/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113273	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
120380	Fee-for-Service	1609986363	1609986363	1	1	RALEY'S	12/21/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	211 W EAST AVE	None	CHICO	CA	95926	7202	04	06007	39.75557148	-121.8632682	Butte County
120400	Fee-for-Service	1336167550	1336167550	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
120402	Fee-for-Service	1700893294	1700893294	1	1	REYNOLDS, STEVEN H DO	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	6475	01	General Practice	0	In state provider	None	5977 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
120447	Fee-for-Service	1720266539	1720266539	1	1	RHOADS, KIM FELDER MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70811	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
120479	Fee-for-Service	1972707024	1972707024	1	1	RAVARI-ABADIAN, AFSOON	1/14/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96614	08	Family Practice	0	In state provider	MD	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
120481	Fee-for-Service	1588648968	1588648968	1	1	ROSENFIELD, ALAN L MD	9/29/1992	174400000X	NA	Other	026	PHYSICIANS	75293	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
120483	Fee-for-Service	1245678051	1245678051	1	1	RUDE, TEMITOPE O MD	6/27/2023	208800000X	NA	Other	026	PHYSICIANS	156737	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120535	Fee-for-Service	1508111709	1508111709	1	1	ROBBINS, LAURA K OD	11/18/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
120538	Fee-for-Service	1528042348	1528042348	1	1	ROEBKEN, CURTIS K MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	24747	47	Miscellaneous	0	In state provider	None	1125 SIR FRANCIS DRAKE	BLVD	KENTFIELD	CA	94904	1418	21	06041	37.95899686	-122.5520873	Marin County
120542	Fee-for-Service	1609936483	1609936483	1	1	RASTEGAR, JOHN H MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53847	40	Pediatrics	0	In state provider	VERMNT FMLY CARE MED CLI	1300 N VERMONT AVE	STE 310	LOS ANGELES	CA	90029	1760	19	06037	34.0956033	-118.2916918	Los Angeles County
120552	Fee-for-Service	1255310041	1255310041	1	1	ROSADO, ARIOSTO E MD	10/16/2019	207RC0200X	NA	Other	026	PHYSICIANS	152810	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
120635	Fee-for-Service	1245491349	1245491349	1	1	RYAN, HILLARY B MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110817	30	Radiology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
120639	Fee-for-Service	1912288309	1912288309	1	1	RANCHO PHYSICAL THERAPY, INC	12/8/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	6850 BROCKTON AVE	STE 212	RIVERSIDE	CA	92506	3808	33	06065	33.9493261	-117.3967206	Riverside County
120676	Fee-for-Service	1699799833	1699799833	1	1	RAO, VIJENDRA J MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91225	42	Nuclear Medicine	0	In state provider	None	8227 RESEDA BLVD	None	RESEDA	CA	91335	1247	19	06037	34.220178	-118.536107	Los Angeles County
120687	Fee-for-Service	1336167550	1336167550	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
120689	Fee-for-Service	1043241821	1043241821	1	1	RUIZ, RUBEN MD AMC	1/31/1992	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FAMILIAR	403 W F ST	None	ONTARIO	CA	91762	3207	36	06071	34.069293	-117.655065	San Bernardino County
120704	Fee-for-Service	1013915669	1013915669	1	1	ROSNER, HOWARD L MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86552	05	Anesthesiology	0	In state provider	None	3530 WILSHIRE BLVD	STE 350	LOS ANGELES	CA	90010	2335	19	06037	34.06171652	-118.301427	Los Angeles County
120710	Fee-for-Service	1124117254	1124117254	1	1	RENELLA, PIERANGELO MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86410	None	None	0	In state provider	None	445 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78155791	-117.8673241	Orange County
120738	Fee-for-Service	1023045234	1023045234	1	1	RAZI, DAVID F MD INC	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53431	40	Pediatrics	0	In state provider	None	3451 W CENTURY BLVD	None	INGLEWOOD	CA	90303	1218	19	06037	33.948198	-118.3321575	Los Angeles County
120754	Fee-for-Service	1104901867	1104901867	1	1	RAY, ANJANA MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33064	40	Pediatrics	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
120757	Fee-for-Service	1568687374	1568687374	1	1	ROFAGHA, SORAYA MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97120	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
120766	Fee-for-Service	1588648968	1588648968	1	1	ROSENFIELD, ALAN L MD	9/29/1992	174400000X	NA	Other	026	PHYSICIANS	75293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
120826	Fee-for-Service	1528042348	1528042348	1	1	ROEBKEN, CURTIS K MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	24747	41	Internal Medicine	0	In state provider	None	1125 SIR FRANCIS DRAKE	BLVD	KENTFIELD	CA	94904	1418	21	06041	37.95899686	-122.5520873	Marin County
120849	Fee-for-Service	1679503940	1679503940	1	1	RAMOS, VENUS F MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72017	25	Physical Medicine and Rehabilitation	0	In state provider	None	2840 LONG BEACH BLVD	STE 130	LONG BEACH	CA	90806	1593	19	06037	33.808743	-118.189341	Los Angeles County
120863	Fee-for-Service	1467401638	1467401638	1	1	RAMIREZ, SARA A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85658	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	31862 COAST HWY	STE 302	LAGUNA BEACH	CA	92651	6772	30	06059	33.49991814	-117.7423921	Orange County
120875	Fee-for-Service	1811001217	1811001217	1	1	ROBINSON, PETER J MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	37254	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1414 S GRAND AVE	STE 475	LOS ANGELES	CA	90015	3079	19	06037	34.03661142	-118.2657227	Los Angeles County
120880	Fee-for-Service	1396118568	1396118568	1	1	RDM FOREVER LLC	7/2/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4774 RIVERSIDE DR	SUITE F	CHINO	CA	91710	3339	36	06071	34.0190245	-117.7009065	San Bernardino County
120883	Fee-for-Service	1861924326	1861924326	1	1	RAO, APPAJOSULA MD	10/28/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
120962	Fee-for-Service	1508068958	1508068958	1	1	RANDOLPH, SAMUEL M MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97396	30	Radiology	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
120963	Fee-for-Service	1699799833	1699799833	1	1	RAO, VIJENDRA J MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91225	30	Radiology	0	In state provider	None	8227 RESEDA BLVD	None	RESEDA	CA	91335	1247	19	06037	34.220178	-118.536107	Los Angeles County
120973	Fee-for-Service	1982274940	1982274940	1	1	REINERT, MEGAN U CCC-SLP	2/11/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
121018	Fee-for-Service	1528333077	1528333077	1	1	RABIZADEH, FARIBA LMFT	11/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12304 SANTA MONICA BLVD	SUITE 314	LOS ANGELES	CA	90025	2551	19	06037	34.03948285	-118.4656304	Los Angeles County
121025	Fee-for-Service	1023045234	1023045234	1	1	RAZI, DAVID F MD INC	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53431	41	Internal Medicine	0	In state provider	None	3451 W CENTURY BLVD	None	INGLEWOOD	CA	90303	1218	19	06037	33.948198	-118.3321575	Los Angeles County
121055	Fee-for-Service	1588648968	1588648968	1	1	ROSENFIELD, ALAN L MD	9/29/1992	174400000X	NA	Other	026	PHYSICIANS	75293	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
121072	Fee-for-Service	1013941046	1013941046	1	1	REA, NICOLE J	3/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
121127	Fee-for-Service	1811347339	1811347339	1	1	RENFROW, CHRISTOPHER R	12/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
121140	Fee-for-Service	1669508206	1669508206	1	1	RAJA, SHEELA MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77301	41	Internal Medicine	0	In state provider	None	12291 WASHINGTON BLVD	STE 300	WHITTIER	CA	90606	2549	19	06037	33.96734104	-118.0508773	Los Angeles County
121162	Fee-for-Service	1205085446	1205085446	1	1	ROJAS, DAVID	10/17/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
121173	Fee-for-Service	1396118568	1396118568	1	1	RDM FOREVER LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4774 RIVERSIDE DR	SUITE F	CHINO	CA	91710	3339	36	06071	34.0190245	-117.7009065	San Bernardino County
121187	Fee-for-Service	1750368163	1750368163	1	1	ROSSARO, LORENZO	4/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	68436	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
121190	Fee-for-Service	1780911495	1780911495	1	1	ROTTER, PHILIP S MD	6/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111831	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
121202	Fee-for-Service	1497707384	1497707384	1	1	RAUCHMAN, STEVEN H MD	10/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	54533	18	Ophthalmology	0	In state provider	None	11550 INDIAN HILLS RD	STE 341	MISSION HILLS	CA	91345	1203	19	06037	34.28024575	-118.4588775	Los Angeles County
121241	Fee-for-Service	1558183665	1558183665	1	1	RANGEL, TANICA TOLABOR CERT	10/30/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
121284	Fee-for-Service	1003312232	1003312232	1	1	RONDEAU, JUAN C	9/12/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175970	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
121304	Fee-for-Service	1730266685	1730266685	1	1	REZNIK, ELLA MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69401	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
121333	Fee-for-Service	1679303184	1679303184	1	1	RONQUILLO, GRETCHEN NP	11/18/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
121336	Fee-for-Service	1467548651	1467548651	1	1	ROY, JAMES F MD INC	7/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35406	41	Internal Medicine	0	In state provider	None	341 MAGNOLIA AVE	STE 207	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
121342	Fee-for-Service	1912550880	1912550880	1	1	RASTEGARI, BYRON DO	10/3/2022	390200000X	NA	Other	026	PHYSICIANS	20280	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
121343	Fee-for-Service	1285091991	1285091991	1	1	RAMOS-HAGGAN, ANNETTE NP	5/8/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
121375	Fee-for-Service	1235685041	1235685041	1	1	REGO, DIANA Z NP	1/4/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
121397	Fee-for-Service	1487608931	1487608931	1	7	RENAISSANCE IMAGING MED	5/29/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	500 S VIRGIL AVE	STE 102-103	LOS ANGELES	CA	90020	1404	19	06037	34.064964	-118.2870335	Los Angeles County
121414	Fee-for-Service	1992800312	1992800312	1	1	RICHARD D & JAMES S	7/1/1991	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ROSS PTRS	530 W DUNNE AVE	None	MORGAN HILL	CA	95037	4823	43	06085	37.12215262	-121.6601139	Santa Clara County
121433	Fee-for-Service	1568661627	1568661627	1	1	RICHARDSON, MICHAEL C MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100666	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
121470	Fee-for-Service	1679981237	1679981237	1	1	RANUCCI, ALICIA PSYD	9/20/2023	174400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
121499	Fee-for-Service	1063984318	1063984318	1	1	RIVERS, LYNN M CRNA	5/23/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
121540	Fee-for-Service	1548358344	1548358344	1	1	RODRIGUEZ, MARIA HELLEN	10/31/1985	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50241	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	850 S ATLANTIC BLVD	STE 301	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
121547	Fee-for-Service	1699041525	1699041525	1	1	RONY SALEM	4/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
121563	Fee-for-Service	1780898981	1780898981	1	1	RHEE, JOHN HA MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108907	30	Radiology	0	In state provider	None	23485 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2004	19	06037	34.42107219	-118.5628381	Los Angeles County
121581	Fee-for-Service	1972661387	1972661387	1	1	ROGERS, ELIZABETH E MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91161	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
121614	Fee-for-Service	1225074545	1225074545	1	1	ROGERS, PETER J MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	47822	22	Pathology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
121622	Fee-for-Service	1467548651	1467548651	1	1	ROY, JAMES F MD INC	7/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35406	10	Gastroenterology (M.D. only)	0	In state provider	None	341 MAGNOLIA AVE	STE 207	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
121655	Fee-for-Service	1467895839	1467895839	1	1	RUTATANGWA, ALICE K DO	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16346	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121662	Fee-for-Service	1710065933	1710065933	1	3	RADYS CHILDRENS HOSPITAL	10/25/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	5565 GROSSMONT CENTER	STE 2	LA MESA	CA	91942	3037	37	06073	32.77978322	-117.0094766	San Diego County
121668	Fee-for-Service	1700996469	1700996469	1	1	RALEYS	11/16/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 SOUTH MAIN ST	None	RED BLUFF	CA	96080	4338	52	06103	40.16302592	-122.2281015	Tehama County
121671	Fee-for-Service	1619296506	1619296506	2	1	REMEDY MEDICAL EQUIPMENT INC	5/7/2018	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6905 W PERSHING COURT	None	VISALIA	CA	93291	7945	54	06107	36.33894	-119.3681025	Tulare County
121682	Fee-for-Service	1770901613	1770901613	1	1	RAGSDALE & CLAYTON	8/10/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CENTERS INC	23000 ATLANTIC CIRCLE	None	MORENO VALLEY	CA	92553	5990	33	06065	33.93307833	-117.2610923	Riverside County
121685	Fee-for-Service	1487917068	1487917068	1	1	RICHARDSON, DAMIEN A MD	12/2/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161985	None	None	0	In state provider	None	2141 N HARBOR BLVD	SUITE 35000	FULLERTON	CA	92835	3616	30	06059	33.89443025	-117.9288328	Orange County
121740	Fee-for-Service	1235295502	1235295502	1	1	RALPHS GROCERY COMPANY	4/3/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #083	13321 E SOUTH ST	None	CERRITOS	CA	90703	7308	19	06037	33.85878045	-118.0476135	Los Angeles County
121767	Fee-for-Service	1528321239	1528321239	1	1	ROLON-ARROYO, BENJAMIN PHD	8/5/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
121776	Fee-for-Service	1497033344	1497033344	1	1	RAFTOPOULOS, EVANTHIS M PT	7/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
121847	Fee-for-Service	1235615881	1235615881	1	1	RECOUP HOME HEALTH	1/13/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4421 WEST RIVERSIDE DR	SUITE 204	BURBANK	CA	91505	4051	19	06037	34.15222602	-118.3487357	Los Angeles County
121870	Fee-for-Service	1497985923	1497985923	1	1	REYNOLDS, CARRIE MD	3/28/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	159796	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
121940	Fee-for-Service	1972538254	1972538254	1	1	REMMES, MICHELLE L MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39729	08	Family Practice	0	In state provider	None	3807 UNION AVE	None	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
121947	Fee-for-Service	1417214073	1417214073	1	1	REDDY, RYAN MD	10/16/2023	207UN0902X	NA	Other	026	PHYSICIANS	186907	None	None	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
121951	Fee-for-Service	1902193832	1902193832	1	1	RODRIGUEZ, NICOLAS R OD	12/21/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 E SANTA BARBARA ST	STE C	SANTA PAULA	CA	93060	2675	56	06111	34.35269772	-119.069955	Ventura County
121973	Fee-for-Service	1558107698	1558107698	1	1	RGTACS INC PROFESSIONAL CORP	10/18/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	ORATION	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
122005	Fee-for-Service	1053754499	1053754499	1	1	RIVERA, GASPAR MD	9/12/2017	390200000X	NA	Other	026	PHYSICIANS	132585	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
122027	Fee-for-Service	1770905739	1770905739	1	1	RESENDEZ, DENISE LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
122042	Fee-for-Service	1861889537	1861889537	1	1	ROBISON, TREAVOR MD	10/12/2021	2080P0203X	NA	Other	026	PHYSICIANS	145876	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
122046	Fee-for-Service	1952692287	1952692287	1	1	REE, MICHAEL H DO	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12562	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
122057	Fee-for-Service	1659447977	1659447977	1	1	RIVERA, ROBERT H MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67652	41	Internal Medicine	0	In state provider	None	401 S GLENOAKS BLVD	STE 101	BURBANK	CA	91502	2707	19	06037	34.18077992	-118.3029503	Los Angeles County
122087	Fee-for-Service	1386266724	1386266724	1	1	REZKALLA, NADER M MD	8/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185455	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
122100	Fee-for-Service	1841359585	1841359585	1	1	ROSENTHAL, MELISSA A MD	3/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96176	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
122111	Fee-for-Service	1336297373	1336297373	1	1	RODARTE, MONICA M MD	1/7/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89955	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
122122	Fee-for-Service	1811727423	1811727423	1	1	RONQUILLO, TERESA LMFT	2/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
122147	Fee-for-Service	1609079854	1609079854	1	1	REYES, SUSIE MD	10/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95187	41	Internal Medicine	0	In state provider	None	520 N PROSPECT AVE	STE 103	REDONDO BEACH	CA	90277	3033	19	06037	33.8529819	-118.3802954	Los Angeles County
122150	Fee-for-Service	1609253624	1609253624	1	1	RAINWATER, CRISTINA I LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
122186	Fee-for-Service	1932235942	1932235942	1	1	RSCR CALIFORNIA, INC	2/6/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HILL ROAD HOME	10162 HILL RD	None	GARDEN GROVE	CA	92840	1527	30	06059	33.79405635	-117.9558018	Orange County
122241	Fee-for-Service	1780001818	1780001818	1	1	ROBERTS, SCHON C MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2306	00	None	36.132948	-115.136874	Clark County
122261	Fee-for-Service	1558107698	1558107698	1	1	RGTACS INC PROFESSIONAL CORP	10/18/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	ORATION	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
122300	Fee-for-Service	1811016579	1811016579	1	1	ROLAND, CATHERINE CNP	3/8/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	79440 CORPORATE CENTER D	STE 108	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
122309	Fee-for-Service	1316292931	1316292931	1	1	RATTANAVICH, RUNGWASEE MD	9/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157364	45	Nephrology (Renal-Kidney)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
122334	Fee-for-Service	1083122972	1083122972	1	1	RO, SUSIE LCSW	7/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
122340	Fee-for-Service	1255427043	1255427043	1	1	ROBERTS, TREVOR M	9/23/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11121 SUN CENTER DR	None	RANCHO CORDOVA	CA	95670	6161	34	06067	38.595627	-121.270149	Sacramento County
122370	Fee-for-Service	1154550887	1154550887	1	1	RIVAS, MILADYS M	10/5/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH ST	SUITE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
122373	Fee-for-Service	1619995073	1619995073	1	1	RAPP, JEFFREY S MD	10/16/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	84267	41	Internal Medicine	0	In state provider	None	8635 W 3RD STREET	SUITE 1185W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
122456	Fee-for-Service	1780610832	1780610832	1	1	RUEL, THEODORE DUMONT MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78286	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
122465	Fee-for-Service	1346314648	1346314648	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTH CALIFORNIA I LLC	8139 ELK GROVE BLVD	SUITE 200	ELK GROVE	CA	95758	5519	34	06067	38.409687	-121.4071515	Sacramento County
122483	Fee-for-Service	1518144989	1518144989	1	1	ROSENBERG, RICHARD A DPM INC	10/24/2011	332BC3200X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 306	LONG BEACH	CA	90805	4595	19	06037	33.86018093	-118.1537163	Los Angeles County
122505	Fee-for-Service	1588026033	1588026033	1	1	RUIZ, JORGE L MD	8/7/2020	207L00000X	NA	Other	026	PHYSICIANS	152784	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
122533	Fee-for-Service	1972867984	1972867984	1	1	ROSENBLATT, DAVID M PHD	8/20/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1129 MARSH ST	None	SAN LUIS OBISPO	CA	93401	3323	40	06079	35.28151781	-120.6582022	San Luis Obispo County
122558	Fee-for-Service	1730410804	1730410804	1	1	ROSE, RICHARD L PT	10/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1401 EL MONTE WAY	None	DINUBA	CA	93618	9165	54	06107	36.54610751	-119.4108615	Tulare County
122596	Fee-for-Service	1346938628	1346938628	1	1	REANO, DESIREE ANGULO	7/17/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7611 PRINCESS DIANA CT	None	VALLEJO	CA	94591	8558	48	06095	38.13073478	-122.2111423	Solano County
122598	Fee-for-Service	1033229794	1033229794	1	1	RALEY'S	7/10/1978	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3001 TRAVIS BLVD	None	FAIRFIELD	CA	94534	3442	48	06095	38.25827221	-122.066432	Solano County
122612	Fee-for-Service	1497941454	1497941454	1	1	RAFAAT, KARIM T MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81002	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
122623	Fee-for-Service	1891890760	1891890760	1	1	RAMANATHAN, RANGASAMY MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41002	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
122627	Fee-for-Service	1396470175	1396470175	1	1	RAZAL, NEIL RYAN NP	11/14/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
122633	Fee-for-Service	1336171818	1336171818	1	1	REGENTS OF THE UNIVERSITY OF	11/1/2001	193200000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	101 THE CITY DR S	BLDG 55	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
122663	Fee-for-Service	1619995073	1619995073	1	1	RAPP, JEFFREY S MD	10/16/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	84267	77	Infectious Disease	0	In state provider	None	8635 W 3RD STREET	SUITE 1185W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
122697	Fee-for-Service	1558820340	1558820340	1	1	RUWALA, DHAVAL V DO	11/15/2023	282N00000X	NA	Hospitals	026	PHYSICIANS	21148	None	None	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
122708	Fee-for-Service	1790811289	1790811289	1	1	RIDGECREST REGIONAL HOSPITAL	7/20/1976	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1109 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	15	06029	35.641224	-117.669891	Kern County
122730	Fee-for-Service	1790783439	1790783439	1	1	RUSSELL R DD	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	11100 WARNER AVE	STE 306	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
122741	Fee-for-Service	1477503308	1477503308	1	1	RAMMOHAN, CHIDAMBARAM MD	11/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	71128	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
122770	Fee-for-Service	1447416771	1447416771	1	1	RAHGOZAR, PAYMON MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107647	02	General Surgery	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
122790	Fee-for-Service	1952552804	1952552804	1	1	ROSE, MERCEDES R NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
122806	Fee-for-Service	1548589856	1548589856	1	1	REEVES, NICHOLAS P MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121127	36	Psychiatry	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
122829	Fee-for-Service	1730342064	1730342064	1	1	ROHDENBURG, PAUL W MD	12/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
122871	Fee-for-Service	1437142692	1437142692	1	1	REGENTS/UCDPBG/IM PULMON	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
122877	Fee-for-Service	1720006471	1720006471	1	1	ROSENBURG, JOAN R MD	4/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69466	08	Family Practice	0	In state provider	None	720 NORTH TUSTIN AVE	SUITE 100	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
122880	Fee-for-Service	1558525857	1558525857	1	1	RUIZ, MAGDALENA MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100401	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
122885	Fee-for-Service	1346938628	1346938628	1	1	REANO, DESIREE ANGULO	7/17/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7611 PRINCESS DIANA CT	None	VALLEJO	CA	94591	8558	48	06095	38.13073478	-122.2111423	Solano County
122933	Fee-for-Service	1780656728	1780656728	1	1	ROSEN, ADAM S DO	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9197	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
122959	Fee-for-Service	1710413885	1710413885	1	1	REICH, MICHAEL S MD	9/15/2020	207P00000X	NA	Other	026	PHYSICIANS	169866	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
123008	Fee-for-Service	1740603760	1740603760	1	1	ROMERO, JULIE LMFT	8/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123024	Fee-for-Service	1326009838	1326009838	1	1	REIMER, GALEN M MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35918	01	General Practice	0	In state provider	None	1102 CLARK AVE	STE 120A	SANTA MARIA	CA	93455	5175	42	06083	34.86499805	-120.4185338	Santa Barbara County
123045	Fee-for-Service	1295184695	1295184695	1	1	ROY, CHARLOTTE M MD	8/16/2021	207P00000X	NA	Other	026	PHYSICIANS	172019	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
123052	Fee-for-Service	1063417657	1063417657	1	1	RAIED ABDULLAH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEPHROLOGY SPECIALIST	4802 BROADWAY	None	GARY	IN	46408	0000	00	None	41.53095	-87.336549	Lake County
123056	Fee-for-Service	1750716866	1750716866	1	1	REN, HONG MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127440	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
123059	Fee-for-Service	1144933714	1144933714	1	1	REEDLEY SKILLED CARE LLC	12/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1090 E DINUBA AVENUE	None	REEDLEY	CA	93654	3577	10	06019	36.58970076	-119.4376006	Fresno County
123092	Fee-for-Service	1770680944	1770680944	1	1	ROME, ROBERT J LP	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6345 BALBOA BLVD	BLDG 3 STE 250	ENCINO	CA	91316	1519	19	06037	34.18620241	-118.5011527	Los Angeles County
123137	Fee-for-Service	1275531337	1275531337	2	1	RENDLER, NATHAN MD	9/29/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64231	40	Pediatrics	0	In state provider	None	477 N EL CAMINO REAL	#B105	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
123166	Fee-for-Service	1336101625	1336101625	1	1	ROBERTSON, JAMES CRNA	10/17/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
123218	Fee-for-Service	1679672448	1679672448	1	1	ROMERO, LAURA S MD	7/30/1995	207ND0900X	NA	Dermatology	026	PHYSICIANS	74772	07	Dermatology	0	In state provider	None	230 PROSPECT PL	STE 260	CORONADO	CA	92118	1987	37	06073	32.69468235	-117.1677128	San Diego County
123240	Fee-for-Service	1730237611	1730237611	1	1	RADKE, TIMOTHY A MD	6/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74303	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
123250	Fee-for-Service	1639480072	1639480072	1	1	RAY, SOHINI MD	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131572	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	969 PLUMAS BLVD	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
123252	Fee-for-Service	1952308363	1952308363	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1984	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	1730	19	06037	34.0653632	-118.4458393	Los Angeles County
123278	Fee-for-Service	1770818239	1770818239	1	1	ROSS, JENNIFER M MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11550	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	STE 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
123312	Fee-for-Service	1316386659	1316386659	1	1	RASCHKE, ERIC T DO	8/4/2020	208600000X	NA	General Surgery	026	PHYSICIANS	17495	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123316	Fee-for-Service	1528324167	1528324167	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	501 6TH STREET	None	TAFT	CA	93268	2704	15	06029	35.14427303	-119.4591272	Kern County
123372	Fee-for-Service	1114176898	1114176898	1	1	RAZANI, NOOSHIN MD	12/5/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81796	40	Pediatrics	0	In state provider	None	5220 CLAREMONT AVE	None	OAKLAND	CA	94618	1033	01	06001	37.83868281	-122.2612035	Alameda County
123461	Fee-for-Service	1760541569	1760541569	1	19	RETINA INSTITUTE OF CALIFORN	2/12/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2323 16TH ST	400	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
123469	Fee-for-Service	1679914535	1679914535	1	1	RAVAL, STEPHANIE E W	1/11/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11100 COLOMA ROAD	None	RANCHO CORDOVA	CA	95670	2804	34	06067	38.616606	-121.271949	Sacramento County
123479	Fee-for-Service	1194922542	1194922542	1	1	ROMERO, DENISE M MD	9/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95275	20	Orthopedic Surgery	0	In state provider	None	12 CAMINO ENCINAS	None	ORINDA	CA	94563	3309	07	06013	37.87679015	-122.1800856	Contra Costa County
123496	Fee-for-Service	1629095500	1629095500	1	1	REGENTS OF THE UNIVERSITY OF	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
123510	Fee-for-Service	1114971660	1114971660	1	4	RIVERSIDE HEALTHCARE SYSTEM	12/30/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4510 BROCKTON AVE	STE 175	RIVERSIDE	CA	92501	4020	33	06065	33.97675372	-117.3850798	Riverside County
123541	Fee-for-Service	1952308363	1952308363	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1995	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	1730	19	06037	34.0653632	-118.4458393	Los Angeles County
123543	Fee-for-Service	1710065933	1710065933	1	9	RADYS CHILDRENS HOSPITAL	10/24/2016	261QM0855X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	333 H STREET	SUITE 3010	CHULA VISTA	CA	91910	5558	37	06073	32.63411233	-117.0783636	San Diego County
123576	Fee-for-Service	1033439674	1033439674	1	1	RICHARD, LESLIE A MD	12/30/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69364	09	Gynecology (D.O. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
123581	Fee-for-Service	1730316118	1730316118	1	1	ROLEN, MICHAEL MD	2/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153596	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
123601	Fee-for-Service	1013916261	1013916261	1	1	RICHARDSON, TRENT T MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
123603	Fee-for-Service	1528324167	1528324167	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	501 6TH STREET	None	TAFT	CA	93268	2704	15	06029	35.14427303	-119.4591272	Kern County
123609	Fee-for-Service	1033520002	1033520002	1	1	ROMERO LOPEZ, ADAN DE JESUS	7/31/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144650	08	Family Practice	0	In state provider	MD	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
123648	Fee-for-Service	1578543179	1578543179	1	1	ROMOFF, MARK MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	27803	41	Internal Medicine	0	In state provider	None	15243 VANOWEN ST	STE 406	VAN NUYS	CA	91405	3655	19	06037	34.19394848	-118.4654115	Los Angeles County
123668	Fee-for-Service	1144207333	1144207333	1	1	REDIKER, DONALD E MD	11/30/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	48167	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27800 MEDICAL CENTER RD	STE 126	MISSION VIEJO	CA	92691	6407	30	06059	33.55952733	-117.6645199	Orange County
123681	Fee-for-Service	1124080270	1124080270	1	1	RONALD THARP MD	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
123697	Fee-for-Service	1346377298	1346377298	1	1	RUIZ, MAXIMILIANO LMFT	8/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
123745	Fee-for-Service	1902062409	1902062409	1	1	REX, ELIZABETH S NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
123749	Fee-for-Service	1760541569	1760541569	1	19	RETINA INSTITUTE OF CALIFORN	2/12/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2323 16TH ST	400	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
123755	Fee-for-Service	1538727680	1538727680	1	1	RYS, LAUREN DO	4/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
123763	Fee-for-Service	1710046750	1710046750	1	1	ROHAN, MATTHEW B PT	6/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1350 41ST AVE STE 100	None	CAPITOLA	CA	95010	3934	44	06087	36.970515	-121.9648325	Santa Cruz County
123776	Fee-for-Service	1063609022	1063609022	1	1	REICH, CORYN CO	1/13/2009	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7700 IMPERIAL HWY	#E-2	DOWNEY	CA	90242	3466	19	06037	33.92670648	-118.1580043	Los Angeles County
123782	Fee-for-Service	1639704604	1639704604	1	1	ROSE DESERT HOSPICE	2/14/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	42156 10TH ST W	STE 106	LANCASTER	CA	93534	7025	19	06037	34.64917194	-118.1475672	Los Angeles County
123784	Fee-for-Service	1629095500	1629095500	1	1	REGENTS OF THE UNIVERSITY OF	5/1/1995	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CALIFORNIA	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
123799	Fee-for-Service	1790457349	1790457349	1	1	RAFANAN, AASHIKA D CNP	8/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
123814	Fee-for-Service	1629301676	1629301676	1	1	RICHARD OELBERGER PHD	4/7/2010	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGICAL SERVICES	292 S LA CIENEGA BLVD	SUITE 400 C	BEVERLY HILLS	CA	90211	3351	19	06037	34.06283371	-118.3761195	Los Angeles County
123816	Fee-for-Service	1003966805	1003966805	1	1	ROLING, BRIAN A DPM	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
123817	Fee-for-Service	1659329480	1659329480	1	1	RAGHU, DEEPAK MD	3/24/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
123821	Fee-for-Service	1952308363	1952308363	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1984	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	1730	19	06037	34.0653632	-118.4458393	Los Angeles County
123891	Fee-for-Service	1528324167	1528324167	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	501 6TH STREET	None	TAFT	CA	93268	2704	15	06029	35.14427303	-119.4591272	Kern County
123898	Fee-for-Service	1508031949	1508031949	1	1	RAFIE, AMIR H MD	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115445	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	435 ARDEN AVENUE	SUITE 410	GLENDALE	CA	91203	4020	19	06037	34.15848148	-118.2628845	Los Angeles County
123909	Fee-for-Service	1700844222	1700844222	1	1	REISIN, SOL MD	10/17/1988	207R00000X	NA	Other	026	PHYSICIANS	39697	41	Internal Medicine	0	In state provider	None	450 BIRCH ST	None	CALEXICO	CA	92231	0000	13	06025	32.67912485	-115.4913398	Imperial County
123925	Fee-for-Service	1053490490	1053490490	1	1	RUBIO, CASILDA J MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45122	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
123934	Fee-for-Service	1578543179	1578543179	1	1	ROMOFF, MARK MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	27803	45	Nephrology (Renal-Kidney)	0	In state provider	None	15243 VANOWEN ST	STE 406	VAN NUYS	CA	91405	3655	19	06037	34.19394848	-118.4654115	Los Angeles County
123935	Fee-for-Service	1235391996	1235391996	1	1	ROBISON, NATHAN J MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86955	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
123972	Fee-for-Service	1427125350	1427125350	1	1	RUNNMAN, EVA M MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69315	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
124039	Fee-for-Service	1619122322	1619122322	1	1	RUBIO, STEPHANIE MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97187	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
124068	Fee-for-Service	1639704604	1639704604	1	1	ROSE DESERT HOSPICE	2/14/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	42156 10TH ST W	STE 106	LANCASTER	CA	93534	7025	19	06037	34.64917194	-118.1475672	Los Angeles County
124085	Fee-for-Service	1689050106	1689050106	1	1	REALSOLA, ELSY S LMFT	1/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	433 SOUTH CATARACT AVENU	None	SAN DIMAS	CA	91773	2903	19	06037	34.10233592	-117.8115579	Los Angeles County
124145	Fee-for-Service	1972813087	1972813087	1	1	RIDGECREST REGIONAL HOSPITAL	8/25/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
124147	Fee-for-Service	1427497460	1427497460	1	1	ROSS, ALLISON T	5/9/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5842 E NAPLES PLAZA	None	LONG BEACH	CA	90803	5039	19	06037	33.75610548	-118.1200075	Los Angeles County
124178	Fee-for-Service	1215163894	1215163894	1	1	ROHATGI, NIDHI MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106833	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
124179	Fee-for-Service	1043786593	1043786593	1	1	RUANGSIN, SAKCHAI MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
124180	Fee-for-Service	1528324167	1528324167	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	501 6TH STREET	None	TAFT	CA	93268	2704	15	06029	35.14427303	-119.4591272	Kern County
124211	Fee-for-Service	1053490490	1053490490	1	1	RUBIO, CASILDA J MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45122	41	Internal Medicine	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
124225	Fee-for-Service	1235391996	1235391996	1	1	ROBISON, NATHAN J MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86955	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
124239	Fee-for-Service	1760541569	1760541569	1	18	RETINA INSTITUTE OF CALIFORN	1/13/2025	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	5451 LA PALMA AVE	44	LA PALMA	CA	90623	1732	30	06059	33.84643146	-118.038843	Orange County
124355	Fee-for-Service	1467468652	1467468652	1	1	RINELLA, SCOTT M DO	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	7167	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
124359	Fee-for-Service	1629607171	1629607171	1	1	RINGER, MARK B MD	11/8/2022	207P00000X	NA	Other	026	PHYSICIANS	177597	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
124394	Fee-for-Service	1780729905	1780729905	1	1	RUVALCABA, RAQUEL S LMFT	10/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
124434	Fee-for-Service	1972813087	1972813087	1	1	RIDGECREST REGIONAL HOSPITAL	8/23/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
124442	Fee-for-Service	1952754905	1952754905	1	1	RICHARD-SMALLWOOD, GWENDOLYN	7/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
124497	Fee-for-Service	1346231842	1346231842	1	1	ROBERT J GOODWILL M.D.	11/6/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 S MAIN ST	None	FAIRFIELD	IA	52556	9572	00	None	40.98627	-91.9656045	Jefferson County
124507	Fee-for-Service	1669662227	1669662227	1	1	RAMSDELL, CATHERINE A NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124522	Fee-for-Service	1427134931	1427134931	1	1	RAMASWAMY, DEEPA MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56208	45	Nephrology (Renal-Kidney)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
124529	Fee-for-Service	1760541569	1760541569	1	18	RETINA INSTITUTE OF CALIFORN	1/13/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5451 LA PALMA AVE	44	LA PALMA	CA	90623	1732	30	06059	33.84643146	-118.038843	Orange County
124530	Fee-for-Service	1750437679	1750437679	1	1	RUIZ, JAMEY J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1661 HOLLAND RD	STE 200	MAUMEE	OH	43537	1659	00	None	41.58935532	-83.6771859	Lucas County
124551	Fee-for-Service	1184069650	1184069650	1	1	ROSSFRYE, RICHARD I MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
124556	Fee-for-Service	1356861348	1356861348	1	1	ROMPALA, ANCILLA A MD	5/27/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
124559	Fee-for-Service	1609891209	1609891209	1	1	RALPH'S GROCERY COMPANY	4/1/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPH'S #730	3601 E FOOTHILL BLVD	None	PASADENA	CA	91107	3121	19	06037	34.15020952	-118.075635	Los Angeles County
124565	Fee-for-Service	1124550355	1124550355	1	1	RICHARD J. VASAK, M.D., INC.	6/17/2019	2086S0102X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1044 S FAIR OAKS AVE	STE 101	PASADENA	CA	91105	2622	19	06037	34.12819088	-118.1502923	Los Angeles County
124572	Fee-for-Service	1619300423	1619300423	1	1	RODDA, EMILY A CNP	2/21/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
124580	Fee-for-Service	1881776839	1881776839	1	1	RUHE, ERIC, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5301 E GRANT RD	None	TUCSON	AZ	85712	2805	00	None	32.252391	-110.8790055	Pima County
124589	Fee-for-Service	1952835357	1952835357	1	1	ROGAN, DANIEL T MD	11/12/2022	207P00000X	NA	Other	026	PHYSICIANS	157025	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
124597	Fee-for-Service	1407942436	1407942436	1	1	RAFIQ, REHANA MD	6/5/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42416	40	Pediatrics	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
124615	Fee-for-Service	1932349651	1932349651	1	1	RAO, VIKAS Y MD	12/28/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	141786	14	Neurological Surgery	0	In state provider	None	26732 CROWN VALLEY PKWY	SUITE 541	MISSION VIEJO	CA	92691	6306	30	06059	33.56347704	-117.66546	Orange County
124625	Fee-for-Service	1851553671	1851553671	1	1	RAFAEL, ALLON MD	2/26/2019	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	140809	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
124642	Fee-for-Service	1568422053	1568422053	1	1	RETINA CARE CENTER LLC	4/17/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	748 STATE ST	None	MEDFORD	OR	97504	8473	00	None	42.315624	-122.8303995	Jackson County
124645	Fee-for-Service	1003907387	1003907387	1	2	RUBAUM, LAD E MD	1/1/1979	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	30746	04	Otology, Laryngology, Rhinology	0	In state provider	None	14860 ROSCOE BLVD	STE 305	PANORAMA CITY	CA	91402	7901	19	06037	34.2214515	-118.4573205	Los Angeles County
124687	Fee-for-Service	1053370627	1053370627	1	1	RETSKY, MARVIN I MD	8/27/2004	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MARVIN R & DENNIS K APC	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
124695	Fee-for-Service	1003128323	1003128323	1	1	RAM, HARISH MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127312	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
124713	Fee-for-Service	1053638981	1053638981	1	1	RYAN LEBARON	3/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
124714	Fee-for-Service	1770044190	1770044190	1	1	ROBERTS, CHRISTY M MD	9/19/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176656	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
124716	Fee-for-Service	1033133202	1033133202	1	1	ROGERS, JOSEPH E MD	2/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63276	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
124718	Fee-for-Service	1083049357	1083049357	1	1	ROGERS, ANNA E MD	10/10/2017	390200000X	NA	Other	026	PHYSICIANS	127557	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
124722	Fee-for-Service	1972813087	1972813087	1	1	RIDGECREST REGIONAL HOSPITAL	8/25/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
124832	Fee-for-Service	1730290321	1730290321	1	1	RAJA, MANIKANDA G	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53777	41	Internal Medicine	0	In state provider	None	540 N SAN JACINTO ST	STE B	HEMET	CA	92543	3154	33	06065	33.755229	-116.9586405	Riverside County
124834	Fee-for-Service	1639114697	1639114697	1	1	RAY, ANGELA S MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
124877	Fee-for-Service	1871604694	1871604694	1	1	REYES, ANTONIO T MD	4/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50615	01	General Practice	0	In state provider	None	501 S BROOKHURST RD	None	FULLERTON	CA	92833	3207	30	06059	33.865002	-117.959396	Orange County
124889	Fee-for-Service	1235147117	1235147117	1	1	ROMEY, AMY	9/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
124901	Fee-for-Service	1912338476	1912338476	1	1	RIVER VALLEY HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTRE LP	2490 COURT ST	None	REDDING	CA	96001	2540	45	06089	40.57316148	-122.3922669	Shasta County
124911	Fee-for-Service	1710189352	1710189352	1	1	RIVERSIDE UNIFIED SD	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	None	3380 14TH STREET	None	RIVERSIDE	CA	92501	3810	33	06065	33.9742867	-117.3743972	Riverside County
124925	Fee-for-Service	1740478809	1740478809	1	1	RAGHUNATHAN, AMRITHA MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104604	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
124936	Fee-for-Service	1295711182	1295711182	1	1	RANA, RICHIE K MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92625	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
124942	Fee-for-Service	1821606765	1821606765	1	1	ROBINSON, JAMIE NP	6/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
124975	Fee-for-Service	1578599809	1578599809	1	1	RUIZ, R A MEDICAL CORP	7/21/2005	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RIALTO CLINICA MEDICA	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
124983	Fee-for-Service	1962251579	1962251579	1	1	ROSS, JOHN NP	10/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
124990	Fee-for-Service	1477789832	1477789832	1	1	RSCR CALIFORNIA INC	2/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5979 HARPS COURT	None	SAN DIEGO	CA	92114	5540	37	06073	32.70064303	-117.0689283	San Diego County
124999	Fee-for-Service	1679918395	1679918395	1	1	REGENTS OF THE UNIVERSITY OF	6/17/2020	2251S0007X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA UCLA	1000 VETERAN AVENUE	ROOM 22-64	LOS ANGELES	CA	90095	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
125009	Fee-for-Service	1972813087	1972813087	1	1	RIDGECREST REGIONAL HOSPITAL	8/25/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
125025	Fee-for-Service	1285766493	1285766493	1	2	ROCCO, MONICA A MD	9/18/2017	208600000X	NA	General Surgery	026	PHYSICIANS	44019	02	General Surgery	0	In state provider	None	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
125028	Fee-for-Service	1497141071	1497141071	1	1	RAMADAN, SERA N DO	12/5/2018	207R00000X	NA	Other	026	PHYSICIANS	15054	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
125049	Fee-for-Service	1952525370	1952525370	1	1	RAPP, JONATHAN S MD	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	56799	-	NOT APPLICABLE	0	In state provider	None	1050 WISCONSIN STREET	None	SAN FRANCISCO	CA	94107	3328	38	06075	37.7540295	-122.3986796	San Francisco County
125078	Fee-for-Service	1578045365	1578045365	1	1	RODRIGUEZ-YANEZ, BRITTANY L	12/6/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PCC	11870 PIERCE ST	SUITE 150	RIVERSIDE	CA	92505	4402	33	06065	33.90095662	-117.4936969	Riverside County
125086	Fee-for-Service	1699263434	1699263434	1	1	ROEUNG, SOPHANY NP	9/19/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125113	Fee-for-Service	1235700758	1235700758	1	1	RICAFORTE, ROSEMAY P CNP	7/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1444 S MAIN ST	None	SANTA ANA	CA	92707	1717	30	06059	33.727401	-117.8678195	Orange County
125122	Fee-for-Service	1366028086	1366028086	1	1	RIVERSIDE-SAN BERNARDINO COU	5/11/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	NIC	65175 STATE HIGHWAY 74	None	MOUNTAIN CENTER	CA	92561	9231	36	06071	33.56835866	-116.5267738	Riverside County
125129	Fee-for-Service	1770936841	1770936841	1	1	ROBERTA L MOSA	10/15/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6709 CAMINO DEL PRADO	None	CARLSBAD	CA	92011	3310	37	06073	33.11087132	-117.312269	San Diego County
125133	Fee-for-Service	1821047184	1821047184	1	1	ROSEN, DINA MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92309	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
125146	Fee-for-Service	1265852313	1265852313	1	1	RAJPOOT, JYOTI DO	5/8/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14495	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
125148	Fee-for-Service	1760541569	1760541569	1	7	RETINA INSTITUTE OF CALIFORN	11/6/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44139 MONTEREY AVE	A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
125173	Fee-for-Service	1578641064	1578641064	1	1	REYES, LILLI ANN G MD	4/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89198	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
125178	Fee-for-Service	1649583394	1649583394	1	1	REGALADO, DONNA S LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
125197	Fee-for-Service	1710189352	1710189352	1	1	RIVERSIDE UNIFIED SD	6/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3380 14TH STREET	None	RIVERSIDE	CA	92501	3810	33	06065	33.9742867	-117.3743972	Riverside County
125199	Fee-for-Service	1386698322	1386698322	1	1	RANDALL KLOEPFER M.D.	12/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
125249	Fee-for-Service	1477688810	1477688810	1	1	RSCR CALIFORNIA INC	5/1/1995	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	611 S CENTRAL AVE	None	GLENDALE	CA	91204	2008	19	06037	34.13833829	-118.2578856	Los Angeles County
125260	Fee-for-Service	1851064547	1851064547	1	1	RELIABLE HEALTHCARE LLC	5/5/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	200 NEW STINE RD	SUITE 250	BAKERSFIELD	CA	93309	2658	15	06029	35.352567	-119.061042	Kern County
125261	Fee-for-Service	1578599809	1578599809	1	1	RUIZ, R A MEDICAL CORP	4/29/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	RIALTO CLINICA MEDICA	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
125266	Fee-for-Service	1871545830	1871545830	1	1	RAMSAY, PATRICA L MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
125283	Fee-for-Service	1679918395	1679918395	1	1	REGENTS OF THE UNIVERSITY OF	7/1/2013	2251S0007X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CALIFORNIA UCLA	1000 VETERAN AVENUE	ROOM 22-64	LOS ANGELES	CA	90095	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
125315	Fee-for-Service	1063639003	1063639003	1	1	REBECCA LYNNE REIDY, ARNP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
125353	Fee-for-Service	1871645515	1871645515	1	1	ROUFF, STEVEN L MD INC	5/20/1987	207R00000X	NA	Other	026	PHYSICIANS	24246	41	Internal Medicine	0	In state provider	None	15243 VANOWEN ST	STE 408	VAN NUYS	CA	91405	3658	19	06037	34.19394848	-118.4654115	Los Angeles County
125356	Fee-for-Service	1477578078	1477578078	1	1	RALPHS GROCERY COMPANY	8/1/2000	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #72	1121 N HARBOR BLVD	None	FULLERTON	CA	92832	1312	30	06059	33.88084265	-117.9245141	Orange County
125411	Fee-for-Service	1366028086	1366028086	1	1	RIVERSIDE-SAN BERNARDINO COU	5/11/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NIC	65175 STATE HIGHWAY 74	None	MOUNTAIN CENTER	CA	92561	9231	36	06071	33.56835866	-116.5267738	Riverside County
125415	Fee-for-Service	1770936841	1770936841	1	1	ROBERTA L MOSA	7/22/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6709 CAMINO DEL PRADO	None	CARLSBAD	CA	92011	3310	37	06073	33.11087132	-117.312269	San Diego County
125437	Fee-for-Service	1760541569	1760541569	1	7	RETINA INSTITUTE OF CALIFORN	11/6/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	44139 MONTEREY AVE	A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
125443	Fee-for-Service	1386936862	1386936862	1	1	ROMERO, MICHAEL E DO	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11464	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
125470	Fee-for-Service	1518983055	1518983055	1	1	ROSSI, CARL J MD	11/30/1989	2085R0001X	NA	Other	026	PHYSICIANS	66352	None	None	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
125478	Fee-for-Service	1417111477	1417111477	1	1	RIAD, SHAREEF M MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106536	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125503	Fee-for-Service	1962756668	1962756668	1	1	RAINS, AMY R CRNA	6/26/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
125508	Fee-for-Service	1134164023	1134164023	1	1	RETINA-VITREOUS ASSOC	8/12/1975	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1127 WILSHIRE BLVD	STE 1620	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
125516	Fee-for-Service	1619301488	1619301488	1	1	ROF00GARAN, MOHSEN DO	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10775	41	Internal Medicine	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
125537	Fee-for-Service	1538199104	1538199104	1	1	REDDY, JAGADEESHAWAR MD	3/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77851	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
125549	Fee-for-Service	1578599809	1578599809	1	1	RUIZ, R A MEDICAL CORP	7/21/2005	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	RIALTO CLINICA MEDICA	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
125554	Fee-for-Service	1871545830	1871545830	1	1	RAMSAY, PATRICA L MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
125609	Fee-for-Service	1356861322	1356861322	1	1	REIS, COURTNEE LPCC	6/16/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1101 CALIFORNIA AVE	STE 100	CORONA	CA	92881	6472	33	06065	33.86171794	-117.5440764	Riverside County
125624	Fee-for-Service	1053464628	1053464628	1	1	ROBERTS, LAURA A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
125629	Fee-for-Service	1144704701	1144704701	1	1	ROJANACHAICHANIN, TANIDA PT	10/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
125656	Fee-for-Service	1144252446	1144252446	1	1	REDDY, USHA RANI K MD	12/31/1987	207P00000X	NA	Other	026	PHYSICIANS	44317	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
125664	Fee-for-Service	1801534508	1801534508	1	1	RAYOS DEL SOL, SHANE	9/4/2024	390200000X	NA	Other	026	PHYSICIANS	191600	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
125668	Fee-for-Service	1962138024	1962138024	1	1	ROBBERS, GRACE N	8/25/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	20007 VILLAGE GREEN DR	None	LAKEWOOD	CA	90715	1002	19	06037	33.84832127	-118.0823984	Los Angeles County
125676	Fee-for-Service	1033206552	1033206552	1	1	ROSE, RICHARD S MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	21963	36	Psychiatry	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
125718	Fee-for-Service	1689638280	1689638280	2	1	RIZZA LEPORT, MARIA C MD	11/15/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	32775	None	None	0	In state provider	None	9940 TALBERT AVE	101	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
125755	Fee-for-Service	1740667401	1740667401	1	1	RAMOS, JOSE MD	6/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153423	08	Family Practice	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
125765	Fee-for-Service	1932104908	1932104908	1	1	RENAISSANCE RADIOLOGY	11/4/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
125804	Fee-for-Service	1619301488	1619301488	1	1	ROF00GARAN, MOHSEN DO	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10775	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
125820	Fee-for-Service	1508015918	1508015918	1	1	RAMAKRISHNAN, MUTHUKRISHNAN	4/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	P PSY	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
125904	Fee-for-Service	1003141755	1003141755	1	1	RIVERSIDE COUNTY LATINO	8/21/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	COMMISSION ON ALCOHOL	1612 FIRST STREET	None	COACHELLA	CA	92236	1407	33	06065	33.68337881	-116.1784614	Riverside County
125954	Fee-for-Service	1962138024	1962138024	1	1	ROBBERS, GRACE N	8/25/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	20007 VILLAGE GREEN DR	None	LAKEWOOD	CA	90715	1002	19	06037	33.84832127	-118.0823984	Los Angeles County
125970	Fee-for-Service	1881626505	1881626505	1	1	RONALD J MAGLIOLA, JR., MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1900	00	None	41.46242416	-81.69888235	Cuyahoga County
125978	Fee-for-Service	1427512524	1427512524	1	1	RELIABLE HOME HEALTH INC	5/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10640 SEPULVEDA BLVD	UNIT 2	MISSION HILLS	CA	91345	1919	19	06037	34.26381	-118.467241	Los Angeles County
125998	Fee-for-Service	1619452265	1619452265	1	1	RHYMES, KIERA LPCC	11/3/2023	390200000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
126017	Fee-for-Service	1194295469	1194295469	1	1	RASOOLI, AZIZ DPM	7/9/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
126028	Fee-for-Service	1689881724	1689881724	1	1	RHIM, EUGENE S MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140109	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
126035	Fee-for-Service	1760541569	1760541569	1	4	RETINA INSTITUTE OF CALIFORN	10/16/2020	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	160 E ARTESIA ST	STE 120	POMONA	CA	91767	2900	19	06037	34.07556833	-117.7507835	Los Angeles County
126065	Fee-for-Service	1851792998	1851792998	1	1	RICKER, KELLY E CNA	2/11/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
126074	Fee-for-Service	1396046793	1396046793	1	1	RENNA, BRANDON M	12/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
126077	Fee-for-Service	1871078444	1871078444	1	1	REDONDO, JAMIE A NP	6/27/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1110 S BEN MADDOX WAY	SUITE B	VISALIA	CA	93292	3643	54	06107	36.321048	-119.2761675	Tulare County
126093	Fee-for-Service	1770663916	1770663916	1	1	RAMZY, IBRAHIM MD	2/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50808	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
126255	Fee-for-Service	1740607837	1740607837	1	1	RODRIGUEZ-MENDOZA, MELINDA	5/30/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
126266	Fee-for-Service	1033503347	1033503347	1	1	ROSEN, MATTHEW K MD	3/5/2018	207P00000X	NA	Other	026	PHYSICIANS	144814	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
126277	Fee-for-Service	1518980754	1518980754	1	1	ROHAM, TIMOTHY O MD	9/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	8040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
126278	Fee-for-Service	1699834713	1699834713	1	1	RYAN, COLMAN MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	26490	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1500 SOUTHGATE AVE	STE 113	DALY CITY	CA	94015	2205	41	06081	37.67558248	-122.4750825	San Mateo County
126280	Fee-for-Service	1366903031	1366903031	1	1	RENTERIA, SANDRA CNP	6/24/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
126283	Fee-for-Service	1265466403	1265466403	1	1	REGIMBAL, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HERITAGE REHAB & SPCL CR	7411 PACIFIER AVE S	None	TACOMA	WA	98408	7118	00	None	0	0	None
126288	Fee-for-Service	1326454828	1326454828	1	1	RYAN, MICHAEL PSYD	8/15/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
126298	Fee-for-Service	1104333574	1104333574	1	1	ROBERSON, GERALYN A CNP	10/28/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
126301	Fee-for-Service	1336216183	1336216183	1	1	RYAN, MARIANNE K MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70306	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
126323	Fee-for-Service	1760541569	1760541569	1	4	RETINA INSTITUTE OF CALIFORN	12/5/2007	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	160 E ARTESIA ST	STE 120	POMONA	CA	91767	2900	19	06037	34.07556833	-117.7507835	Los Angeles County
126334	Fee-for-Service	1215091954	1215091954	1	1	ROBBINS, SETH W MD	12/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	76559	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126367	Fee-for-Service	1659135697	1659135697	1	1	RANA, KRUNAL PT	4/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	835 N. HIGHLAND SPRINGS	SUITE 210	BEAUMONT	CA	92223	5770	33	06065	33.93245893	-116.9469871	Riverside County
126377	Fee-for-Service	1013910447	1013910447	1	1	REYES, JOSE S DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1999 EDISON HWY	STES 2, 4, 6	BAKERSFIELD	CA	93305	5554	15	06029	35.37197608	-118.971479	Kern County
126403	Fee-for-Service	1164948659	1164948659	1	1	REYNA, NINA C LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
126439	Fee-for-Service	1255416079	1255416079	1	1	ROCKHILL K. JASON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNV.OF WASHINGTON PHYS	1959 NE PACIFIC ST	MS 359110 C/O UWP	SEATTLE	WA	98145	9110	00	None	47.65080692	-122.3081828	King County
126458	Fee-for-Service	1083997449	1083997449	1	1	RINALDI, PETER D DO	11/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10766	20	Orthopedic Surgery	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
126465	Fee-for-Service	1013329606	1013329606	1	1	ROBLES, MARIBEL LMFT	4/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
126564	Fee-for-Service	1265535702	1265535702	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
126602	Fee-for-Service	1275690836	1275690836	1	1	ROMERO-DURAN, ADOLFO MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84197	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
126644	Fee-for-Service	1760541569	1760541569	1	13	RETINA INSTITUTE OF CALIFORN	9/11/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	288 SANTA ANITA AVE	403	ARCADIA	CA	91006	3183	19	06037	34.143093	-118.0314035	Los Angeles County
126662	Fee-for-Service	1902146673	1902146673	1	1	RYAN, DANA C	8/30/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1940 W ORANGEWOOD	SUITE 110	ORANGE	CA	92868	2067	30	06059	33.79574869	-117.8734735	Orange County
126668	Fee-for-Service	1871090571	1871090571	1	1	RODBUMRUNG, TODSAPORN MD	6/15/2022	207L00000X	NA	Other	026	PHYSICIANS	163584	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126669	Fee-for-Service	1700899630	1700899630	1	1	RAMIREZ, RUBEN	9/30/1988	208800000X	NA	Other	026	PHYSICIANS	45410	34	Urology and Urological Surgery	0	In state provider	None	850 S ATLANTIC BLVD	STE 302	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
126683	Fee-for-Service	1083773030	1083773030	1	1	ROAZEN, BERNARD MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	34618	01	General Practice	0	In state provider	None	1800 SULLIVAN AVE	RM 101	DALY CITY	CA	94015	2227	41	06081	37.68077723	-122.4728941	San Mateo County
126719	Fee-for-Service	1598020646	1598020646	1	1	ROBINSON, MATTHEW D INC	12/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12151	20	Orthopedic Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
126747	Fee-for-Service	1992853931	1992853931	1	1	RITZ, ANGELA R MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82577	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
126752	Fee-for-Service	1083630784	1083630784	1	1	RICHARDSON, DAVID B MD	8/1/1998	302R00000X	NA	Other	026	PHYSICIANS	61532	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126755	Fee-for-Service	1023033628	1023033628	1	1	RALPHS GROCERY COMPANY	10/13/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #207	4315 MISSION BLVD	None	SAN DIEGO	CA	92109	3917	37	06073	32.79414773	-117.2547286	San Diego County
126759	Fee-for-Service	1548258239	1548258239	1	1	RONAGHI, AMIR H MD	10/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55026	30	Radiology	0	In state provider	None	2020 IOWA AVE	STE 103	RIVERSIDE	CA	92507	2417	33	06065	33.992973	-117.3398145	Riverside County
126788	Fee-for-Service	1639379688	1639379688	1	1	RAMOS, JAMES P MD	5/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114464	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
126841	Fee-for-Service	1598924573	1598924573	1	1	ROCK-WILLOUGHBY, JAYME L DO	7/21/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	18263	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
126869	Fee-for-Service	1770100794	1770100794	1	1	ROGOSKI, JUSTIN M MD	6/26/2023	208M00000X	NA	Other	026	PHYSICIANS	186595	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
126885	Fee-for-Service	1942278221	1942278221	1	1	REDDY, MALLU C MD	7/1/1997	207R00000X	NA	Other	026	PHYSICIANS	62958	41	Internal Medicine	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
126889	Fee-for-Service	1265547418	1265547418	1	1	RAHBAR, NASER MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80324	30	Radiology	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
126913	Fee-for-Service	1609042753	1609042753	1	1	RASSI, ANDREW N MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135729	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
126931	Fee-for-Service	1760541569	1760541569	1	13	RETINA INSTITUTE OF CALIFORN	9/11/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	288 SANTA ANITA AVE	403	ARCADIA	CA	91006	3183	19	06037	34.143093	-118.0314035	Los Angeles County
126963	Fee-for-Service	1639794316	1639794316	1	1	REYES, SHIRLEY B	10/20/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11848 LOWELL DRIVE	None	RANCHO CUCAMONGA	CA	91730	3827	36	06071	34.11858499	-117.5466203	San Bernardino County
127022	Fee-for-Service	1598810467	1598810467	1	1	ROOPENIAN, STANLEY O OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11744 1/2 W PICO BLVD	None	LOS ANGELES	CA	90064	1309	19	06037	34.03114957	-118.4465842	Los Angeles County
127027	Fee-for-Service	1144000290	1144000290	1	1	RIVERA, CLAUDIA A LCSW	11/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
127066	Fee-for-Service	1922023993	1922023993	1	1	RUSH, PHILIP A MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	28043	40	Pediatrics	0	In state provider	None	91 GREGORY LN	STE 15	PLEASANT HILL	CA	94523	4927	07	06013	37.94801808	-122.062028	Contra Costa County
127084	Fee-for-Service	1548080195	1548080195	1	1	RAMOS, ROBERT LMFT	11/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
127087	Fee-for-Service	1225128994	1225128994	1	1	RUDOMETKIN, NATHAN J MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81443	18	Ophthalmology	0	In state provider	None	1810 FULLERTON AVE	STE 206	CORONA	CA	92881	3110	33	06065	33.85971	-117.5503495	Riverside County
127090	Fee-for-Service	1790268035	1790268035	1	1	REYES, CYNTHIA A	8/9/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
127113	Fee-for-Service	1730104332	1730104332	1	1	RALPHS GROCERY COMPANY	8/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #031	14049 VENTURA BLVD	None	SHERMAN OAKS	CA	91423	5234	19	06037	34.1493915	-118.4393354	Los Angeles County
127115	Fee-for-Service	1760559827	1760559827	1	1	RAFAEL MARIO SANCHEZ, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HOSPITAL DR	None	TRENTON	TN	38382	3324	00	None	35.96285334	-88.93960808	Gibson County
127163	Fee-for-Service	1295847689	1295847689	1	1	RANDERIA, KALYANI P.	3/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45174	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
127166	Fee-for-Service	1962479261	1962479261	1	1	REDDING ANESTHESIA ASSOCIATE	5/31/1991	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL CLINIC	1335 BUENAVENTURA BLVD	SUITE 100	REDDING	CA	96001	0160	45	06089	40.58222519	-122.4261823	Shasta County
127215	Fee-for-Service	1659650265	1659650265	1	1	RIVERA, MELISSA LMFT	2/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37 AUBURN AVE	9	SIERRA MADRE	CA	91024	1844	19	06037	34.1626081	-118.0549869	Los Angeles County
127252	Fee-for-Service	1639794316	1639794316	1	1	REYES, SHIRLEY B	10/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11848 LOWELL DRIVE	None	RANCHO CUCAMONGA	CA	91730	3827	36	06071	34.11858499	-117.5466203	San Bernardino County
127284	Fee-for-Service	1588228019	1588228019	1	1	REZA, ALLISON K INC	9/24/2018	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
127301	Fee-for-Service	1952405698	1952405698	1	1	REED,WILLIAM J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	0000	00	None	44.067735	-121.268187	Deschutes County
127317	Fee-for-Service	1538269527	1538269527	1	1	REDDING PHYSCL THRPY LP	8/1/1995	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	REDDING PHYSICAL THERAPY	1706 CHURN CREEK RD	None	REDDING	CA	96002	0236	45	06089	40.58139009	-122.3542269	Shasta County
127336	Fee-for-Service	1699966580	1699966580	1	1	ROM, CHRISTOPHER D MD	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93935	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
127363	Fee-for-Service	1497028625	1497028625	1	1	ROGERS, JAMAAL CRNA	1/30/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
127394	Fee-for-Service	1528146602	1528146602	1	1	RANA, MUBASHER E MD	8/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44702	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
127437	Fee-for-Service	1508956152	1508956152	1	1	REM SLEEP LABS INC	9/23/2013	291U00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	14642 NEWPORT AVE	SUITE 260	TUSTIN	CA	92780	6057	30	06059	33.73082212	-117.8293987	Orange County
127444	Fee-for-Service	1851316459	1851316459	1	1	RALPHS GROCERY COMPANY	4/9/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #280	4311 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	8814	19	06037	33.98441859	-118.4426372	Los Angeles County
127447	Fee-for-Service	1366438806	1366438806	2	1	RASUL, MARIA C	9/12/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51160	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	4140	40	06079	35.27804785	-120.649711	San Luis Obispo County
127479	Fee-for-Service	1437252004	1437252004	1	1	ROUDA, LINDA S CNM	10/19/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
127537	Fee-for-Service	1902896301	1902896301	1	1	RIO HONDO CONVALESCENT	6/1/1990	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	273 E BEVERLY BLVD	None	MONTEBELLO	CA	90640	3775	19	06037	34.0146524	-118.0941392	Los Angeles County
127558	Fee-for-Service	1063590156	1063590156	1	1	RUSSIN, MICHAEL P MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73638	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
127559	Fee-for-Service	1457569642	1457569642	1	1	RODRIGUEZ, NORMA MD	11/28/2017	207ZP0102X	NA	Other	026	PHYSICIANS	151407	22	Pathology (M.D. only)	0	In state provider	None	41-111 MONROE STREET	None	INDIO	CA	92201	5564	33	06065	33.70748774	-116.2338705	Riverside County
127562	Fee-for-Service	1396277703	1396277703	1	1	REBOLLEDO, BIANCA MD	7/1/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157704	None	None	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
127637	Fee-for-Service	1730100124	1730100124	1	1	ROTENBERG, JACK S MD	5/8/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	24729	10	Gastroenterology (M.D. only)	0	In state provider	None	3901 LAS POSAS RD	STE 20	CAMARILLO	CA	93010	1504	56	06111	34.2415821	-119.0183756	Ventura County
127684	Fee-for-Service	1205484144	1205484144	1	1	ROZMID, ERICA V PHD	9/10/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
127761	Fee-for-Service	1467962159	1467962159	1	1	REYES, RONICA G LMFT	2/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
127809	Fee-for-Service	1932153582	1932153582	1	1	RHONE, TERENCE P DO	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	6098	None	None	0	In state provider	None	340 W CENTRAL AVE	STE 110	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
127814	Fee-for-Service	1164628335	1164628335	1	1	RAMPTON, MARCUS J MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
127830	Fee-for-Service	1285066878	1285066878	1	1	RIVAS, CARLOS A MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131589	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
127847	Fee-for-Service	1063590156	1063590156	1	1	RUSSIN, MICHAEL P MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73638	78	Neoplastic Diseases/Oncology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
127860	Fee-for-Service	1336752039	1336752039	1	1	RADIATION ONCOLOGY NETWORK O	12/11/2020	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	959 LANE AVE	None	CHULA VISTA	CA	91914	4528	37	06073	32.6508918	-116.9614999	San Diego County
127878	Fee-for-Service	1447498985	1447498985	1	1	RIVERA, WILLIAM B MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111003	02	General Surgery	0	In state provider	None	19333 BEAR VALLEY ROAD	SUITE 106	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
127880	Fee-for-Service	1316721178	1316721178	1	1	RAICES Y CARINO, LLC	2/3/2025	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
127887	Fee-for-Service	1003689688	1003689688	1	1	REYES, ELIJAH PT	11/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
127893	Fee-for-Service	1114971660	1114971660	1	1	RIVERSIDE HEALTHCARE SYSTEM	5/1/1997	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
127914	Fee-for-Service	1497711006	1497711006	1	1	RICHARD JAMES WHITMAN, JR	8/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1727 W FRYE RD	STE 220	CHANDLER	AZ	85224	5298	00	None	33.297993	-111.87063	Maricopa County
127919	Fee-for-Service	1710065933	1710065933	1	12	RADYS CHILDRENS HOSPITAL	1/17/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	386 EAST H ST	SUITE 202	CHULA VISTA	CA	91910	7486	37	06073	32.63995805	-117.0482026	San Diego County
127923	Fee-for-Service	1730100124	1730100124	1	1	ROTENBERG, JACK S MD	5/8/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	24729	41	Internal Medicine	0	In state provider	None	3901 LAS POSAS RD	STE 20	CAMARILLO	CA	93010	1504	56	06111	34.2415821	-119.0183756	Ventura County
127934	Fee-for-Service	1922106475	1922106475	1	1	REINOSO, MARC A MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	77260	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
127971	Fee-for-Service	1912166232	1912166232	1	1	RAPOPORT, LISA N MD	12/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104643	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
128039	Fee-for-Service	1366896169	1366896169	1	1	RADOVSKY, JEREMY D	8/8/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PRKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
128041	Fee-for-Service	1184794380	1184794380	1	1	ROMALIS, DANA N MD	1/11/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101728	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
128059	Fee-for-Service	1164574927	1164574927	1	1	ROYSTER, ROBIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	80 68TH ST SE	None	GRAND RAPIDS	MI	49548	6980	00	None	42.84065955	-85.662657	Kent County
128080	Fee-for-Service	1174570311	1174570311	1	1	RAMASWAMY, SRIRAM MD	10/23/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177542	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
128081	Fee-for-Service	1699706556	1699706556	2	1	RAJU, JAGJIT S MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33552	41	Internal Medicine	0	In state provider	None	455 OCONNOR DRIVE	SUITE 350	SAN JOSE	CA	95128	1646	43	06085	37.326654	-121.939897	Santa Clara County
128136	Fee-for-Service	1063590156	1063590156	1	1	RUSSIN, MICHAEL P MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73638	68	Hematology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
128168	Fee-for-Service	1710913231	1710913231	1	4	REDWOOD FAM DERMATOLOGY MEDI	5/28/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	4727 HOEN AVENUE	STE A	SANTA ROSA	CA	95405	7898	49	06097	38.442744	-122.6641455	Sonoma County
128182	Fee-for-Service	1114971660	1114971660	1	1	RIVERSIDE HEALTHCARE SYSTEM	5/1/1997	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
128199	Fee-for-Service	1689980195	1689980195	1	1	ROKICKI-PARASHAR, JESSE MD	7/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	111156	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
128283	Fee-for-Service	1881198687	1881198687	1	1	RO, GEOFFREY C MD	7/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185252	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
128303	Fee-for-Service	1275896995	1275896995	1	1	RAYO DE SELIKTAR, IRIS PSYD	10/1/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
128335	Fee-for-Service	1255750741	1255750741	1	1	RUDRAPATNA, VIVEK A MD	6/12/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	140681	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
128351	Fee-for-Service	1649980566	1649980566	1	1	REN, RAN LCSW	10/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
128369	Fee-for-Service	1699706556	1699706556	2	1	RAJU, JAGJIT S MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33552	10	Gastroenterology (M.D. only)	0	In state provider	None	455 OCONNOR DRIVE	SUITE 350	SAN JOSE	CA	95128	1646	43	06085	37.326654	-121.939897	Santa Clara County
128381	Fee-for-Service	1144407115	1144407115	1	1	RANDALL, JAMES M MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99468	68	Hematology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
128384	Fee-for-Service	1134164023	1134164023	1	4	RETINA-VITREOUS ASSOC	1/31/1991	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL GROUP	12840 RIVERSIDE DR	STE 402	NORTH HOLLYWOOD	CA	91607	3353	19	06037	34.15759054	-118.4129775	Los Angeles County
128416	Fee-for-Service	1578908067	1578908067	1	1	ROBBINS, DONNA V CCC-SLP	4/29/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
128444	Fee-for-Service	1609101971	1609101971	1	1	RODAS, SALLY LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
128448	Fee-for-Service	1073680930	1073680930	1	1	RAND-LUBY, LESLIE B MD	1/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	84266	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
128501	Fee-for-Service	1558475459	1558475459	1	1	RAHAL, PARAMVIR S M D INC	1/1/2002	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ADVANCED GASTROENTEROLOG	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
128506	Fee-for-Service	1912672593	1912672593	1	1	ROBERTS, SHAWN M PT	5/18/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
128511	Fee-for-Service	1083078901	1083078901	1	1	ROBLES, MARIA CELIS D NP	4/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16323 CLARK AVE	None	BELLFLOWER	CA	90706	5209	19	06037	33.885693	-118.1339975	Los Angeles County
128552	Fee-for-Service	1164557203	1164557203	1	1	RAILTON, GEORGE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
128557	Fee-for-Service	1255565230	1255565230	1	1	RYAN, EMILY E MD	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121515	41	Internal Medicine	0	In state provider	None	8510 BALBOA BLVD	STE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
128592	Fee-for-Service	1104119544	1104119544	1	1	RUDNICK, NICHOLAS T MD	9/27/2017	390200000X	NA	Other	026	PHYSICIANS	148749	30	Radiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
128618	Fee-for-Service	1750795290	1750795290	1	1	REED, GILDA RAE LCSW	9/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37491 ENTERPRISE DRIVE	None	BURNEY	CA	96013	4379	45	06089	40.88784451	-121.6526265	Shasta County
128672	Fee-for-Service	1144407115	1144407115	1	1	RANDALL, JAMES M MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99468	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
128740	Fee-for-Service	1235184912	1235184912	1	1	RENFER, LEONARD G MD	4/8/1996	208800000X	NA	Other	026	PHYSICIANS	72775	34	Urology and Urological Surgery	0	In state provider	None	114 E ROMIE LN	None	SALINAS	CA	93901	3126	27	06053	36.66186399	-121.6545765	Monterey County
128742	Fee-for-Service	1932238763	1932238763	1	1	ROTGER, SARA A LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
128748	Fee-for-Service	1619913977	1619913977	1	1	ROBBINS, BARRY S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27018	30	Radiology	0	In state provider	None	25 N 14TH ST	STE 150	SAN JOSE	CA	95112	6218	43	06085	37.34293357	-121.8775187	Santa Clara County
128760	Fee-for-Service	1467832824	1467832824	1	1	RUSSELL-PLATEAU, SAMANTHA J	6/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
128786	Fee-for-Service	1790929826	1790929826	1	1	ROOSE DIALYSIS LLC	7/1/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1523 E MARCH LANE	STE 200	STOCKTON	CA	95210	5607	39	06077	38.00244788	-121.2897064	San Joaquin County
128788	Fee-for-Service	1558475459	1558475459	1	1	RAHAL, PARAMVIR S M D INC	1/1/2002	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ADVANCED GASTROENTEROLOG	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
128796	Fee-for-Service	1790734648	1790734648	1	1	RAJPOOT, DEEPAK K MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	48316	40	Pediatrics	0	In state provider	PEDIATRIC RENAL MED CORP	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
128801	Fee-for-Service	1619186194	1619186194	1	2	RAJAN, VIKRAM MD	1/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79289	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1301 20TH ST	STE 590	SANTA MONICA	CA	90404	2054	19	06037	34.02976782	-118.4812493	Los Angeles County
128802	Fee-for-Service	1154507283	1154507283	1	1	RICHARDSON, MICHELLE A LMFT	8/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52278	-	NOT APPLICABLE	0	In state provider	None	2523 EL PORTAL DRIVE	103	SAN PABLO	CA	94806	3305	07	06013	37.96550037	-122.338586	Contra Costa County
128812	Fee-for-Service	1255472858	1255472858	1	1	RUOSS, STEPHEN J MD	1/31/1989	207RC0200X	NA	Other	026	PHYSICIANS	57078	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
128828	Fee-for-Service	1487131884	1487131884	1	1	RAFIE, DANIEL	1/21/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	169042	13	Neurology (M.D. only)	0	In state provider	None	401 E CARRILLO ST	None	SANTA BARBARA	CA	93101	1460	42	06083	34.42588572	-119.6972176	Santa Barbara County
128872	Fee-for-Service	1154055606	1154055606	1	1	ROBINSON, JADE V NP	10/11/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
128883	Fee-for-Service	1982738324	1982738324	1	1	RANNEY, RACHAEL L	3/8/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50365	-	NOT APPLICABLE	0	In state provider	None	831 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09030767	-117.7353578	Los Angeles County
128895	Fee-for-Service	1063597326	1063597326	1	1	RIVERSIDE DISCOUNT DRUGS INC	12/7/1992	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12508 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3409	19	06037	34.1575527	-118.405674	Los Angeles County
128917	Fee-for-Service	1639778665	1639778665	1	1	RBRK HEALTHCARE LLC	1/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16870 W BERNARDO DRIVE	STE 400	SAN DIEGO	CA	92127	1678	37	06073	33.01956754	-117.0809122	San Diego County
128936	Fee-for-Service	1427025691	1427025691	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	54	06107	36.54552557	-119.3797841	Tulare County
128949	Fee-for-Service	1255390761	1255390761	1	1	RAY S JENSEN MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1550 N 115TH ST	None	SEATTLE	WA	98133	8401	00	None	47.714643	-122.337108	King County
128951	Fee-for-Service	1649449448	1649449448	1	1	ROH, YOUSIK MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97398	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
128957	Fee-for-Service	1336582063	1336582063	1	1	ROCCHI, VANNA J DO	9/15/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13676	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
128958	Fee-for-Service	1144407115	1144407115	1	1	RANDALL, JAMES M MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99468	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
128962	Fee-for-Service	1447754718	1447754718	1	1	ROSEN, EMILY A MD	6/25/2021	208M00000X	NA	Other	026	PHYSICIANS	163563	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
128968	Fee-for-Service	1528362571	1528362571	1	1	REGENTS OF THE UNIVERSITY OF	4/12/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	CALIFORNIA	1200 GARDEN VIEW RD	STE 200	ENCINITAS	CA	92024	2475	37	06073	33.0584037	-117.2601559	San Diego County
128973	Fee-for-Service	1821294117	1821294117	1	1	ROMO-CONTRERAS, MONICA MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96969	08	Family Practice	0	In state provider	None	3234 MARYSVILLE BLVD	None	SACRAMENTO	CA	95815	1411	34	06067	38.626371	-121.4322615	Sacramento County
129007	Fee-for-Service	1356501688	1356501688	1	1	RECANO, ESTHER M MD	12/21/2018	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
129056	Fee-for-Service	1962468082	1962468082	1	1	RICHARD ELLIS COOKE MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 W MEMORIAL RD	None	OKLAHOMA CITY	OK	73120	8304	00	None	35.606601	-97.6003605	Oklahoma County
129084	Fee-for-Service	1790734648	1790734648	1	1	RAJPOOT, DEEPAK K MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	48316	45	Nephrology (Renal-Kidney)	0	In state provider	PEDIATRIC RENAL MED CORP	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
129087	Fee-for-Service	1619186194	1619186194	1	2	RAJAN, VIKRAM MD	1/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79289	41	Internal Medicine	0	In state provider	None	1301 20TH ST	STE 590	SANTA MONICA	CA	90404	2054	19	06037	34.02976782	-118.4812493	Los Angeles County
129094	Fee-for-Service	1740982032	1740982032	1	1	RADIA CALIFORNIA RADIOLOGY M	5/18/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	EDICAL GROUP INC	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
129114	Fee-for-Service	1558705277	1558705277	1	1	RATHNAYAKE, SAMIRA MD	7/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158787	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
129123	Fee-for-Service	1508905688	1508905688	1	1	RAO, KAMINENI MD	2/28/1986	207K00000X	NA	Other	026	PHYSICIANS	34897	03	Allergy	0	In state provider	None	11015 OLSON DR	STE 3	RANCHO CORDOVA	CA	95670	5654	34	06067	38.596149	-121.282083	Sacramento County
129137	Fee-for-Service	1114987062	1114987062	1	1	RIXEN, DANIEL J DC	1/1/2014	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4726 APPIAN WAY	None	EL SOBRANTE	CA	94803	1825	07	06013	37.97333208	-122.3021149	Contra Costa County
129142	Fee-for-Service	1710065933	1710065933	1	6	RADYS CHILDRENS HOSPITAL	7/1/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
129145	Fee-for-Service	1629117809	1629117809	1	1	RANCHO SANTA FE MEDICAL GROU	9/21/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3230 WARING CT	STE Q	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
129175	Fee-for-Service	1083096531	1083096531	1	1	ROONEY, DAVID M MD	7/8/2020	207WX0009X	NA	Ophthalmology	026	PHYSICIANS	169055	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
129195	Fee-for-Service	1699881250	1699881250	1	1	RANDOLPH, MADDOX MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 521	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
129202	Fee-for-Service	1902914690	1902914690	1	1	RASTROLLO, JOSEPH S MD	4/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33366	05	Anesthesiology	0	In state provider	None	11632 BUTTERFIELD ST	None	LOMA LINDA	CA	92354	3956	36	06071	34.04245392	-117.2371028	San Bernardino County
129206	Fee-for-Service	1639778665	1639778665	1	1	RBRK HEALTHCARE LLC	1/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16870 W BERNARDO DRIVE	STE 400	SAN DIEGO	CA	92127	1678	37	06073	33.01956754	-117.0809122	San Diego County
129208	Fee-for-Service	1710919931	1710919931	1	1	ROSS, ANDREW J MD	2/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	74867	41	Internal Medicine	0	In state provider	None	2850 TELEGRAPH AVE	None	BERKELEY	CA	94705	1192	01	06001	37.85808554	-122.2594469	Alameda County
129224	Fee-for-Service	1427025691	1427025691	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	54	06107	36.54552557	-119.3797841	Tulare County
129239	Fee-for-Service	1740761675	1740761675	1	1	RUIZ, ANDRES J LMFT	3/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
129254	Fee-for-Service	1528362571	1528362571	1	1	REGENTS OF THE UNIVERSITY OF	4/12/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	CALIFORNIA	1200 GARDEN VIEW RD	STE 200	ENCINITAS	CA	92024	2475	37	06073	33.0584037	-117.2601559	San Diego County
129271	Fee-for-Service	1710397153	1710397153	1	1	REZAI, TANIA MD	3/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	139162	01	General Practice	0	In state provider	None	5767 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.68164	-121.327164	Sacramento County
129279	Fee-for-Service	1659313971	1659313971	1	1	RASIC, MLADEN A MD	5/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77464	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
129299	Fee-for-Service	1609018084	1609018084	1	1	ROSENBERG, NATHAN S MD	10/28/2016	2081P0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
129357	Fee-for-Service	1275768467	1275768467	1	1	ROOHIPOUR, RAMIN M MD FACS	5/15/2024	208600000X	NA	General Surgery	026	PHYSICIANS	117259	70	Clinic (mixed specialty)	0	In state provider	None	21250 HAWTHORNE BLVD	SUITE 430	TORRANCE	CA	90503	5506	19	06037	33.83566432	-118.3531683	Los Angeles County
129389	Fee-for-Service	1831159888	1831159888	1	1	REISS, JILL E MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69223	02	General Surgery	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
129410	Fee-for-Service	1508905688	1508905688	1	1	RAO, KAMINENI MD	2/28/1986	207K00000X	NA	Other	026	PHYSICIANS	34897	40	Pediatrics	0	In state provider	None	11015 OLSON DR	STE 3	RANCHO CORDOVA	CA	95670	5654	34	06067	38.596149	-121.282083	Sacramento County
129415	Fee-for-Service	1346357845	1346357845	1	1	RUSSELL, VICTORRIA F NP	5/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
129430	Fee-for-Service	1629117809	1629117809	1	1	RANCHO SANTA FE MEDICAL GROU	5/21/2015	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	3230 WARING CT	STE Q	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
129435	Fee-for-Service	1780620013	1780620013	1	1	RUBINSTEIN, MICHAEL P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58799	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 208	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
129454	Fee-for-Service	1093828337	1093828337	1	1	RASMUSSEN, ROBIN K MD	10/1/1999	207P00000X	NA	Other	026	PHYSICIANS	69442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1026 MANGROVE AVE	STE 10	CHICO	CA	95926	3556	04	06007	39.73971182	-121.8368837	Butte County
129457	Fee-for-Service	1245225440	1245225440	1	1	REY, ARNOLD M MD	11/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83297	08	Family Practice	0	In state provider	None	114 MISSION RANCH BLD	# 10	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
129464	Fee-for-Service	1215110879	1215110879	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	216 E FRESNO ST	None	AVENAL	CA	93204	1525	16	06031	36.00349612	-120.1355935	Kings County
129500	Fee-for-Service	1184657694	1184657694	1	1	ROCHOLL,CHRISTIAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	4805	00	None	47.647989	-117.4112415	Spokane County
129505	Fee-for-Service	1508946419	1508946419	1	1	RAMER, SANDRA J MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	26113	83	Rheumatology	0	In state provider	None	1301 20TH ST	STE 390	SANTA MONICA	CA	90404	2080	19	06037	34.02976782	-118.4812493	Los Angeles County
129513	Fee-for-Service	1427025691	1427025691	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	54	06107	36.54552557	-119.3797841	Tulare County
129541	Fee-for-Service	1528362571	1528362571	1	1	REGENTS OF THE UNIVERSITY OF	4/12/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CALIFORNIA	1200 GARDEN VIEW RD	STE 200	ENCINITAS	CA	92024	2475	37	06073	33.0584037	-117.2601559	San Diego County
129545	Fee-for-Service	1851368054	1851368054	1	1	RAZI, SALMAN S MD	10/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	55879	34	Urology and Urological Surgery	0	In state provider	INC	2160 W GRANTLINE RD	STE 140	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
129557	Fee-for-Service	1770781932	1770781932	1	1	RICHARD WHITING BENTLEY M.D.	9/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
129567	Fee-for-Service	1659313971	1659313971	1	1	RASIC, MLADEN A MD	5/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77464	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
129603	Fee-for-Service	1952322083	1952322083	1	1	RIDGEWAY, MICHAEL G MD	11/8/1995	208600000X	NA	General Surgery	026	PHYSICIANS	51663	02	General Surgery	0	In state provider	None	333 SUNRISE AVE	None	ROSEVILLE	CA	95661	3479	31	06061	38.740806	-121.272001	Placer County
129605	Fee-for-Service	1043268949	1043268949	1	1	RAHIMI, MARYAM MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54568	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
129614	Fee-for-Service	1164524997	1164524997	1	1	RASI, LEROY M MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86456	20	Orthopedic Surgery	0	In state provider	MONTEREY BAY ORTHOPAEDIC	276 GREEN VALLEY RD	None	FREEDOM	CA	95019	3112	44	06087	36.93863516	-121.770631	Santa Cruz County
129618	Fee-for-Service	1699900456	1699900456	1	1	ROSE, DERRICK A CRNA	8/26/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
129684	Fee-for-Service	1649737644	1649737644	1	1	RHOANE, CAELAINN B DO	12/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20219	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
129720	Fee-for-Service	1629117809	1629117809	1	1	RANCHO SANTA FE MEDICAL GROU	5/21/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP INC	3230 WARING CT	STE Q	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
129743	Fee-for-Service	1487625562	1487625562	1	1	REICHMAN, RONALD P MD	7/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37038	83	Rheumatology	0	In state provider	None	1505 W AVENUE J	STE 101	LANCASTER	CA	93534	2844	19	06037	34.68945168	-118.1571066	Los Angeles County
129747	Fee-for-Service	1700140159	1700140159	1	1	ROBITZ, RACHEL A MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127641	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
129748	Fee-for-Service	1437228079	1437228079	2	1	RIVERA-NIEVES, JESUS A MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54808	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129750	Fee-for-Service	1710065933	1710065933	1	14	RADYS CHILDRENS HOSPITAL	6/5/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDRENS WAY	FLOOR 1	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
129754	Fee-for-Service	1215110879	1215110879	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	216 E FRESNO ST	None	AVENAL	CA	93204	1525	16	06031	36.00349612	-120.1355935	Kings County
129796	Fee-for-Service	1225176050	1225176050	1	1	ROYAL AMBULANCE INC	1/26/2006	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14676 DOOLITTLE DR	None	SAN LEANDRO	CA	94577	6617	01	06001	37.692405	-122.1733705	Alameda County
129797	Fee-for-Service	1447233622	1447233622	1	1	RAVAGO, FRANK L.	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49230	41	Internal Medicine	0	In state provider	None	99 AIRPORT BLVD	None	FREEDOM	CA	95019	2917	44	06087	36.93884013	-121.7776254	Santa Cruz County
129802	Fee-for-Service	1427025691	1427025691	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	54	06107	36.54552557	-119.3797841	Tulare County
129826	Fee-for-Service	1801870233	1801870233	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
129842	Fee-for-Service	1801889068	1801889068	1	2	REGENTS/UCDPBG/SUR ONCOL	5/1/1999	2086X0206X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
129867	Fee-for-Service	1912962614	1912962614	1	1	RANDALL, JOSH M MD	9/7/2022	208800000X	NA	Other	026	PHYSICIANS	85620	None	None	0	In state provider	None	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	30	06059	33.60999658	-117.7126577	Orange County
129888	Fee-for-Service	1043268949	1043268949	1	1	RAHIMI, MARYAM MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54568	01	General Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
129920	Fee-for-Service	1841511409	1841511409	1	1	REZAYAT, TALAYEH DO	6/21/2017	207RC0200X	NA	Other	026	PHYSICIANS	12035	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
129977	Fee-for-Service	1225328115	1225328115	1	1	REGAN, JESSIE L LMFT	4/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
129981	Fee-for-Service	1235367079	1235367079	1	1	RIDER, CASEY L	12/27/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
129995	Fee-for-Service	1487903019	1487903019	1	1	REVADIGAR, NEELAMBIKA S MD	2/24/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	139061	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
130008	Fee-for-Service	1629117809	1629117809	1	1	RANCHO SANTA FE MEDICAL GROU	5/21/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	GROUP INC	3230 WARING CT	STE Q	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
130011	Fee-for-Service	1396085478	1396085478	1	2	RODICA ELIGIA COTA	8/18/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5008 FITZWILLIAM ST	None	ROSEVILLE	CA	95747	4106	31	06061	38.79718937	-121.3668889	Placer County
130030	Fee-for-Service	1457838831	1457838831	1	1	ROXBURY PHARMACY INC	3/4/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	465 N ROXBURY DRIVE	103	BEVERLY HILLS	CA	90210	4271	19	06037	34.06832918	-118.4072114	Los Angeles County
130041	Fee-for-Service	1215110879	1215110879	2	1	REEDLEY COMMUNITY HOSPITAL	12/12/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	216 E FRESNO ST	None	AVENAL	CA	93204	1525	16	06031	36.00349612	-120.1355935	Kings County
130045	Fee-for-Service	1245255736	1245255736	1	1	RITCHIE, PHYLLIS S B MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84220	77	Infectious Disease	0	In state provider	None	1695 NORTH SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
130048	Fee-for-Service	1174603997	1174603997	1	1	ROSTEN, JOHN G OD	5/19/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	125 N LINCOLN ST	STE A	DIXON	CA	95620	3259	48	06095	38.44614779	-121.8364229	Solano County
130054	Fee-for-Service	1043625825	1043625825	1	1	ROBERTSON, CASSIE M LCSW	6/15/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
130064	Fee-for-Service	1093819724	1093819724	1	2	RICHARD J TREVINO MD A PROFE	10/1/2021	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SSIONAL CORPORATION	227 N JACKSON AVE	STE 235	SAN JOSE	CA	95116	1607	43	06085	37.36478223	-121.8497978	Santa Clara County
130077	Fee-for-Service	1730682394	1730682394	1	14	RURAL PHYSICIANS GROUP, PC	2/15/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	350 S. OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
130083	Fee-for-Service	1982839320	1982839320	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	846 BUEN TIEMPO DRIVE	None	CHULA VISTA	CA	91910	6502	37	06073	32.63259766	-117.0352981	San Diego County
130094	Fee-for-Service	1164490454	1164490454	1	1	RANCHO PHYSICAL THERAPY, INC	10/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	38605 CALISTOGA DR	SUITE 140	MURRIETA	CA	92563	4820	33	06065	33.5604938	-117.1273924	Riverside County
130110	Fee-for-Service	1548520638	1548520638	1	1	RAMIREZ, JULIUS-ANGELO L	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146391	01	General Practice	0	In state provider	None	108 GREEN VALLEY ROAD	None	FREEDOM	CA	95019	3110	44	06087	36.93669269	-121.7720262	Santa Cruz County
130111	Fee-for-Service	1407893191	1407893191	1	1	RICHARD J JOCHEM, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 N 12TH ST	None	MILWAUKEE	WI	53233	1305	00	None	43.042428	-87.92718546	Milwaukee County
130148	Fee-for-Service	1104917913	1104917913	1	1	REDDY, SUREKHA N MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81664	41	Internal Medicine	0	In state provider	None	685 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
130155	Fee-for-Service	1316375744	1316375744	1	1	REZENDE CAMARGO PORTES,	5/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	PEDRO NP	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
130177	Fee-for-Service	1215172937	1215172937	1	1	RAD, STEVE MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110265	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130250	Fee-for-Service	1043898901	1043898901	1	1	RAMACHANDRAN, MAYA K MD	4/1/2024	207R00000X	NA	Other	026	PHYSICIANS	192473	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130265	Fee-for-Service	1902396302	1902396302	1	1	ROSENBERG, MARA W MD	6/10/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	185356	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130275	Fee-for-Service	1497399620	1497399620	1	1	RINGWOOD DIALYSIS LLC	2/19/2021	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1335 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.99880375	-122.286739	Contra Costa County
130279	Fee-for-Service	1851854525	1851854525	1	1	REYES, AARON Z MD	8/22/2022	208M00000X	NA	Other	026	PHYSICIANS	179549	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130294	Fee-for-Service	1629117809	1629117809	1	1	RANCHO SANTA FE MEDICAL GROU	5/21/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	3230 WARING CT	STE Q	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
130301	Fee-for-Service	1528447448	1528447448	1	1	ROMAIN, JOSHUA MD	12/17/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	176454	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
130303	Fee-for-Service	1801812441	1801812441	1	1	ROTH, ANTOINETTE R MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83151	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
130327	Fee-for-Service	1295783744	1295783744	1	1	ROSENTHAL, MONICA A MD	8/31/1984	207P00000X	NA	Other	026	PHYSICIANS	52899	08	Family Practice	0	In state provider	None	2100 WEBSTER ST	SUITE 516	SAN FRANCISCO	CA	94115	2381	38	06075	37.7904826	-122.4324477	San Francisco County
130329	Fee-for-Service	1215110879	1215110879	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	216 E FRESNO ST	None	AVENAL	CA	93204	1525	16	06031	36.00349612	-120.1355935	Kings County
130333	Fee-for-Service	1760541569	1760541569	1	31	RETINA INSTITUTE OF CALIFORN	2/24/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7339 EL CAJON BLVD	J/K	LA MESA	CA	91942	7435	37	06073	32.76875533	-117.0388333	San Diego County
130365	Fee-for-Service	1730682394	1730682394	1	14	RURAL PHYSICIANS GROUP, PC	2/15/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	350 S. OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
130370	Fee-for-Service	1689893786	1689893786	1	1	REYNOSO HERNANDEZ, RONALD L	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120854	41	Internal Medicine	0	In state provider	MD	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
130390	Fee-for-Service	1245594761	1245594761	1	1	RAO, ANOOP V MD	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135879	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
130392	Fee-for-Service	1245358324	1245358324	1	1	RAGHUPATHY, ARUN K MD	7/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103439	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 BON AIR ROAD	#100	LARKSPUR	CA	94939	1144	21	06041	37.94364568	-122.5396483	Marin County
130398	Fee-for-Service	1326344300	1326344300	1	1	ROSE-SMITH, AMBER M	7/24/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3306 N FORDHAM AVE	None	FRESNO	CA	93727	8032	10	06019	36.7804265	-119.6880202	Fresno County
130437	Fee-for-Service	1104917913	1104917913	1	1	REDDY, SUREKHA N MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81664	40	Pediatrics	0	In state provider	None	685 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
130504	Fee-for-Service	1154350601	1154350601	1	1	RUSSELL, CHRISTY ANN MD	8/26/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49893	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
130512	Fee-for-Service	1730766890	1730766890	1	1	RAMOS, VICTORIA-LYNN L DO	8/19/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	23252	40	Pediatrics	0	In state provider	None	73555 SAN GORGONIO WAY	None	PALM DESERT	CA	92260	3549	33	06065	33.7231981	-116.3812055	Riverside County
130557	Fee-for-Service	1497072888	1497072888	1	1	RAY, LARA PHD	2/1/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
130582	Fee-for-Service	1750331468	1750331468	1	1	ROSEN, RON S MD	2/17/2021	207U00000X	NA	Other	026	PHYSICIANS	96556	None	None	0	In state provider	None	2211 MOORPARK AVE	STE 220	SAN JOSE	CA	95128	2654	43	06085	37.31613943	-121.9326665	Santa Clara County
130587	Fee-for-Service	1134169535	1134169535	2	10	REACH AIR MEDICAL SERVICES L	12/1/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1400 SKY HARBOR DR	None	OLIVEHURST	CA	95961	7418	58	06115	39.092319	-121.5674325	Yuba County
130614	Fee-for-Service	1295783744	1295783744	1	1	ROSENTHAL, MONICA A MD	8/31/1984	207P00000X	NA	Other	026	PHYSICIANS	52899	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2100 WEBSTER ST	SUITE 516	SAN FRANCISCO	CA	94115	2381	38	06075	37.7904826	-122.4324477	San Francisco County
130620	Fee-for-Service	1760541569	1760541569	1	31	RETINA INSTITUTE OF CALIFORN	2/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	7339 EL CAJON BLVD	J/K	LA MESA	CA	91942	7435	37	06073	32.76875533	-117.0388333	San Diego County
130664	Fee-for-Service	1346232402	1346232402	1	1	ROUS, DAVID L PT	5/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 23RD ST	None	BAKERSFIELD	CA	93301	2306	15	06029	35.38001554	-119.015649	Kern County
130682	Fee-for-Service	1245358324	1245358324	1	1	RAGHUPATHY, ARUN K MD	7/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103439	41	Internal Medicine	0	In state provider	None	2 BON AIR ROAD	#100	LARKSPUR	CA	94939	1144	21	06041	37.94364568	-122.5396483	Marin County
130685	Fee-for-Service	1326344300	1326344300	1	1	ROSE-SMITH, AMBER M	7/24/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3306 N FORDHAM AVE	None	FRESNO	CA	93727	8032	10	06019	36.7804265	-119.6880202	Fresno County
130717	Fee-for-Service	1538291307	1538291307	1	1	ROEGGE, ALVIN L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 S TELSHOR BLVD	None	LAS CRUCES	NM	88011	5069	00	None	32.29238673	-106.7351331	Doña Ana County
130729	Fee-for-Service	1700940897	1700940897	1	1	ROMERO, JAVIER A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66041	02	General Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
130731	Fee-for-Service	1194839043	1194839043	2	1	ROYAL DIAGNOSTICS INC	6/8/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	14440 HAMLIN STREET	None	VAN NUYS	CA	91401	1409	19	06037	34.18863849	-118.448046	Los Angeles County
130745	Fee-for-Service	1831265297	1831265297	1	1	REMA, KUTTANCHERI V MD	6/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53129	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	# 220	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
130791	Fee-for-Service	1265893556	1265893556	1	1	RICHTER, CHRISTINA L	1/6/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
130832	Fee-for-Service	1831116714	1831116714	1	1	RAMOS, ADRIAN ERIC MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69699	08	Family Practice	0	In state provider	None	1108 WARD AVE	BLDG A, STE 1	PATTERSON	CA	95363	8529	50	06099	37.48636445	-121.1407911	Stanislaus County
130883	Fee-for-Service	1740237700	1740237700	2	1	RICHARDSON, GARY L DC	11/25/2011	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2620 LARKSPUR LANE	SUITE V	REDDING	CA	96002	1043	45	06089	40.5690659	-122.3555361	Shasta County
130951	Fee-for-Service	1265687263	1265687263	1	1	RUSSELL, LINDA R LMFT	1/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
130982	Fee-for-Service	1548766017	1548766017	1	1	RABELHOFER, ANGELA J MD	12/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163398	None	None	0	In state provider	None	1600 E CITRUS AVENUE	None	REDLANDS	CA	92374	4270	36	06071	34.05557272	-117.1468659	San Bernardino County
131065	Fee-for-Service	1235524430	1235524430	1	1	RAMIREZ, JESSICA E MD	12/8/2022	207R00000X	NA	Other	026	PHYSICIANS	152554	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
131067	Fee-for-Service	1164431607	1164431607	1	1	RONALD STEWART, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
131098	Fee-for-Service	1366136665	1366136665	1	1	RURAL HEALTH NETWORK INC	9/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1349 MAIN ST	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
131112	Fee-for-Service	1689234783	1689234783	1	1	RANGEL VENTURA, FRANCIS MD	8/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182083	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
131134	Fee-for-Service	1669595096	1669595096	1	2	ROUHE, HELENA L LMFT	12/18/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	SUITE 105	WALNUT CREEK	CA	94597	3945	07	06013	37.89859467	-122.0843018	Contra Costa County
131147	Fee-for-Service	1477087690	1477087690	1	1	REGIONAL HEALTHCARE INC	1/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11755 VICTORY BLVD	SUITE 106	NORTH HOLLYWOOD	CA	91606	3451	19	06037	34.18670448	-118.389699	Los Angeles County
131226	Fee-for-Service	1730180415	1730180415	1	1	RIVERSIDE MEDICAL CLINIC	2/16/2018	111N00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
131246	Fee-for-Service	1376751628	1376751628	1	1	RINKER, JORDAN S	9/30/1989	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	60829	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
131270	Fee-for-Service	1073967394	1073967394	1	1	RIZKALLA, MIRNA S MD	11/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161724	08	Family Practice	0	In state provider	None	3650 E SOUTH ST	STE 404	LAKEWOOD	CA	90712	1508	19	06037	33.8601747	-118.1494013	Los Angeles County
131292	Fee-for-Service	1033609649	1033609649	1	1	RAMIREZ, FERNANDO DPM	8/27/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
131293	Fee-for-Service	1558586669	1558586669	1	1	ROBBINS, RACHEL A PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	425 GOUGH ST	None	SAN FRANCISCO	CA	94102	4415	38	06075	37.7772585	-122.4230739	San Francisco County
131326	Fee-for-Service	1821462938	1821462938	1	1	RUDNICK, ERIC MD	3/15/2016	207P00000X	NA	Other	026	PHYSICIANS	76393	None	None	0	In state provider	None	2550 SISTER MARY	COLUMBIA DR	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
131346	Fee-for-Service	1215050299	1215050299	1	1	REDDING, DAVID L DO	5/1/1998	204C00000X	NA	Other	026	PHYSICIANS	6636	12	Manipulative Therapy (D.O. only)	0	In state provider	None	360 E MISSION BLVD	None	POMONA	CA	91766	1847	19	06037	34.05514856	-117.7475076	Los Angeles County
131347	Fee-for-Service	1316026446	1316026446	1	1	RUBINO, JOSEPH M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
131357	Fee-for-Service	1679606156	1679606156	1	1	RUBEN, SAMUEL M MD MPH	3/7/2022	2083P0901X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	35819	-	NOT APPLICABLE	0	In state provider	None	455 K STREET	None	CRESCENT CITY	CA	95531	8301	08	06015	41.75468313	-124.1960818	Del Norte County
131385	Fee-for-Service	1366136665	1366136665	1	1	RURAL HEALTH NETWORK INC	9/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1349 MAIN ST	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
131409	Fee-for-Service	1205849577	1205849577	1	1	RETINO, ROSARIO B MD INC	12/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51896	40	Pediatrics	0	In state provider	None	320 W G ST	STE 101	ONTARIO	CA	91762	3233	36	06071	34.070859	-117.6543585	San Bernardino County
131480	Fee-for-Service	1922049311	1922049311	1	1	ROBERTS, TAWNA L OD	1/28/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
131486	Fee-for-Service	1720015282	1720015282	1	1	REDDY, SUDHIR K B MD	12/29/2011	174400000X	NA	Other	026	PHYSICIANS	48880	None	None	0	In state provider	None	525 N 13TH AVE	STE A	UPLAND	CA	91786	4969	36	06071	34.09996045	-117.6334849	San Bernardino County
131514	Fee-for-Service	1730180415	1730180415	1	1	RIVERSIDE MEDICAL CLINIC	9/11/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
131554	Fee-for-Service	1114361581	1114361581	1	1	RAAM, RYAN MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125475	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
131569	Fee-for-Service	1225122039	1225122039	1	1	REDDY, RAVITA MD	2/3/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	85458	None	None	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
131608	Fee-for-Service	1700821519	1700821519	1	1	RATAN L TIWARI MD INC	1/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
131634	Fee-for-Service	1215050299	1215050299	1	1	REDDING, DAVID L DO	5/1/1998	204C00000X	NA	Other	026	PHYSICIANS	6636	08	Family Practice	0	In state provider	None	360 E MISSION BLVD	None	POMONA	CA	91766	1847	19	06037	34.05514856	-117.7475076	Los Angeles County
131641	Fee-for-Service	1003089871	1003089871	1	1	RICHARDS, PATRICK MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94510	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
131647	Fee-for-Service	1427080175	1427080175	1	1	ROSS, JAMIE L MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50599	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
131651	Fee-for-Service	1164682589	1164682589	1	1	REDMOND, JONAS W MD	1/14/2020	2085R0204X	NA	Other	026	PHYSICIANS	166851	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
131657	Fee-for-Service	1538400924	1538400924	1	1	ROSILLO, BERENICE D	5/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18075 VENTURA BLVD	STE 132	ENCINO	CA	91316	3595	19	06037	34.16527698	-118.5267	Los Angeles County
131680	Fee-for-Service	1841777125	1841777125	1	1	RIOS VALADEZ, GUADALUPE	5/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
131687	Fee-for-Service	1871826974	1871826974	1	1	RINGWOOD, KIMBERLY	9/13/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
131697	Fee-for-Service	1114946753	1114946753	1	1	RODRIGUEZ, GEORGE J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	69365	41	Internal Medicine	0	In state provider	None	225 EAST 2ND AVE	STE 203	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
131700	Fee-for-Service	1174966071	1174966071	1	1	REGENTS OF THE UNIVERSITY OF	4/12/2022	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
131723	Fee-for-Service	1083050025	1083050025	1	1	RODRIGUEZ-PLA, ALICIA MD	9/1/2022	207RR0500X	NA	Other	026	PHYSICIANS	142638	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
131738	Fee-for-Service	1053790196	1053790196	1	1	RAHNEMA, CYRUS D MD	12/2/2022	208600000X	NA	General Surgery	026	PHYSICIANS	171879	None	None	0	In state provider	None	4768 PALM AVE	None	RIVERSIDE	CA	92501	4012	33	06065	33.97590034	-117.3912866	Riverside County
131746	Fee-for-Service	1114387446	1114387446	1	1	RIALTO HEALTHCARE, LLC	2/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1471 S RIVERSIDE AVE	None	RIALTO	CA	92376	7703	36	06071	34.07459705	-117.3702576	San Bernardino County
131752	Fee-for-Service	1346358900	1346358900	1	1	ROBBINS, ROBERT C MD	11/30/1992	208G00000X	NA	General Surgery	026	PHYSICIANS	46093	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
131779	Fee-for-Service	1588006357	1588006357	1	1	REEDOM, ZERUAH LMFT	5/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
131803	Fee-for-Service	1730180415	1730180415	1	1	RIVERSIDE MEDICAL CLINIC	1/16/2019	111N00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
131874	Fee-for-Service	1891158804	1891158804	1	1	RUAN, ALEXANDRA MD	6/23/2020	207L00000X	NA	Other	026	PHYSICIANS	150975	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
131896	Fee-for-Service	1700821519	1700821519	1	1	RATAN L TIWARI MD INC	1/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
131910	Fee-for-Service	1558850537	1558850537	1	1	RAIBLE, MONICA E MD	9/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180811	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
131912	Fee-for-Service	1720683253	1720683253	1	1	ROSE GARDEN HOSPICE INC	8/10/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	STE 311A	LOS ANGELES	CA	90039	1539	19	06037	34.12369709	-118.2682266	Los Angeles County
131966	Fee-for-Service	1821271248	1821271248	1	1	RETINA SPECIALISTS OF	2/13/2008	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	THE CENTRAL COAST, INC	628 CALIFORNIA BLVD	STE C	SAN LUIS OBISPO	CA	93401	2542	40	06079	35.28917428	-120.6578269	San Luis Obispo County
131985	Fee-for-Service	1174966071	1174966071	1	1	REGENTS OF THE UNIVERSITY OF	8/22/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
132059	Fee-for-Service	1972007649	1972007649	1	1	RAMIREZ, BRENDA L MD	3/18/2021	208M00000X	NA	Other	026	PHYSICIANS	166195	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
132062	Fee-for-Service	1306971775	1306971775	1	1	RAHBAR, MAHNAZ MD	7/21/2009	207R00000X	NA	Other	026	PHYSICIANS	85153	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
132074	Fee-for-Service	1093980823	1093980823	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1939 ACADEMY AVENUE	None	SANGER	CA	93657	3737	10	06019	36.68936951	-119.5550306	Fresno County
132088	Fee-for-Service	1730180415	1730180415	1	1	RIVERSIDE MEDICAL CLINIC	12/31/1996	111N00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
132101	Fee-for-Service	1689733172	1689733172	1	1	RICE, JAMES C MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53783	45	Nephrology (Renal-Kidney)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
132106	Fee-for-Service	1770741027	1770741027	1	1	ROBERT THOMAS MELTON	3/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	940 E 5TH ST	None	COQUILLE	OR	97423	1666	00	None	43.17908426	-124.1788744	Coos County
132162	Fee-for-Service	1497962096	1497962096	1	1	RAGO, OSCAR MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
132201	Fee-for-Service	1720683253	1720683253	1	1	ROSE GARDEN HOSPICE INC	8/10/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	STE 311A	LOS ANGELES	CA	90039	1539	19	06037	34.12369709	-118.2682266	Los Angeles County
132209	Fee-for-Service	1740643204	1740643204	1	1	RETSON, TARA A MD	5/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161838	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
132213	Fee-for-Service	1457526972	1457526972	1	1	RIDDLE, EMILIE B MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150145	08	Family Practice	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
132224	Fee-for-Service	1346021193	1346021193	1	1	RESILIENCE CENTER FOR MENTAL	1/3/2025	103T00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS	422 N SAN JACINTO ST	None	HEMET	CA	92543	3124	33	06065	33.753564	-116.9586305	Riverside County
132242	Fee-for-Service	1013978469	1013978469	1	1	RENAL TREATMENT CENTERS	11/14/2004	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1225 WILLOW PASS RD	None	CONCORD	CA	94520	5218	07	06013	37.96784119	-122.0535179	Contra Costa County
132246	Fee-for-Service	1124173794	1124173794	1	1	RIVERA, JORGE A R MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73080	40	Pediatrics	0	In state provider	None	1186 LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.23014473	-119.3277192	Tulare County
132275	Fee-for-Service	1174966071	1174966071	1	1	REGENTS OF THE UNIVERSITY OF	10/24/2022	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
132277	Fee-for-Service	1750340808	1750340808	1	1	RUCKER, RICHARD D JR MD	1/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	89456	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
132306	Fee-for-Service	1275645400	1275645400	1	1	RENCK, GREGORY R MD	2/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151370	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
132321	Fee-for-Service	1669685293	1669685293	1	1	RHETTA, TERI L MD	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93663	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
132363	Fee-for-Service	1093980823	1093980823	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1939 ACADEMY AVENUE	None	SANGER	CA	93657	3737	10	06019	36.68936951	-119.5550306	Fresno County
132393	Fee-for-Service	1689733172	1689733172	1	1	RICE, JAMES C MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53783	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
132399	Fee-for-Service	1083945406	1083945406	1	1	RIGBY, ALICIA M NP	4/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
132409	Fee-for-Service	1467560458	1467560458	1	1	ROSENBERG, HEATHER D DC	8/13/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	ER	901 SUNRISE AVE	STE. B-3	ROSEVILLE	CA	95661	4519	31	06061	38.732238	-121.2720325	Placer County
132411	Fee-for-Service	1487802187	1487802187	1	1	RANGWALA, RAZIA A MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105656	08	Family Practice	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
132429	Fee-for-Service	1487730123	1487730123	1	1	RANAEI, RODNEY N MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7664	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
132438	Fee-for-Service	1649538869	1649538869	1	1	RAMENO, MARIA G LCSW	4/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1604 FORD AVE	SUITE 2B	MODESTO	CA	95350	4649	50	06099	37.66748595	-120.9836064	Stanislaus County
132439	Fee-for-Service	1114074051	1114074051	1	1	RANDOLPH, DAVID A MD	8/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	501 EAST HAMPDEN AVENUE	None	ENGLEWOOD	CO	80113	2702	00	None	39.6531952	-104.9810967	Arapahoe County
132484	Fee-for-Service	1376139006	1376139006	1	1	RHEMA THERAPY INC.	4/22/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CHILD THERAPY, INC.	4949 BUCKLEY WAY	113	BAKERSFIELD	CA	93309	4842	15	06029	35.33866564	-119.0541714	Kern County
132501	Fee-for-Service	1023737251	1023737251	1	1	READY TRANSPORTATION LLC	2/16/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3774 GROVE ST	SUITE L2	LEMON GROVE	CA	91945	1878	37	06073	32.74642662	-117.0271281	San Diego County
132508	Fee-for-Service	1346021193	1346021193	1	1	RESILIENCE CENTER FOR MENTAL	5/19/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	WELLNESS	422 N SAN JACINTO ST	None	HEMET	CA	92543	3124	33	06065	33.753564	-116.9586305	Riverside County
132517	Fee-for-Service	1033651310	1033651310	1	1	REYES, KARLA A LMFT	9/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
132538	Fee-for-Service	1982860706	1982860706	1	1	ROSENBLUM-FISHMAN, SARA D PH	8/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
132557	Fee-for-Service	1649316662	1649316662	1	1	RIOS, CHARLES LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 EAST STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
132558	Fee-for-Service	1467630228	1467630228	1	1	RUBINSHTEYN, INESSA	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1670 S AMPHLETT BLVD	STE 214	SAN MATEO	CA	94402	2511	41	06081	37.55945622	-122.3024868	San Mateo County
132565	Fee-for-Service	1174966071	1174966071	1	1	REGENTS OF THE UNIVERSITY OF	1/19/2021	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CALIFORNIA	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
132628	Fee-for-Service	1700261286	1700261286	1	1	ROCKHOLD, TEONA G LMFT	8/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LD	12740 ROLLING RIDGE DRIV	None	VICTORVILLE	CA	92395	5132	36	06071	34.48280284	-117.2615566	San Bernardino County
132635	Fee-for-Service	1235113077	1235113077	1	2	ROSE, KAREN M LMFT	6/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	870 MARKET ST	SUITE 449	SAN FRANCISCO	CA	94102	2915	38	06075	37.7848184	-122.4070488	San Francisco County
132649	Fee-for-Service	1093980823	1093980823	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1939 ACADEMY AVENUE	None	SANGER	CA	93657	3737	10	06019	36.68936951	-119.5550306	Fresno County
132664	Fee-for-Service	1467656256	1467656256	1	1	RAMAKRISHNAN, ASHWIN MD	3/25/2010	390200000X	NA	Other	026	PHYSICIANS	104140	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
132667	Fee-for-Service	1891062998	1891062998	1	1	REY, RODOLFO MD	1/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127855	None	None	0	In state provider	None	141 N MAIN STREET	None	LAKE ELSINORE	CA	92530	4118	33	06065	33.66881794	-117.3273839	Riverside County
132703	Fee-for-Service	1972888774	1972888774	1	1	REDDINGIUS, JASON A CRNA	8/12/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
132719	Fee-for-Service	1477573202	1477573202	1	1	RUNNINGS, KRISTA L	7/24/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
132742	Fee-for-Service	1811126683	1811126683	1	1	RAYTIS, JOHN L MD	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98456	05	Anesthesiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
132753	Fee-for-Service	1043203102	1043203102	1	2	REGENTS/UCDPBG/IM GASTRO	8/26/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
132786	Fee-for-Service	1649560913	1649560913	1	1	REED, KARIN E MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124226	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132790	Fee-for-Service	1982864609	1982864609	1	1	ROHER, ALEX A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	110018	05	Anesthesiology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
132793	Fee-for-Service	1710065933	1710065933	1	5	RADYS CHILDRENS HOSPITAL	10/25/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8010 FROST STREET	STE 200	SAN DIEGO	CA	92123	4290	37	06073	32.80026879	-117.1520059	San Diego County
132796	Fee-for-Service	1346021193	1346021193	1	1	RESILIENCE CENTER FOR MENTAL	1/3/2025	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS	422 N SAN JACINTO ST	None	HEMET	CA	92543	3124	33	06065	33.753564	-116.9586305	Riverside County
132797	Fee-for-Service	1093780561	1093780561	1	1	RICHARD W TREPETA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PATHOLOGY ASSOCIATES	350 W THOMAS ROAD	None	PHOENIX	AZ	85013	0000	00	None	33.480864	-112.0795155	Maricopa County
132809	Fee-for-Service	1801827688	1801827688	1	1	RANDHAWA, TEJPAL S MD	8/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91158	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE D400	STOCKTON	CA	95210	6675	39	06077	38.00315652	-121.2868715	San Joaquin County
132851	Fee-for-Service	1174966071	1174966071	1	1	REGENTS OF THE UNIVERSITY OF	7/22/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CALIFORNIA	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
132893	Fee-for-Service	1053699348	1053699348	1	1	RETS, ANTON V MD	6/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
132929	Fee-for-Service	1649590522	1649590522	1	1	RYAN, BRIGID S LMFT	9/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4525 MONTGOMERY DR	STE 14	SANTA ROSA	CA	95409	5358	49	06097	38.458062	-122.671152	Sonoma County
132938	Fee-for-Service	1093980823	1093980823	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1939 ACADEMY AVENUE	None	SANGER	CA	93657	3737	10	06019	36.68936951	-119.5550306	Fresno County
133029	Fee-for-Service	1205315066	1205315066	1	1	RILEY, JAMIN LCSW	12/8/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
133042	Fee-for-Service	1043203102	1043203102	1	2	REGENTS/UCDPBG/IM GASTRO	5/1/1999	207RG0100X	NA	Gastroenterology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
133059	Fee-for-Service	1598859530	1598859530	1	1	ROBINSON, SCOTT L MD	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	29175	05	Anesthesiology	0	In state provider	None	411 30TH ST	STE 204	OAKLAND	CA	94609	3303	01	06001	37.81903474	-122.2649444	Alameda County
133119	Fee-for-Service	1134164023	1134164023	1	3	RETINA-VITREOUS ASSOC	9/1/1998	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL GROUP	3440 LOMITA BLVD	STE 327	TORRANCE	CA	90505	4830	19	06037	33.81328127	-118.3452927	Los Angeles County
133127	Fee-for-Service	1164710588	1164710588	1	1	ROTTER, PHILIP MD, INC	11/1/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	111831	20	Orthopedic Surgery	0	In state provider	None	999 NORTH TUSTIN AVE	SUITE 109	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
133161	Fee-for-Service	1306220074	1306220074	1	1	RAMIREZ, KATRINA D PSYD	10/6/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
133195	Fee-for-Service	1134216294	1134216294	1	1	REHAB UNITED INC	7/25/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3959 RUFFIN RD	STE F	SAN DIEGO	CA	92123	1830	37	06073	32.81438099	-117.1216603	San Diego County
133199	Fee-for-Service	1548326606	1548326606	1	1	ROZELLE, ANDREW L MD	7/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83950	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
133213	Fee-for-Service	1003877531	1003877531	1	1	ROXAS-BUTLIG, EVANGELINE G M	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	78060	None	None	0	In state provider	None	940 E DOMINGUEZ ST	STE D	CARSON	CA	90746	7205	19	06037	33.84040849	-118.2582045	Los Angeles County
133243	Fee-for-Service	1003918848	1003918848	1	1	RICHEYLUCERO, SARA J MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61884	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
133255	Fee-for-Service	1376807941	1376807941	1	1	REHMAN, ADEEL U MD	7/10/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133258	Fee-for-Service	1154695963	1154695963	1	1	RILEY, BRUCE S LMFT	12/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34085	-	NOT APPLICABLE	0	In state provider	None	1315 N BULLIS ROAD	SUITE 2	COMPTON	CA	90221	1655	19	06037	33.90520155	-118.2072299	Los Angeles County
133296	Fee-for-Service	1932323862	1932323862	1	1	RANA, RICH S MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120621	30	Radiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
133314	Fee-for-Service	1407831662	1407831662	1	1	RANSIBRAHMANAKUL, KANAT	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66312	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
133315	Fee-for-Service	1336752039	1336752039	1	2	RADIATION ONCOLOGY NETWORK O	12/16/2020	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	F SOUTHERN CALIFORNIA	1410 S LA BRUCHERIE RD	STE B	EL CENTRO	CA	92243	9676	13	06025	32.78048827	-115.578488	Imperial County
133327	Fee-for-Service	1962496596	1962496596	2	1	RESEDA PHARMACY INC	3/23/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6900 RESEDA BLVD	STE #E	RESEDA	CA	91335	4270	19	06037	34.19591085	-118.5360127	Los Angeles County
133329	Fee-for-Service	1417390956	1417390956	1	1	RYAN, CODY R U MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132944	01	General Practice	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91911	5736	37	06073	32.62870793	-117.0750108	San Diego County
133332	Fee-for-Service	1407263569	1407263569	1	1	RAI CARE CENTER OF NORTHERN	5/22/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA II, LLC	626 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2117	38	06075	37.76171812	-122.4072332	San Francisco County
133349	Fee-for-Service	1154478030	1154478030	1	1	REDDY, ADHIKARI V MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116968	14	Neurological Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
133363	Fee-for-Service	1942374616	1942374616	1	1	ROBLES-KORTMEYER, E DC	8/16/1993	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	67555 E PALM CANYON DR	STE C108	CATHEDRAL CITY	CA	92234	5404	33	06065	33.78899689	-116.4834161	Riverside County
133386	Fee-for-Service	1942235254	1942235254	1	1	RODRIGUEZ, JUAN R MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90344	None	None	0	In state provider	None	1661 SOQUEL DR	STE G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
133426	Fee-for-Service	1730701863	1730701863	1	1	ROLAND, KAREN NP	10/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
133482	Fee-for-Service	1720251184	1720251184	1	1	RIM, SEAN MD	6/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123588	02	General Surgery	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
133505	Fee-for-Service	1295769156	1295769156	1	1	RITTER, MICHAEL S MD	2/28/1992	207P00000X	NA	Other	026	PHYSICIANS	74723	None	None	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
133540	Fee-for-Service	1760560858	1760560858	1	1	RAYGOR, PRAKASHKUMAR MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41680	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
133543	Fee-for-Service	1376807941	1376807941	1	1	REHMAN, ADEEL U MD	7/10/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133547	Fee-for-Service	1497286306	1497286306	1	1	RODRIGUEZ, GRACE MD	6/15/2020	207P00000X	NA	Other	026	PHYSICIANS	168084	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
133554	Fee-for-Service	1871988709	1871988709	1	1	RANADIVE, ALISHA A MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145888	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
133597	Fee-for-Service	1629836580	1629836580	1	1	RAMIREZ-AGUILAR, JESSICA NP	4/18/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
133647	Fee-for-Service	1093178915	1093178915	1	1	RYAN M SOUTHARD MD	5/16/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	625 UNITED DR	STE 410	CONWAY	AR	72032	7826	00	None	35.057736	-92.420874	Faulkner County
133745	Fee-for-Service	1992392120	1992392120	1	1	RESOLUTE HOME HEALTH CARE	12/8/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	715 N CENTRAL AVE	STE 218	GLENDALE	CA	91203	1225	19	06037	34.15695962	-118.2580155	Los Angeles County
133753	Fee-for-Service	1336270404	1336270404	1	1	ROUDEBUSH-ALBAUGH, MEREDITH	10/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C LCSW	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
133782	Fee-for-Service	1609535491	1609535491	1	1	REAL CARE HOME HEALTH	3/4/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7335 VAN NUYS BLVD	STE 107-B	VAN NUYS	CA	91405	1951	19	06037	34.203843	-118.448776	Los Angeles County
133826	Fee-for-Service	1093842361	1093842361	1	1	ROCKCREEK INC	8/16/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27590 VILLA AVE	None	HIGHLAND	CA	92346	3286	36	06071	34.12319962	-117.2024751	San Bernardino County
133829	Fee-for-Service	1720281090	1720281090	1	1	RUSSELL, DAVID J MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112048	18	Ophthalmology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
133830	Fee-for-Service	1841942711	1841942711	1	1	REDLINE TRANSIT LLC	3/24/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	75 DECLARATION DR	SUITE #4	CHICO	CA	95973	7643	04	06007	39.77193449	-121.8722331	Butte County
133840	Fee-for-Service	1154557577	1154557577	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1841 TAMARAND WAY	None	SAN DIEGO	CA	92154	2860	37	06073	32.56730997	-117.0943661	San Diego County
133859	Fee-for-Service	1851047914	1851047914	1	1	RUIZ, RAYMOND P	9/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2079 ORANGE TREE LN	None	REDLANDS	CA	92374	2849	36	06071	34.06798772	-117.2255785	San Bernardino County
133867	Fee-for-Service	1124189683	1124189683	1	1	RIZVI, SYED T MD	8/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53519	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
133872	Fee-for-Service	1851454425	1851454425	1	1	REYHAN, ANNE PSYD	11/18/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23987	-	NOT APPLICABLE	0	In state provider	None	125 W F ST	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
133880	Fee-for-Service	1386792331	1386792331	1	1	REYNOLDS, VANESSA R MD	5/9/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62828	01	General Practice	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
133884	Fee-for-Service	1053502781	1053502781	1	2	RURAL METRO CORPORATION	3/28/2022	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	None	2029 S ARIZONA AVE	None	YUMA	AZ	85364	6549	00	None	32.690439	-114.615783	Yuma County
133921	Fee-for-Service	1801479076	1801479076	1	1	RINCON BAND OF LUISENO MISSI	7/29/2021	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ES	33485 VALLEY CENTER RD	None	VALLEY CENTER	CA	92082	6047	37	06073	33.2577588	-116.9573543	San Diego County
133936	Fee-for-Service	1659494680	1659494680	1	1	ROBERT JOHN BUNNELL, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
134011	Fee-for-Service	1245454636	1245454636	1	1	ROTH, REBECCA LMFT	10/30/2024	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14583 BIG BASIN WAY	STE 2B	SARATOGA	CA	95070	6072	43	06085	37.25598369	-122.0357593	Santa Clara County
134023	Fee-for-Service	1215991252	1215991252	1	1	RICCI, RAYMOND MD	10/31/1983	207P00000X	NA	Other	026	PHYSICIANS	47776	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 SUMMIT ST	None	OAKLAND	CA	94609	3410	01	06001	37.82018974	-122.2643221	Alameda County
134047	Fee-for-Service	1861438566	1861438566	1	1	RAHMAN, SIAMAK MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76878	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134056	Fee-for-Service	1710463203	1710463203	1	1	REYNOSO, MELISSA J OT	1/29/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W ARROW HWY	130	SAN DIMAS	CA	91773	2330	19	06037	34.10677054	-117.8331379	Los Angeles County
134078	Fee-for-Service	1356340764	1356340764	1	1	RAJAGOPALAN, JAISHREE MD	7/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85803	41	Internal Medicine	0	In state provider	None	2511 LOGAN ST	None	SELMA	CA	93662	3012	10	06019	36.570951	-119.613866	Fresno County
134109	Fee-for-Service	1669838678	1669838678	1	1	R.E.A.C.H. PROJECT	8/9/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9100 BRENTWOOD BLVD	None	BRENTWOOD	CA	94513	4000	07	06013	37.91890165	-121.6845946	Contra Costa County
134170	Fee-for-Service	1386792331	1386792331	1	1	REYNOLDS, VANESSA R MD	5/9/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62828	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
134194	Fee-for-Service	1952538589	1952538589	1	1	ROBINSON, ANDREW Y MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148477	13	Neurology (M.D. only)	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
134221	Fee-for-Service	1992322200	1992322200	1	1	REIS, KESSIA O CRNA	9/21/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
134230	Fee-for-Service	1053378380	1053378380	1	1	REID, DAVID A MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	33085	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
134267	Fee-for-Service	1285615955	1285615955	1	1	ROLAND D REINHART M D A PROF	8/12/2020	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ESSIONAL CORPORATION	39800 PORTOLA	None	PALM DESERT	CA	92260	0620	33	06065	33.76148288	-116.3735976	Riverside County
134280	Fee-for-Service	1487781159	1487781159	1	1	RES-CARE CALIFORNIA, INC	12/1/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8525 MEANDERING WAY	None	ANTELOPE	CA	95843	5863	34	06067	38.724579	-121.3505145	Sacramento County
134281	Fee-for-Service	1225364060	1225364060	3	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1781 SIMPSON ST	None	KINGSBURG	CA	93631	1934	10	06019	36.51738698	-119.5584916	Fresno County
134283	Fee-for-Service	1104659598	1104659598	1	1	ROOTED WILLOW SERVICES, INC.	3/20/2025	193400000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
134295	Fee-for-Service	1295305498	1295305498	1	1	RADIANT LIGHT HOME HEALTH	1/3/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2600 FOOTHILL BLVD	STE 305	LA CRESCENTA	CA	91214	4579	19	06037	34.22121465	-118.2352382	Los Angeles County
134299	Fee-for-Service	1629086830	1629086830	1	1	RALPHS GROCERY COMPANY	12/18/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #106	3515 SPORTS ARENA BLVD	None	SAN DIEGO	CA	92110	4920	37	06073	32.751621	-117.2113875	San Diego County
134302	Fee-for-Service	1174503858	1174503858	1	1	RABBANI, RITA R. MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2930 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1854	00	None	48.77232859	-122.4750679	Whatcom County
134340	Fee-for-Service	1871559898	1871559898	1	1	RAHMAN, SURAIYA S MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54271	None	None	0	In state provider	None	895 E YOBRA LINDA BLVD	STE 101	PLACENTIA	CA	92870	7600	30	06059	33.88944355	-117.8486322	Orange County
134364	Fee-for-Service	1659696367	1659696367	1	1	RATNAYAKE, CHANDIMA R MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111827	01	General Practice	0	In state provider	None	1600 E CITRUS AVE	None	REDLANDS	CA	92374	4802	36	06071	34.05557272	-117.1468659	San Bernardino County
134368	Fee-for-Service	1518402676	1518402676	1	1	RYAN, JOHN F MD	6/12/2024	390200000X	NA	Other	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134395	Fee-for-Service	1871378125	1871378125	1	1	RECINOS, JAMES E PT	9/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3400 CENTRAL AVE	145	RIVERSIDE	CA	92506	2161	33	06065	33.95355249	-117.385407	Riverside County
134402	Fee-for-Service	1003034588	1003034588	1	1	RAGHIB, TIMUR O MD	1/24/2022	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
134451	Fee-for-Service	1801921952	1801921952	1	3	ROY MEDICAL GROUP INC	4/30/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1543 E PALMDALE BLVD	STE C	PALMDALE	CA	93550	2030	19	06037	34.57966352	-118.101582	Los Angeles County
134460	Fee-for-Service	1972828366	1972828366	1	1	RAND, JAMIE G MD	6/1/2019	208600000X	NA	General Surgery	026	PHYSICIANS	149229	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
134521	Fee-for-Service	1689089526	1689089526	1	1	RIGGS, JOHN M MD	10/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157388	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
134531	Fee-for-Service	1205063534	1205063534	1	1	RIVERA, AMADEO D JR MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128342	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
134536	Fee-for-Service	1962288423	1962288423	1	1	RUIZ RAMIREZ, CONCESA M NP	1/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
134547	Fee-for-Service	1124666706	1124666706	1	1	RENAISSANCE HOSPICE CARE INC	12/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11485 VENTURA BLVD	UNIT A	STUDIO CITY	CA	91604	3143	19	06037	34.13967312	-118.381726	Los Angeles County
134555	Fee-for-Service	1225298441	1225298441	1	1	RITTER, STONSON T MD	1/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126804	05	Anesthesiology	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
134557	Fee-for-Service	1073000105	1073000105	1	2	RADIOLOGICA INC.	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
134572	Fee-for-Service	1225364060	1225364060	3	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1781 SIMPSON ST	None	KINGSBURG	CA	93631	1934	10	06019	36.51738698	-119.5584916	Fresno County
134596	Fee-for-Service	1962683060	1962683060	1	1	RITCHIE, MARK A MD	7/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	48077	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
134625	Fee-for-Service	1134169535	1134169535	2	38	REACH AIR MEDICAL SERVICES L	10/1/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LC	16000 KASOTA RD	BLDG 1	APPLE VALLEY	CA	92307	2208	36	06071	34.542603	-117.266839	San Bernardino County
134654	Fee-for-Service	1881190403	1881190403	1	1	ROGICH, JEROME J MD	9/9/2022	207P00000X	NA	Other	026	PHYSICIANS	174255	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
134685	Fee-for-Service	1093712689	1093712689	2	1	REDDING PATHOLOGISTS	10/10/2012	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	2036 RAILROAD AVE	None	REDDING	CA	96001	1801	45	06089	40.57806515	-122.3920754	Shasta County
134694	Fee-for-Service	1134169535	1134169535	2	25	REACH AIR MEDICAL SERVICES L	2/7/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	1050 N EASTERN AVE	STE B	BRAWLEY	CA	92227	1720	13	06025	32.99127652	-115.5177451	Imperial County
134717	Fee-for-Service	1972731404	1972731404	1	1	RITTER, MARY E MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114187	40	Pediatrics	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
134734	Fee-for-Service	1003269499	1003269499	1	1	ROBINSON, ANTONETTE LMFT	5/15/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 E LEXINGTON AVE	None	EL CAJON	CA	92020	4511	37	06073	32.79269801	-116.9617323	San Diego County
134738	Fee-for-Service	1720159619	1720159619	1	1	RASGON, SCOTT A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45547	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
134739	Fee-for-Service	1801921952	1801921952	1	3	ROY MEDICAL GROUP INC	4/30/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1543 E PALMDALE BLVD	STE C	PALMDALE	CA	93550	2030	19	06037	34.57966352	-118.101582	Los Angeles County
134751	Fee-for-Service	1114971660	1114971660	1	3	RIVERSIDE HEALTHCARE SYSTEM	10/27/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4510 BROCKTON AVE	STE 175	RIVERSIDE	CA	92501	4020	33	06065	33.97675372	-117.3850798	Riverside County
134760	Fee-for-Service	1245650514	1245650514	1	1	RUDE, JENNIFER N MD	4/13/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164890	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
134805	Fee-for-Service	1952514531	1952514531	1	1	REIMERS, NICOLE M LMFT	11/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2575 FOREST AVE	None	CHICO	CA	95928	7686	04	06007	39.71801447	-121.7927912	Butte County
134831	Fee-for-Service	1093411969	1093411969	1	1	REGIONAL EYECARE SERVICES, P	2/27/2024	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 W HELLMAN AVE	#302	MONTEREY PARK	CA	91754	1209	19	06037	34.06972847	-118.124154	Los Angeles County
134834	Fee-for-Service	1124666706	1124666706	1	1	RENAISSANCE HOSPICE CARE INC	12/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11485 VENTURA BLVD	UNIT A	STUDIO CITY	CA	91604	3143	19	06037	34.13967312	-118.381726	Los Angeles County
134858	Fee-for-Service	1225364060	1225364060	3	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1781 SIMPSON ST	None	KINGSBURG	CA	93631	1934	10	06019	36.51738698	-119.5584916	Fresno County
134891	Fee-for-Service	1518367952	1518367952	1	1	ROSE, NICOLE M LCSW	2/22/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7293 DUMOSA AVE	SUITE 5, 7 & 8	YUCCA VALLEY	CA	92284	3700	36	06071	34.12094334	-116.4177385	San Bernardino County
134950	Fee-for-Service	1881056364	1881056364	1	1	ROHLFING, ANNE B MD	7/10/2019	208M00000X	NA	Other	026	PHYSICIANS	155092	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
134964	Fee-for-Service	1366947616	1366947616	1	1	RUSH, BRITTANY S MD	9/9/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175971	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
134976	Fee-for-Service	1558448324	1558448324	1	1	REILLY, BRENDA MD	9/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77176	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
135017	Fee-for-Service	1134747595	1134747595	1	1	ROSE, DAWN E CNP	11/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
135026	Fee-for-Service	1558497404	1558497404	1	1	RSCR CALIFORNIA, INC	3/15/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1447 E 15TH ST	None	UPLAND	CA	91786	2436	36	06071	34.11797331	-117.6299162	San Bernardino County
135084	Fee-for-Service	1710065933	1710065933	1	1	RADYS CHILDRENS HOSPITAL	12/1/1979	282NC2000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
135113	Fee-for-Service	1205919503	1205919503	1	1	REDDY, MOHAN JUVVALA R MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53458	36	Psychiatry	0	In state provider	None	770 MAGNOLIA AVE	SUITE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
135118	Fee-for-Service	1093411969	1093411969	1	1	REGIONAL EYECARE SERVICES, P	2/27/2024	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	120 W HELLMAN AVE	#302	MONTEREY PARK	CA	91754	1209	19	06037	34.06972847	-118.124154	Los Angeles County
135131	Fee-for-Service	1093937781	1093937781	1	1	REDMAN, CHARLES R	1/25/2023	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
135138	Fee-for-Service	1124008719	1124008719	1	1	REGENTS OF THE UNIV CA	9/12/1995	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	2000 O ST	STE 210	SACRAMENTO	CA	95814	5286	34	06067	38.57106572	-121.4822412	Sacramento County
135149	Fee-for-Service	1225364060	1225364060	3	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1781 SIMPSON ST	None	KINGSBURG	CA	93631	1934	10	06019	36.51738698	-119.5584916	Fresno County
135204	Fee-for-Service	1467483735	1467483735	1	1	RICE, DAVID C. PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1812 CAPITOL ST	None	VALLEJO	CA	94590	5721	48	06095	38.10287416	-122.2376784	Solano County
135249	Fee-for-Service	1124023254	1124023254	1	1	RIGOBERTO O GUTIERREZ	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76723	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	,MD	2809 OLIVE HWY	STE 370	OROVILLE	CA	95966	6136	04	06007	39.50386798	-121.5410203	Butte County
135260	Fee-for-Service	1154618551	1154618551	1	1	RANGEL BARRERA, CARLOS MD	2/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	124448	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
135276	Fee-for-Service	1427030519	1427030519	1	1	ROHLA MICHAEL DO	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1118 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2590	40	06079	35.11970198	-120.5969908	San Luis Obispo County
135309	Fee-for-Service	1619367117	1619367117	1	1	RIBEIRO, TATIANA X LMFT	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107244	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
135345	Fee-for-Service	1093143927	1093143927	1	1	RICHTER, KILEY E	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
135347	Fee-for-Service	1316987126	1316987126	1	2	REHAB ALLIANCE	1/30/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22995 MILL CREEK DR	SUITE A	LAGUNA HILLS	CA	92653	1215	30	06059	33.62819651	-117.7351762	Orange County
135372	Fee-for-Service	1710065933	1710065933	1	1	RADYS CHILDRENS HOSPITAL	12/1/1977	282NC2000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
135444	Fee-for-Service	1417962978	1417962978	1	1	RASHMI SABU	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNM MEDICAL GROUP	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
135461	Fee-for-Service	1639379514	1639379514	1	1	ROTHMAN, STEPHANIE J DO	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11776	79	Neurology-Child	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
135465	Fee-for-Service	1669653945	1669653945	1	1	RAO, VIJAY A MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97858	30	Radiology	0	In state provider	None	330 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
135491	Fee-for-Service	1346508629	1346508629	1	1	REICHER, JOSHUA J MD	8/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	126838	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
135522	Fee-for-Service	1558378059	1558378059	1	1	RAMADURAI, RAGHU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 N LINCOLN AVE	None	PARK RIDGE	IL	60068	3141	00	None	42.01638426	-87.84312845	Cook County
135541	Fee-for-Service	1124023254	1124023254	1	1	RIGOBERTO O GUTIERREZ	4/21/2006	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	,MD	2809 OLIVE HWY	STE 370	OROVILLE	CA	95966	6136	04	06007	39.50386798	-121.5410203	Butte County
135550	Fee-for-Service	1790936342	1790936342	1	1	RAMADAN, OSAMA A MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92401	41	Internal Medicine	0	In state provider	None	4580 CALIFORNIA AVENUE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
135561	Fee-for-Service	1912088436	1912088436	1	1	REILLY, KEVIN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
135576	Fee-for-Service	1699180349	1699180349	1	1	RAAM, MANU S MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130853	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
135624	Fee-for-Service	1508912130	1508912130	1	1	ROMERO, CAMILA X	11/2/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93812	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
135646	Fee-for-Service	1114426285	1114426285	1	1	RIOS RESTREPO, LINA M NP	8/12/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
135653	Fee-for-Service	1568544278	1568544278	1	1	RASMUSSEN, BETH A MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127660	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
135660	Fee-for-Service	1710065933	1710065933	1	1	RADYS CHILDRENS HOSPITAL	9/24/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
135666	Fee-for-Service	1770554669	1770554669	1	2	RODRIGUEZ, HECTOR J MD	7/5/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	29728	45	Nephrology (Renal-Kidney)	0	In state provider	None	1125 S BEVERLY DR	425	LOS ANGELES	CA	90035	1192	19	06037	34.05696658	-118.3966613	Los Angeles County
135708	Fee-for-Service	1942707591	1942707591	1	1	REYES, JESSICA R MD	12/27/2022	207L00000X	NA	Other	026	PHYSICIANS	178587	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
135770	Fee-for-Service	1760151419	1760151419	1	1	REGAL ADHC INC	11/29/2023	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	253 EAST FOOTHILL BLVD	None	ARCADIA	CA	91006	2509	19	06037	34.15110019	-118.0233311	Los Angeles County
135778	Fee-for-Service	1477092823	1477092823	1	1	RIO BRAVO-GREELEY UNION	7/1/2016	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ELEMENTARY SCHOOL DISTRI	6521 ENOS LANE	None	BAKERSFIELD	CA	93314	8721	15	06029	35.41932	-119.251978	Kern County
135818	Fee-for-Service	1780910810	1780910810	1	1	RAFIE, REZA MD	12/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109184	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
135829	Fee-for-Service	1124023254	1124023254	1	1	RIGOBERTO O GUTIERREZ	4/21/2006	207V00000X	NA	Obstetrics & Gynecology	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	,MD	2809 OLIVE HWY	STE 370	OROVILLE	CA	95966	6136	04	06007	39.50386798	-121.5410203	Butte County
135851	Fee-for-Service	1205235124	1205235124	1	1	RUVALCABA, BRENDA A MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145775	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
135897	Fee-for-Service	1386785657	1386785657	1	2	ROSS, CAROLYN C	4/14/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	37347	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
135910	Fee-for-Service	1154379584	1154379584	1	1	REDBERG, RITA F MD	12/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70059	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
135931	Fee-for-Service	1740205343	1740205343	1	1	RALPHS GROCERY COMPANY	2/7/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #741	674 LAS POSAS RD	None	CAMARILLO	CA	93010	5716	56	06111	34.222842	-119.0677095	Ventura County
135960	Fee-for-Service	1174940753	1174940753	1	1	ROBERTS, KATHRYN M CNM	1/22/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
135975	Fee-for-Service	1962029637	1962029637	1	1	REYES, RANDY CNP	12/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	683 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
136019	Fee-for-Service	1013445642	1013445642	1	1	ROBINSON, CHRISTOPHER T MD	10/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167094	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
136021	Fee-for-Service	1083103188	1083103188	1	1	RIDDLE, ENRIQUE G MD	6/21/2022	261QU0200X	NA	Other	026	PHYSICIANS	175421	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
136040	Fee-for-Service	1740546787	1740546787	1	1	RED EAGLE, ALEXANDER R MD	12/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126723	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
136069	Fee-for-Service	1578752176	1578752176	1	1	ROHLFING, CHANTAL M LCSW	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	921 THE ALAMEDA	107	BERKELEY	CA	94707	2311	01	06001	37.89086106	-122.2769457	Alameda County
136114	Fee-for-Service	1124023254	1124023254	1	1	RIGOBERTO O GUTIERREZ	4/21/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	,MD	2809 OLIVE HWY	STE 370	OROVILLE	CA	95966	6136	04	06007	39.50386798	-121.5410203	Butte County
136130	Fee-for-Service	1730480245	1730480245	1	1	REFF, JODY A	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
136164	Fee-for-Service	1720284854	1720284854	1	1	ROSTAMIAN, SHARIS N PSYD	7/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
136174	Fee-for-Service	1205884210	1205884210	1	1	REGENTS OF THE UNIVERSITY OF	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
136206	Fee-for-Service	1790363604	1790363604	1	1	RAZAQI, SARA MD	8/21/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
136224	Fee-for-Service	1992723555	1992723555	1	1	RENAISSANCE RADIOLOGY	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	LINDA KAUFMAN	12276 HESPERIA RD	None	VICTORVILLE	CA	92395	5838	36	06071	34.47424926	-117.2915621	San Bernardino County
136232	Fee-for-Service	1841224862	1841224862	1	1	RAMDALL, RISHA B MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106535	90	Pathology-Forensic	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
136245	Fee-for-Service	1669975488	1669975488	1	1	RANSOHOFF, JULIA D MD	4/17/2025	207RX0202X	NA	Oncology	026	PHYSICIANS	163583	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136255	Fee-for-Service	1477920478	1477920478	1	1	RUGLESS, KELLI L L PHD	5/17/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
136272	Fee-for-Service	1245745215	1245745215	1	1	RAD OPTOMETRIC CARE INC	8/18/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14006 RIVERSIDE DR	SUITE 274	SHERMAN OAKS	CA	91423	1963	19	06037	34.15757854	-118.437858	Los Angeles County
136288	Fee-for-Service	1306675962	1306675962	1	1	RAMIREZ, ALEJANDRA AU	7/31/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	16030 VENTURA BLVD	SUITE 610	ENCINO	CA	91436	4471	19	06037	34.15615339	-118.4824038	Los Angeles County
136295	Fee-for-Service	1306948799	1306948799	1	1	RALEYS	3/30/1995	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8870 MADISON AVE	None	FAIR OAKS	CA	95628	3909	34	06067	38.662551	-121.228155	Sacramento County
136298	Fee-for-Service	1710265244	1710265244	1	1	ROSTAMIAN, ARMAN G MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123230	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ	AVE STE 125	LOS ANGELES	CA	90033	2445	19	06037	34.05112725	-118.2173921	Los Angeles County
136305	Fee-for-Service	1912535410	1912535410	1	1	RAMOS, JOSHUA N MD	6/4/2024	207L00000X	NA	Other	026	PHYSICIANS	187725	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
136360	Fee-for-Service	1548205461	1548205461	1	1	REM SLEEP DIAGNOSTICS INC	6/11/2009	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	855 BORDEAUX WAY	# 220	NAPA	CA	94558	7568	28	06055	38.24914335	-122.271666	Napa County
136366	Fee-for-Service	1700283751	1700283751	1	1	ROUTHIER, KAREL MD	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	154672	36	Psychiatry	0	In state provider	None	950 CIRCLE DR	None	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
136375	Fee-for-Service	1750570248	1750570248	1	1	RAZA, SYED J MD INC	6/29/2004	193400000X	NA	Other	026	PHYSICIANS	52952	43	Pediatric Allergy	0	In state provider	ADVANCED CARDIO MED GRP	15962 QUANTICO RD	None	APPLE VALLEY	CA	92307	9998	36	06071	34.54129924	-117.2707306	San Bernardino County
136377	Fee-for-Service	1972754877	1972754877	1	1	REDDY, KARTHEEK K MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125790	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.8002375	-117.1546269	San Diego County
136382	Fee-for-Service	1982920765	1982920765	1	1	RUZHNIKOV, MAURA R Z MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119721	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
136393	Fee-for-Service	1558540237	1558540237	1	1	REHANI, BHAVYA MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131844	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
136402	Fee-for-Service	1649265356	1649265356	1	1	ROMERO, GEORGE G MD	7/1/1994	207L00000X	NA	Other	026	PHYSICIANS	56056	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
136409	Fee-for-Service	1861628828	1861628828	1	1	ROSS, MINDY K MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99914	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
136457	Fee-for-Service	1114288586	1114288586	1	1	RIVERSIDE LIFE SERVICES INC	1/31/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3727 MCCRAY STREET	None	RIVERSIDE	CA	92506	2928	33	06065	33.948557	-117.3976041	Riverside County
136462	Fee-for-Service	1205884210	1205884210	1	1	REGENTS OF THE UNIVERSITY OF	1/11/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
136476	Fee-for-Service	1811444961	1811444961	1	1	ROTHMAN, ALANA L NP	8/22/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
136533	Fee-for-Service	1669975488	1669975488	1	1	RANSOHOFF, JULIA D MD	4/17/2025	207RX0202X	NA	Oncology	026	PHYSICIANS	163583	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136588	Fee-for-Service	1710358791	1710358791	1	1	RIDERER, HILDA L DO	2/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14289	41	Internal Medicine	0	In state provider	None	1420 SOUTH CENTRAL AVE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
136603	Fee-for-Service	1659554087	1659554087	1	1	ROSS, JESSICA A MD	8/5/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	86375	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
136630	Fee-for-Service	1083641807	1083641807	1	1	RACCA, JEFFREY W MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	NEW MEXICO ORTHO ASSOC	201 CEDAR ST SE	STE# 6600	ALBUQUERQUE	NM	87106	4915	00	None	35.08078421	-106.6341683	Bernalillo County
136647	Fee-for-Service	1063510824	1063510824	1	1	RICHTAND, NEIL M MD	4/24/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	65199	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
136649	Fee-for-Service	1508285412	1508285412	1	1	RUBINCHIKOVA, YELENA DO	7/17/2020	207RC0200X	NA	Other	026	PHYSICIANS	18265	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
136678	Fee-for-Service	1942388020	1942388020	1	1	ROLLE, THOMAS M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45007	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
136708	Fee-for-Service	1689646705	1689646705	1	1	RANA N AHMAD MD	12/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
136715	Fee-for-Service	1669883831	1669883831	1	1	REILLY, JAMES MD	8/9/2023	207P00000X	NA	Other	026	PHYSICIANS	185992	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
136745	Fee-for-Service	1235559782	1235559782	1	1	REECE-NGUYEN, TRAVIS L MD	7/9/2019	207L00000X	NA	Other	026	PHYSICIANS	155840	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136751	Fee-for-Service	1386057594	1386057594	1	1	ROSALES INC	7/12/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2955 E HILLCREST DR	SUITE 128	THOUSAND OAKS	CA	91362	3178	56	06111	34.17313733	-118.8347453	Ventura County
136833	Fee-for-Service	1760541569	1760541569	1	6	RETINA INSTITUTE OF CALIFORN	10/26/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	40690 CALIFORNIA OAKS	B	MURRIETA	CA	92562	1947	33	06065	33.57085341	-117.2044062	Riverside County
136918	Fee-for-Service	1093161903	1093161903	1	1	ROBERG, DYLAN M DPM	10/9/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
136954	Fee-for-Service	1144511189	1144511189	1	1	RONALD ROGERS MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
136968	Fee-for-Service	1518074491	1518074491	1	1	RANGARAJAN, VAIJAYANTHY	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71285	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
137002	Fee-for-Service	1528531274	1528531274	1	1	REDON, KENNETH ADRIAN B NP	3/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9905 BACE AVE	None	BAKERSFIELD	CA	93307	6211	15	06029	35.264556	-119.004446	Kern County
137015	Fee-for-Service	1497332431	1497332431	1	1	RAMADAS, RAMYA MD	9/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
137016	Fee-for-Service	1740295138	1740295138	1	1	ROCCO, ROBERT P MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	26562	01	General Practice	0	In state provider	None	901 SUNSET DR	STE 1	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
137031	Fee-for-Service	1629364104	1629364104	1	1	ROY, SHRUTI A DO	6/20/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17241	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
137032	Fee-for-Service	1184675761	1184675761	1	1	RAMJI, SHAHIRA MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	69740	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
137038	Fee-for-Service	1659394633	1659394633	1	1	RADNIA, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92103	None	None	0	In state provider	None	1016 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1505	19	06037	34.05875861	-118.3836306	Los Angeles County
137041	Fee-for-Service	1386057594	1386057594	1	1	ROSALES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2955 E HILLCREST DR	SUITE 128	THOUSAND OAKS	CA	91362	3178	56	06111	34.17313733	-118.8347453	Ventura County
137060	Fee-for-Service	1619589157	1619589157	1	1	RODRIGUEZ, REBECCA E LMFT	2/26/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2246 N. STATE COLLEGE BL	None	FULLERTON	CA	92831	1361	30	06059	33.8963708	-117.8917733	Orange County
137061	Fee-for-Service	1568939924	1568939924	1	1	ROUSHION, COURTNEY M LCSW	12/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
137086	Fee-for-Service	1396085478	1396085478	1	1	RODICA ELIGIA COTA	3/10/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5008 FITZWILLIAM ST	None	ROSEVILLE	CA	95747	4106	31	06061	38.79718937	-121.3668889	Placer County
137110	Fee-for-Service	1912670308	1912670308	1	1	RIVER CITY MEDICAL GROUP, IN	5/20/2022	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7311 GREENHAVEN DR	165	SACRAMENTO	CA	95831	3572	34	06067	38.492622	-121.5219195	Sacramento County
137125	Fee-for-Service	1760541569	1760541569	1	6	RETINA INSTITUTE OF CALIFORN	2/16/2021	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	40690 CALIFORNIA OAKS	B	MURRIETA	CA	92562	1947	33	06065	33.57085341	-117.2044062	Riverside County
137168	Fee-for-Service	1174122436	1174122436	1	3	RICHARD LIN DO INC	9/7/2023	207XS0117X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	11180 WARNER AVE	161	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
137189	Fee-for-Service	1447679923	1447679923	1	1	RAMKUMAR, MUKUND MD	9/23/2021	207RC0200X	NA	Other	026	PHYSICIANS	156037	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
137192	Fee-for-Service	1124607379	1124607379	1	1	ROOHANI, DARIUS MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	183778	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 150	MISSION VIEJO	CA	92691	8018	30	06059	33.56286021	-117.6673449	Orange County
137217	Fee-for-Service	1134169535	1134169535	2	16	REACH AIR MEDICAL SERVICES L	3/6/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1111 AIRPORT ROAD	None	IMPERIAL	CA	92251	1828	13	06025	32.83456409	-115.5722102	Imperial County
137236	Fee-for-Service	1164746871	1164746871	1	1	ROQUE, CHARLES	5/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137241	Fee-for-Service	1104144690	1104144690	1	1	RAJARAMAN, RAJSEKAR R MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122557	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
137253	Fee-for-Service	1598843161	1598843161	1	1	ROTH, DAVID R MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
137261	Fee-for-Service	1083788327	1083788327	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF I LLC	1781 SANTA CLARA DRIVE	None	ROSEVILLE	CA	95661	2921	31	06061	38.74703978	-121.2620534	Placer County
137282	Fee-for-Service	1932279494	1932279494	1	1	ROESKE, WILLIAM R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
137291	Fee-for-Service	1538384623	1538384623	1	1	RAED KHAIRY	2/14/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
137303	Fee-for-Service	1740295138	1740295138	1	1	ROCCO, ROBERT P MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	26562	08	Family Practice	0	In state provider	None	901 SUNSET DR	STE 1	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
137321	Fee-for-Service	1629364104	1629364104	1	1	ROY, SHRUTI A DO	6/20/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17241	66	Emergency Medicine (Urgent Care)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
137353	Fee-for-Service	1841404951	1841404951	1	1	ROBINSON, DUSTIN E MD	7/21/2009	204F00000X	NA	General Surgery	026	PHYSICIANS	107214	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
137372	Fee-for-Service	1285068015	1285068015	1	1	REITER, MEHERA V LCSW	3/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
137406	Fee-for-Service	1154344760	1154344760	1	1	RAO, RAVINDRA MD	6/8/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32898	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	# 1200	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
137504	Fee-for-Service	1306258959	1306258959	1	1	RUHLAND, ELLIOT M LMFT	2/20/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W FIRST ST	SUITE 346	CLAREMONT	CA	91711	4742	19	06037	34.09450024	-117.7183344	Los Angeles County
137533	Fee-for-Service	1104144690	1104144690	1	1	RAJARAMAN, RAJSEKAR R MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122557	79	Neurology-Child	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
137555	Fee-for-Service	1568496826	1568496826	1	1	RICH, DONALD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28215	01	General Practice	0	In state provider	None	706 WESTERN DR	None	SANTA CRUZ	CA	95060	3033	44	06087	36.96965569	-122.058468	Santa Cruz County
137557	Fee-for-Service	1710033527	1710033527	1	1	RUTHERGLEN, JOHN P	1/2/2009	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 BAYWOOD AVE	STE 1	SAN MATEO	CA	94402	1537	41	06081	37.56513159	-122.3284067	San Mateo County
137570	Fee-for-Service	1952756348	1952756348	1	1	RYE, VAN N MD	5/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153295	None	None	0	In state provider	None	1031 W CHAPMAN AVENUE	SUITE 101	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
137598	Fee-for-Service	1619747011	1619747011	1	1	REYNOLDS, AMBER L	2/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	45	06089	0	0	None
137624	Fee-for-Service	1922179639	1922179639	1	1	RUBINSTEIN, RITA H MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31647	08	Family Practice	0	In state provider	None	340 W CENTRAL AVE	STE 138	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
137643	Fee-for-Service	1043447972	1043447972	1	1	RAJENDRAN, PRIYA M MD	3/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102452	07	Dermatology	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
137662	Fee-for-Service	1780872721	1780872721	1	1	RAO, NIMMAGADDA N MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	26699	41	Internal Medicine	0	In state provider	None	760 WASHBURN AVE	STE 7	CORONA	CA	92882	3303	33	06065	33.87374678	-117.5678721	Riverside County
137714	Fee-for-Service	1861213001	1861213001	1	1	REISNER HEALING CENTER	1/28/2025	261QM0801X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	38780 TRADE CENTER DR	STE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
137730	Fee-for-Service	1710429147	1710429147	1	1	RODRIQUEZ, WILLIAM A LCSW	2/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	606 AMARRA LN	None	VISTA	CA	92083	3343	37	06073	33.21315526	-117.2565959	San Diego County
137738	Fee-for-Service	1063440006	1063440006	1	1	RICCI, ORLANDO MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	86084	05	Anesthesiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
137775	Fee-for-Service	1386746741	1386746741	1	1	REGENTS OF THE UNIVERSITY OF	10/4/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
137830	Fee-for-Service	1841332491	1841332491	1	1	ROBERTS, KRISTEN F LMFT	5/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2127 W ORANGEWOOD AVE	B	ORANGE	CA	92868	1978	30	06059	33.7958145	-117.8754165	Orange County
137873	Fee-for-Service	1760457592	1760457592	1	1	RASHKIN, ALAN MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2925 SYCAMORE DR	STE 202	SIMI VALLEY	CA	93065	1208	56	06111	34.288398	-118.7439175	Ventura County
137918	Fee-for-Service	1578597878	1578597878	1	1	RAY, SUBHRANSU K MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86936	18	Ophthalmology	0	In state provider	None	122 LA CASA VIA	STE 223	WALNUT CREEK	CA	94598	3014	07	06013	37.91198028	-122.041845	Contra Costa County
137922	Fee-for-Service	1710262472	1710262472	1	1	RAD, AMIR H M MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118311	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1451 IRVINE BLVD	None	TUSTIN	CA	92780	3804	30	06059	33.74507677	-117.8047636	Orange County
137940	Fee-for-Service	1770503161	1770503161	1	1	RABBANI, FARHAD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	44623	None	None	0	In state provider	None	8920 WILSHIRE BLVD	STE 106	BEVERLY HILLS	CA	90211	2000	19	06037	34.06703599	-118.3863456	Los Angeles County
137999	Fee-for-Service	1326191610	1326191610	1	1	ROCKER, JOSHUA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	27005 76TH AVE	None	NEW HYDE PARK	NY	11040	1402	00	None	40.75318311	-73.70703519	Queens County
138063	Fee-for-Service	1386746741	1386746741	1	1	REGENTS OF THE UNIVERSITY OF	7/3/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138070	Fee-for-Service	1235649260	1235649260	1	2	RENEWING HOPE FAMILY COUNSEL	5/24/2021	104100000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
138160	Fee-for-Service	1760457592	1760457592	1	1	RASHKIN, ALAN MD	10/30/1980	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	38481	20	Orthopedic Surgery	0	In state provider	None	2925 SYCAMORE DR	STE 202	SIMI VALLEY	CA	93065	1208	56	06111	34.288398	-118.7439175	Ventura County
138175	Fee-for-Service	1770554669	1770554669	1	1	RODRIGUEZ, HECTOR J MD	9/1/1981	207RN0300X	NA	Nephrology	026	PHYSICIANS	29728	45	Nephrology (Renal-Kidney)	0	In state provider	None	9400 BRIGHTON WAY	STE 301	BEVERLY HILLS	CA	90210	4710	19	06037	34.07043476	-118.4011952	Los Angeles County
138177	Fee-for-Service	1891152963	1891152963	1	1	REYES, HAYDEE D	2/17/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 BROADWAY	None	OAKLAND	CA	94611	4615	01	06001	37.833289	-122.2531244	Alameda County
138194	Fee-for-Service	1265790406	1265790406	1	1	RODRIGUEZ, CHRISTOPER D S M	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130635	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
138207	Fee-for-Service	1184914913	1184914913	1	1	ROSS, NAOMI E MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124337	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
138222	Fee-for-Service	1891728788	1891728788	1	1	RASHIDI, MAHMOUD N MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87654	14	Neurological Surgery	0	In state provider	None	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
138237	Fee-for-Service	1588323133	1588323133	1	1	ROSEN, ROXANNA L PSYD	2/9/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
138334	Fee-for-Service	1720213382	1720213382	1	1	RIVES, CASEY N MD	3/6/2019	207R00000X	NA	Other	026	PHYSICIANS	155656	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
138338	Fee-for-Service	1447489893	1447489893	1	1	REAGLE, GABRIEL Z DO	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10912	41	Internal Medicine	0	In state provider	None	1428 PHILLIPS LANE	SUITE 203	SAN LUIS OBISPO	CA	93401	2551	40	06079	35.28794905	-120.6574321	San Luis Obispo County
138352	Fee-for-Service	1386746741	1386746741	1	1	REGENTS OF THE UNIVERSITY OF	9/16/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138354	Fee-for-Service	1235649260	1235649260	1	2	RENEWING HOPE FAMILY COUNSEL	7/10/2020	104100000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
138381	Fee-for-Service	1710065933	1710065933	1	2	RADYS CHILDRENS HOSPITAL	10/25/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	625 W CITRACADO PKWY	None	ESCONDIDO	CA	92025	6428	37	06073	33.09166731	-117.0784699	San Diego County
138426	Fee-for-Service	1639264294	1639264294	1	1	ROHDE, MARIA L LMFT	5/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1051 WEST AVE M14	STE B	PALMDALE	CA	93551	1434	19	06037	34.63304847	-118.149579	Los Angeles County
138462	Fee-for-Service	1770554669	1770554669	1	1	RODRIGUEZ, HECTOR J MD	9/1/1981	207RN0300X	NA	Nephrology	026	PHYSICIANS	29728	41	Internal Medicine	0	In state provider	None	9400 BRIGHTON WAY	STE 301	BEVERLY HILLS	CA	90210	4710	19	06037	34.07043476	-118.4011952	Los Angeles County
138494	Fee-for-Service	1649418401	1649418401	1	1	ROLOFF KRISTINA A DO	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10186	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
138529	Fee-for-Service	1497195200	1497195200	1	1	RANDHAWA, SONIA PSYD	1/17/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
138548	Fee-for-Service	1699353078	1699353078	1	1	REZAEI, SHEILA DO	9/25/2024	390200000X	NA	Other	026	PHYSICIANS	22429	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
138572	Fee-for-Service	1710460878	1710460878	1	1	RIVERSIDE EYE PARTNERS A PRO	5/26/2020	261QM2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FESSIONAL MEDICAL CORPOR	6377 RIVERSIDE AVE	STE 170	RIVERSIDE	CA	92506	3155	33	06065	33.9516	-117.387977	Riverside County
138575	Fee-for-Service	1851148860	1851148860	1	1	ROGERS, JENNIFER	7/8/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	333 GELLERT BLVD	STE 118	DALY CITY	CA	94015	2690	41	06081	37.66672018	-122.4685948	San Mateo County
138589	Fee-for-Service	1598828022	1598828022	1	1	REDDY, VIJAYALAKSHMI M MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69268	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
138594	Fee-for-Service	1285015313	1285015313	1	1	ROSEN, AARON M MD	4/14/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160663	None	None	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
138640	Fee-for-Service	1386746741	1386746741	1	1	REGENTS OF THE UNIVERSITY OF	10/28/2021	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138643	Fee-for-Service	1235649260	1235649260	1	2	RENEWING HOPE FAMILY COUNSEL	7/10/2020	104100000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ING CENTER, INC.	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
138657	Fee-for-Service	1447253125	1447253125	1	1	RIDGECREST REGIONAL HOSPITAL	12/1/1977	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
138753	Fee-for-Service	1124103254	1124103254	1	1	RAI, MEETINDER MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	49556	41	Internal Medicine	0	In state provider	None	1930 E HATCH RD	STE A	MODESTO	CA	95351	5141	50	06099	37.60918353	-120.9607965	Stanislaus County
138778	Fee-for-Service	1598809667	1598809667	1	1	REDLANDS COMM HOSP	1/1/1995	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
138805	Fee-for-Service	1629075882	1629075882	1	1	RUSHOVICH, ALAN M MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42199	22	Pathology (M.D. only)	0	In state provider	None	15375 BARRANCA PKWY	SUITE H-105	IRVINE	CA	92618	2209	30	06059	33.66174175	-117.7431116	Orange County
138808	Fee-for-Service	1477587327	1477587327	1	1	REY, JEFFREY MD	10/31/1991	207P00000X	NA	Other	026	PHYSICIANS	35481	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
138858	Fee-for-Service	1710460878	1710460878	1	1	RIVERSIDE EYE PARTNERS A PRO	5/26/2020	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	FESSIONAL MEDICAL CORPOR	6377 RIVERSIDE AVE	STE 170	RIVERSIDE	CA	92506	3155	33	06065	33.9516	-117.387977	Riverside County
138866	Fee-for-Service	1578294625	1578294625	1	1	RASMUSSEN, KAYLA MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	192039	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
138927	Fee-for-Service	1386746741	1386746741	1	1	REGENTS OF THE UNIVERSITY OF	9/16/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138933	Fee-for-Service	1235649260	1235649260	1	2	RENEWING HOPE FAMILY COUNSEL	7/10/2020	104100000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ING CENTER, INC.	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
138935	Fee-for-Service	1508936675	1508936675	1	1	RODRIGUEZ, GERONIMO G MD	12/31/1980	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36572	01	General Practice	0	In state provider	None	31 W BELLEVUE DR	None	PASADENA	CA	91105	2501	19	06037	34.13834649	-118.15119	Los Angeles County
138943	Fee-for-Service	1447253125	1447253125	1	1	RIDGECREST REGIONAL HOSPITAL	12/1/1977	282NR1301X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
138960	Fee-for-Service	1356492060	1356492060	1	1	ROKAW, JOSHUA A MD	3/31/1992	207R00000X	NA	Other	026	PHYSICIANS	59641	01	General Practice	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
138996	Fee-for-Service	1255355186	1255355186	1	1	RIZVI, HAIDER MD	9/13/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54680	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
139022	Fee-for-Service	1467535997	1467535997	1	1	RENO, ROCHELLE M PHD	9/6/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11980 SAN VICENTE BLVD	STE 801	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
139039	Fee-for-Service	1124103254	1124103254	1	1	RAI, MEETINDER MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	49556	01	General Practice	0	In state provider	None	1930 E HATCH RD	STE A	MODESTO	CA	95351	5141	50	06099	37.60918353	-120.9607965	Stanislaus County
139057	Fee-for-Service	1316333602	1316333602	1	1	RECLOSADO-BACLAY, CLAIRE M P	7/10/2020	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SYD	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
139066	Fee-for-Service	1922074731	1922074731	1	1	REIER, ALICE C MD	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81697	78	Neoplastic Diseases/Oncology	0	In state provider	None	3300 WEBSTER ST	STE 900	OAKLAND	CA	94609	3156	01	06001	37.82132826	-122.2621843	Alameda County
139088	Fee-for-Service	1679631543	1679631543	1	1	RHEE, JINSOO MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53313	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
139095	Fee-for-Service	1528575602	1528575602	1	1	RIMKA, REBECCA J NP	5/19/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
139126	Fee-for-Service	1326128950	1326128950	1	1	ROUEL, LINDA Y MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107575	01	General Practice	0	In state provider	None	860 JAMACHA ROAD	STE 107	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
139147	Fee-for-Service	1710460878	1710460878	1	1	RIVERSIDE EYE PARTNERS A PRO	5/26/2020	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	FESSIONAL MEDICAL CORPOR	6377 RIVERSIDE AVE	STE 170	RIVERSIDE	CA	92506	3155	33	06065	33.9516	-117.387977	Riverside County
139166	Fee-for-Service	1538434964	1538434964	1	1	RAMIREDDY, ARCHANA MD	8/12/2021	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160902	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
139181	Fee-for-Service	1750374815	1750374815	1	2	REGENTS/UCDPBG/GYN ONCOL	5/1/1999	207VX0201X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
139191	Fee-for-Service	1952800781	1952800781	1	1	REYNA-TOBAR, RENE CNP	2/15/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
139200	Fee-for-Service	1154734572	1154734572	1	1	RAO, SONALI A MD	2/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	155974	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
139219	Fee-for-Service	1235649260	1235649260	1	2	RENEWING HOPE FAMILY COUNSEL	12/27/2021	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
139239	Fee-for-Service	1609192699	1609192699	1	1	RAMUSSEN, LINDSEY K MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152436	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
139253	Fee-for-Service	1003809963	1003809963	1	1	REXINGER, KENNETH L MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69073	41	Internal Medicine	0	In state provider	None	27800 MEDICAL CENTER RD	STE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
139259	Fee-for-Service	1679891006	1679891006	1	1	RIVAZ, MARYAM MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
139353	Fee-for-Service	1922074731	1922074731	1	1	REIER, ALICE C MD	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81697	68	Hematology	0	In state provider	None	3300 WEBSTER ST	STE 900	OAKLAND	CA	94609	3156	01	06001	37.82132826	-122.2621843	Alameda County
139409	Fee-for-Service	1306278460	1306278460	1	1	RUSAW, JALENA L LMFT	7/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3960 INDUSTRIAL BLVD	200	WEST SACRAMENTO	CA	95691	3496	57	06113	38.57029234	-121.5767941	Yolo County
139423	Fee-for-Service	1013277227	1013277227	1	1	ROJAS, CATHERINE PSYD	5/20/2024	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
139442	Fee-for-Service	1609899111	1609899111	1	1	ROGERS, ANTHONY MD	2/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76956	08	Family Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
139444	Fee-for-Service	1366477150	1366477150	1	1	REEVES, MICHELLE	1/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61065	08	Family Practice	0	In state provider	None	25455 BARTON RD	# 106	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
139467	Fee-for-Service	1750374815	1750374815	1	2	REGENTS/UCDPBG/GYN ONCOL	8/17/2023	207VX0201X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
139473	Fee-for-Service	1245911288	1245911288	1	1	RADFORD, CHRISTOPHER R CRNA	2/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
139477	Fee-for-Service	1851572572	1851572572	2	1	RICHRON INC	5/16/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1520 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1134	19	06037	34.04719452	-117.9472502	Los Angeles County
139517	Fee-for-Service	1366986390	1366986390	1	1	RAMOS, TINA B NP	6/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
139526	Fee-for-Service	1366536757	1366536757	1	1	RAO, DEEPTI	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD AVE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
139541	Fee-for-Service	1831573278	1831573278	1	1	RICE, JASON L CCC-SLP	11/20/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
139572	Fee-for-Service	1891368908	1891368908	1	1	ROBERTSON, SIENNA LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1340 BELLO STREET	None	PISMO BEACH	CA	93449	2320	40	06079	35.14605938	-120.6428003	San Luis Obispo County
139587	Fee-for-Service	1427173129	1427173129	1	1	RAMOS, ERNEST D MD	3/30/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	563 N MOUNTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.100505	-117.6703307	San Bernardino County
139605	Fee-for-Service	1710928387	1710928387	1	1	RAMSEY LARSON MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
139617	Fee-for-Service	1669546990	1669546990	1	1	RAI CARE CTRS NO CA I	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	2350 N CALIFORNIA ST	None	STOCKTON	CA	95204	5506	39	06077	37.97506325	-121.2908551	San Joaquin County
139641	Fee-for-Service	1063829075	1063829075	1	1	RAO, SAHIL MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146481	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
139658	Fee-for-Service	1194013003	1194013003	1	1	RHOADS, MEGAN PSYD	9/23/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
139707	Fee-for-Service	1033385810	1033385810	1	1	ROPER, GLADE E	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101307	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
139721	Fee-for-Service	1174632780	1174632780	1	2	REDDIX, BRUCE A MD	4/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	40169	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	44155 W 15TH ST	None	LANCASTER	CA	93534	4079	19	06037	34.685127	-118.1604375	Los Angeles County
139727	Fee-for-Service	1750407995	1750407995	1	1	RUEKBERG, JUDITH H NP	10/28/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
139729	Fee-for-Service	1558073650	1558073650	1	1	RISLER, VINCENT W CRNA	5/4/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
139749	Fee-for-Service	1730535261	1730535261	1	1	R & N GUPTA MD PROFESSIONAL	7/15/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	341 E MAIN ST	STE 100	SAN JACINTO	CA	92583	4205	33	06065	33.78391437	-116.9562698	Riverside County
139756	Fee-for-Service	1821591686	1821591686	1	1	ROGOL, ALISSA M MD	5/15/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	164131	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
139811	Fee-for-Service	1558529099	1558529099	1	1	ROGERS, WHITNEY E PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
139818	Fee-for-Service	1710051321	1710051321	1	1	RAPKO, SONIA I MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95783	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
139822	Fee-for-Service	1801331251	1801331251	1	1	RAMIREZ, DENISE	4/27/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
139901	Fee-for-Service	1487976668	1487976668	1	1	REZVANI, MOHAMMAD MD	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113116	42	Nuclear Medicine	0	In state provider	None	125 S 5TH ST	None	BRAWLEY	CA	92227	2402	13	06025	32.97758931	-115.5337892	Imperial County
139923	Fee-for-Service	1710065933	1710065933	1	10	RADYS CHILDRENS HOSPITAL	1/9/2017	261QM0855X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	11752 EL CAMINO REAL	SUITE 100	SAN DIEGO	CA	92130	2050	37	06073	32.93046973	-117.2372372	San Diego County
139939	Fee-for-Service	1093185431	1093185431	1	1	RAZO, JOSEPH PSYD	12/13/2024	171M00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
139945	Fee-for-Service	1477620391	1477620391	1	1	RAPP, MELISSA H MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80043	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
139975	Fee-for-Service	1518038181	1518038181	1	1	RIFKIND, PATRICE A	1/16/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	23861 MCBEAN PKWY	STE E-16	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
139977	Fee-for-Service	1184840506	1184840506	1	1	RAJKUMAR SUGUMARAN MD	4/27/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9520 W PALM LN	STE 150-A	PHOENIX	AZ	85037	4403	00	None	33.468894	-112.267413	Maricopa County
139998	Fee-for-Service	1730251554	1730251554	1	1	ROW, LINDA H MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73548	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
140019	Fee-for-Service	1568403731	1568403731	1	1	RAHIMI, MENEZHA DO	2/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
140023	Fee-for-Service	1992480131	1992480131	1	1	RESTORED PATHWAYS FAMILY COU	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NSELING COLLECTIVE, PC	222 FASHION LN	212	TUSTIN	CA	92780	3339	30	06059	33.74712935	-117.8174161	Orange County
140036	Fee-for-Service	1841025137	1841025137	1	1	RODRIGUEZ, MAYRA AU	11/22/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
140049	Fee-for-Service	1891209359	1891209359	1	1	ROC MEDICAL	8/27/2018	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1805 N CALIFORNIA ST	406	STOCKTON	CA	95204	6037	39	06077	37.9711691	-121.2894221	San Joaquin County
140088	Fee-for-Service	1134169535	1134169535	2	29	REACH AIR MEDICAL SERVICES L	6/6/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1950 AIRPORT ROAD	None	NAPA	CA	94558	6326	28	06055	38.22078492	-122.2735085	Napa County
140097	Fee-for-Service	1396951828	1396951828	1	1	REARDON, PAUL F MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	49699	36	Psychiatry	0	In state provider	None	15 CORPORATE PLAZA DR	STE 140	NEWPORT BEACH	CA	92660	7940	30	06059	33.61013779	-117.8755739	Orange County
140129	Fee-for-Service	1750312559	1750312559	1	1	REW, DESIREE LCSW	1/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
140135	Fee-for-Service	1801921952	1801921952	1	1	ROY MEDICAL GROUP INC	1/1/1996	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	21001 SHERMAN WAY	STE 15	CANOGA PARK	CA	91303	3678	19	06037	34.20113553	-118.5912126	Los Angeles County
140137	Fee-for-Service	1285958520	1285958520	1	1	RANSOM, COURTNEY L LCSW	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
140158	Fee-for-Service	1508176652	1508176652	1	1	ROGERS, SHARONNE E NP	7/7/2022	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2321 86TH AVE	None	OAKLAND	CA	94605	3907	01	06001	37.75799854	-122.1658677	Alameda County
140190	Fee-for-Service	1487976668	1487976668	1	1	REZVANI, MOHAMMAD MD	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113116	41	Internal Medicine	0	In state provider	None	125 S 5TH ST	None	BRAWLEY	CA	92227	2402	13	06025	32.97758931	-115.5337892	Imperial County
140196	Fee-for-Service	1417175621	1417175621	1	1	RUTH A HAMAD, MD APC	2/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	130 WEST ALOSTA AVE	SUITE 208	GLENDORA	CA	91740	0000	19	06037	34.1286357	-117.8649383	Los Angeles County
140208	Fee-for-Service	1598943862	1598943862	1	1	RODRIGUEZ, STEPHANIE M	7/29/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
140243	Fee-for-Service	1235122250	1235122250	1	2	REGENTS/UCDPBG/RAD ONC	8/3/2023	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140250	Fee-for-Service	1538480686	1538480686	1	1	RICHTER, STEFAN E MD	2/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131352	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
140258	Fee-for-Service	1750976056	1750976056	1	1	RAMA DRUGS, INC.	5/6/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1022 E CHEVY CHASE DR	STE. D	GLENDALE	CA	91205	4865	19	06037	34.1337567	-118.242151	Los Angeles County
140276	Fee-for-Service	1154884484	1154884484	1	1	RIZK, LAUDY NP	10/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1563	34	06067	38.546091	-121.447305	Sacramento County
140288	Fee-for-Service	1447397641	1447397641	1	1	ROSS, STACI D LMFT	12/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1352 OREGON STREET	None	REDDING	CA	96001	1621	45	06089	40.58468628	-122.3949533	Shasta County
140338	Fee-for-Service	1396101978	1396101978	1	1	ROBBINS, DENISHIA J LCSW	7/11/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
140367	Fee-for-Service	1881820207	1881820207	1	1	RSCR CALIFORNIA INCORPORATED	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1130 LAURISTON DR	None	SAN DIEGO	CA	92154	3325	37	06073	32.57538726	-117.0715977	San Diego County
140373	Fee-for-Service	1447290028	1447290028	1	1	REED, FRED D MD	7/31/1984	207L00000X	NA	Other	026	PHYSICIANS	41401	05	Anesthesiology	0	In state provider	HUMANA HOSP W ANAHEIM	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
140386	Fee-for-Service	1396951828	1396951828	1	1	REARDON, PAUL F MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	49699	01	General Practice	0	In state provider	None	15 CORPORATE PLAZA DR	STE 140	NEWPORT BEACH	CA	92660	7940	30	06059	33.61013779	-117.8755739	Orange County
140390	Fee-for-Service	1811923774	1811923774	1	1	ROSS, ROBERT GEORGE	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2865 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
140395	Fee-for-Service	1346264587	1346264587	1	1	RAHMAN, NAINAMOHAMED MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34425	04	Otology, Laryngology, Rhinology	0	In state provider	None	1761 W ROMNEYA DR	STE IJ	ANAHEIM	CA	92801	1807	30	06059	33.85068221	-117.9440731	Orange County
140468	Fee-for-Service	1154339786	1154339786	1	1	ROSENTHAL, PHILIP MD	1/1/1988	207R00000X	NA	Other	026	PHYSICIANS	54802	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
140471	Fee-for-Service	1922556703	1922556703	1	1	RACKLEFF, KATHERANE L LCSW	3/4/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
140473	Fee-for-Service	1730919994	1730919994	1	1	RICE, CHAILYNE L BIRTH DOULA	10/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
140492	Fee-for-Service	1730290321	1730290321	1	2	RAJA, MANIKANDA G MD	5/31/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53777	-	NOT APPLICABLE	0	In state provider	None	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	33	06065	33.74755247	-116.9539875	Riverside County
140531	Fee-for-Service	1235122250	1235122250	1	2	REGENTS/UCDPBG/RAD ONC	5/1/1999	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140537	Fee-for-Service	1538480686	1538480686	1	1	RICHTER, STEFAN E MD	2/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MED PLAZA	STE 365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
140543	Fee-for-Service	1336927672	1336927672	1	1	ROULEAU, JENNIFER NP	1/11/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140545	Fee-for-Service	1740260280	1740260280	1	1	RHEIN, FRANCISCO Q MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84596	41	Internal Medicine	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
140560	Fee-for-Service	1669107454	1669107454	1	1	RVR CORPORATION	9/1/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17544 SAN JOSE STREET	None	GRANADA HILLS	CA	91344	6009	19	06037	34.26123448	-118.517004	Los Angeles County
140564	Fee-for-Service	1154408003	1154408003	1	1	RUIZ JR, ATENODORO R MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89383	10	Gastroenterology (M.D. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
140582	Fee-for-Service	1891853826	1891853826	1	1	RALEY'S	12/8/2006	3336C0004X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4255 E MORADA LN	None	STOCKTON	CA	95212	1600	39	06077	38.03718807	-121.2602684	San Joaquin County
140668	Fee-for-Service	1740547744	1740547744	1	1	RIPP, NICOLAS J MD	2/20/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	129654	40	Pediatrics	0	In state provider	None	2921 REDONDO AVE	None	LONG BEACH	CA	90806	2415	19	06037	33.808185	-118.1513675	Los Angeles County
140670	Fee-for-Service	1427165299	1427165299	1	1	RENSLOW, SCOTT D MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	75728	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
140672	Fee-for-Service	1467073098	1467073098	1	1	REVIVE MEDICAL SUPPLIES	5/5/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1617 S BURLINGTON AVE	None	LOS ANGELES	CA	90006	0000	19	06037	34.04184317	-118.2812716	Los Angeles County
140721	Fee-for-Service	1245679554	1245679554	1	1	RAHMAN, TAHMINA MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137970	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
140741	Fee-for-Service	1073000105	1073000105	1	5	RADIOLOGICA INC.	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	9917	49	06097	38.39674221	-122.8201502	Sonoma County
140763	Fee-for-Service	1174606016	1174606016	1	1	RAYAN, SUNIL S MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87655	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
140854	Fee-for-Service	1477889210	1477889210	1	1	R HOUSE, INC	1/24/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	540C MIDDLE RINCON ROAD	None	SANTA ROSA	CA	95409	3107	49	06097	38.47113179	-122.6695884	Sonoma County
140855	Fee-for-Service	1114005873	1114005873	2	2	RODRIGUEZ, VICTOR M MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	65512	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
140862	Fee-for-Service	1811969215	1811969215	1	1	RUDINSKY, SHERRI L MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2180	37	06073	32.75034388	-117.161023	San Diego County
140871	Fee-for-Service	1417274200	1417274200	1	1	RUSSELL, JOSHUA W MD	9/6/2022	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	517 3RD STREET	22	EUREKA	CA	95501	3203	12	06023	40.80367671	-124.166036	Humboldt County
140876	Fee-for-Service	1942382817	1942382817	1	1	RAJAGOPAL, SATISH K MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144760	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
140890	Fee-for-Service	1669539524	1669539524	1	1	ROBLES, ROBERTO LCSW	12/16/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
140931	Fee-for-Service	1972752202	1972752202	1	1	REUTHER, MARSHA S K MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110235	04	Otology, Laryngology, Rhinology	0	In state provider	None	9834 GENESSEE AVE	SUITE 111	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
140960	Fee-for-Service	1083741359	1083741359	1	1	ROCKCREEK, INC	9/1/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10277 MONTE VISTA ST	None	RANCHO CUCAMONGA	CA	91701	5236	36	06071	34.12731621	-117.5808003	San Bernardino County
140996	Fee-for-Service	1013399195	1013399195	1	2	REZAI, MOHAMMED DO	9/3/2024	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	14895	-	NOT APPLICABLE	0	In state provider	None	1459 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	6221	56	06111	34.17803055	-118.8544931	Ventura County
141016	Fee-for-Service	1801982632	1801982632	1	1	RANA, HUMERA MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113489	41	Internal Medicine	0	In state provider	None	11705 SLATE AVE	None	RIVERSIDE	CA	92505	5199	33	06065	33.9027276	-117.4928061	Riverside County
141031	Fee-for-Service	1336547256	1336547256	1	1	RUDGE, CHERRY LOU C RN	10/5/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	30	06059	33.66214655	-117.6532809	Orange County
141045	Fee-for-Service	1659147569	1659147569	1	1	RT INDUSTRIES INC	1/11/2024	2278P4000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12114 JACKSONVILLE AVE	None	BAKERSFIELD	CA	93312	5655	15	06029	35.41183778	-119.1376054	Kern County
141052	Fee-for-Service	1174606016	1174606016	1	1	RAYAN, SUNIL S MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87655	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
141075	Fee-for-Service	1285165837	1285165837	1	1	RIDDLES, JOHN PAUL	4/26/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	905 FAIRVIEW DR	None	GRIDLEY	CA	95948	2206	04	06007	39.36771131	-121.6861391	Butte County
141099	Fee-for-Service	1366090342	1366090342	1	1	REILY, MEGAN A LCSW	10/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
141141	Fee-for-Service	1134164023	1134164023	1	2	RETINA-VITREOUS ASSOC	2/28/1988	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	8641 WILSHIRE BLVD	STE 210	BEVERLY HILLS	CA	90211	2920	19	06037	34.06614972	-118.3798912	Los Angeles County
141151	Fee-for-Service	1891710497	1891710497	1	1	RALPHS GROCERY COMPANY	8/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #712	1100 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4330	19	06037	34.18830415	-118.3188493	Los Angeles County
141160	Fee-for-Service	1558435164	1558435164	1	1	ROMSON, JOSEPH L MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70584	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141164	Fee-for-Service	1689888968	1689888968	1	1	RUBANENKO, GABRIEL INC	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	39466	20	Orthopedic Surgery	0	In state provider	None	6200 WILSHIRE BLVD	STE 910	LOS ANGELES	CA	90048	5810	19	06037	34.06319291	-118.3636025	Los Angeles County
141168	Fee-for-Service	1770933996	1770933996	1	1	RUIZ, MIRIAM I MD	9/16/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172020	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
141175	Fee-for-Service	1952554198	1952554198	1	1	RICHARDSON, RESHAWNDA LMFT	12/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
141200	Fee-for-Service	1881697340	1881697340	1	1	RAMOS, DAVID E MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
141222	Fee-for-Service	1437329281	1437329281	1	1	ROSENBECK, JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEPHI MEDICAL CLINIC	48 W 1500 N	None	NEPHI	UT	84648	8900	00	None	39.7306275	-111.83724	Juab County
141285	Fee-for-Service	1013399195	1013399195	1	1	REZAI, MOHAMMED DO	5/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14895	08	Family Practice	0	In state provider	None	3967 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	3628	56	06111	34.16162541	-118.823888	Ventura County
141306	Fee-for-Service	1497934772	1497934772	1	1	REBECCA SPAIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OREGON HEALTH	3303 SW BOND AVE SUITE 8	None	PORTLAND	OR	97239	4501	00	None	45.49894088	-122.6708542	Multnomah County
141307	Fee-for-Service	1730414707	1730414707	1	1	RIVERSIDE RECOVERY RESOURCES	7/14/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3757 ELIZABETH ST	None	RIVERSIDE	CA	92506	2508	33	06065	33.958665	-117.3916445	Riverside County
141331	Fee-for-Service	1619400777	1619400777	1	1	RAJASINGHAM, ANTHONY	12/15/2020	207R00000X	NA	Other	026	PHYSICIANS	165844	None	None	0	In state provider	None	350 TERRACINA	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
141353	Fee-for-Service	1265758205	1265758205	1	1	RUSTHOVEN, CHAD G MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141363	Fee-for-Service	1285165837	1285165837	1	1	RIDDLES, JOHN PAUL	4/26/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	905 FAIRVIEW DR	None	GRIDLEY	CA	95948	2206	04	06007	39.36771131	-121.6861391	Butte County
141367	Fee-for-Service	1134188923	1134188923	1	1	RENAL TREATMENT CENTERS	12/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	595 TAMARACK AVE	STE A	BREA	CA	92821	3125	30	06059	33.92800228	-117.9001504	Orange County
141384	Fee-for-Service	1649430034	1649430034	1	1	RAYMOND-FLESCH, MARISSA MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120726	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
141410	Fee-for-Service	1902425317	1902425317	1	1	RASTOGI, ROHAN MD	2/25/2024	207R00000X	NA	Other	026	PHYSICIANS	189056	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
141451	Fee-for-Service	1689888968	1689888968	1	1	RUBANENKO, GABRIEL INC	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	39466	01	General Practice	0	In state provider	None	6200 WILSHIRE BLVD	STE 910	LOS ANGELES	CA	90048	5810	19	06037	34.06319291	-118.3636025	Los Angeles County
141577	Fee-for-Service	1861700841	1861700841	1	1	RODRIGUEZ-CUADRADO, GLORIA I	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131486	01	General Practice	0	In state provider	MD	4214 W BEVERLY BLVD	SUITE 212	LOS ANGELES	CA	90004	4429	19	06037	34.07626052	-118.301031	Los Angeles County
141582	Fee-for-Service	1881761609	1881761609	1	1	RAMNANI, SUNIL MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	54124	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
141636	Fee-for-Service	1386796613	1386796613	1	1	ROSEN, GLENN D MD	5/31/1992	207RP1001X	NA	Pulmonology	026	PHYSICIANS	57077	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
141642	Fee-for-Service	1265758205	1265758205	1	1	RUSTHOVEN, CHAD G MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141661	Fee-for-Service	1386766798	1386766798	1	1	ROAN, MARCH A Y MD	3/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99163	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
141691	Fee-for-Service	1184642209	1184642209	1	1	RUTKOWSKI, NICOLE K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75119	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
141698	Fee-for-Service	1336274182	1336274182	1	1	RODGERS, JOHN W MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115826	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
141710	Fee-for-Service	1013282243	1013282243	1	1	RANGANATH, HARSHA A MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137539	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	MER 35	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
141791	Fee-for-Service	1043390297	1043390297	1	1	RAYMUNDO, MANITA A MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72213	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
141801	Fee-for-Service	1285789149	1285789149	1	1	RUZICS, ERVIN P MD	6/15/2015	204F00000X	NA	General Surgery	026	PHYSICIANS	51676	34	Urology and Urological Surgery	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
141826	Fee-for-Service	1861541070	1861541070	1	1	ROSENFELD, GINNI S MD	1/10/2007	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83201	None	None	0	In state provider	None	3628 E IMPERIAL HWY	STE 200	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
141827	Fee-for-Service	1750374872	1750374872	1	1	REGENTS/UCDPBG/OTOLARYNG	7/18/2019	207Y00000X	NA	ENT/Otolaryngology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
141843	Fee-for-Service	1366754319	1366754319	1	1	REHRER, MATTHEW W MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112284	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
141941	Fee-for-Service	1740667047	1740667047	1	1	REDDY, ARCHANA K MD	10/5/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	146005	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
141953	Fee-for-Service	1083069611	1083069611	1	1	REDDY, NAVYA M MD	11/2/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	151525	None	None	0	In state provider	None	625 W CITRACADO PKWY	108	ESCONDIDO	CA	92025	6428	37	06073	33.09166731	-117.0784699	San Diego County
141989	Fee-for-Service	1164669925	1164669925	1	1	RIVERS, COLLEEN M MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131697	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
142025	Fee-for-Service	1588980841	1588980841	1	1	RIVERA, RACHEAL A CNM	9/7/2022	363LX0001X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
142065	Fee-for-Service	1609143775	1609143775	1	1	RAYHANABAD, JESSICA A MD INC	11/28/2011	208600000X	NA	General Surgery	026	PHYSICIANS	99470	02	General Surgery	0	In state provider	None	3951 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3303	30	06059	33.80318745	-118.06398	Orange County
142106	Fee-for-Service	1295958874	1295958874	1	1	ROSSI, LAURA E PHD	10/22/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22465	-	NOT APPLICABLE	0	In state provider	None	3230 WARING CT	SUITE A	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
142116	Fee-for-Service	1639326705	1639326705	1	1	RAHMAN, AKHIL	9/6/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
142117	Fee-for-Service	1750374872	1750374872	1	1	REGENTS/UCDPBG/OTOLARYNG	9/13/2022	207Y00000X	NA	ENT/Otolaryngology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142129	Fee-for-Service	1578670634	1578670634	1	1	ROBERT W HUFF MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
142161	Fee-for-Service	1730682394	1730682394	1	12	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
142174	Fee-for-Service	1063636579	1063636579	1	1	ROSENBAND, LINDA M MD	1/30/2008	208M00000X	NA	Other	026	PHYSICIANS	99472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
142196	Fee-for-Service	1780781930	1780781930	1	1	ROSELLINI, THERESE E DO	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6845	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8170 LAGUNA BLVD	STE 303	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
142225	Fee-for-Service	1780609743	1780609743	1	1	RIES, JEFFREY D MD	2/14/2017	207P00000X	NA	Other	026	PHYSICIANS	140455	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
142242	Fee-for-Service	1720512932	1720512932	1	1	RODIN, JULIANNA G MD	11/28/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	187899	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
142252	Fee-for-Service	1982150538	1982150538	1	1	RUSSELL, HARRIET E PT	8/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
142259	Fee-for-Service	1871519108	1871519108	1	1	ROMERO, CARDY D MD	7/16/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	165805	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
142296	Fee-for-Service	1699964486	1699964486	1	1	REDDY, HARINI A MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99162	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
142324	Fee-for-Service	1780606061	1780606061	1	1	RAHBAR, FARSHID S MD	12/13/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38265	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1804	LOS ANGELES	CA	90067	2021	19	06037	34.05887194	-118.4122914	Los Angeles County
142346	Fee-for-Service	1750325163	1750325163	1	1	RESTREPO, LUCAS MD	6/6/2006	2084N0400X	NA	Neurology	026	PHYSICIANS	94086	None	None	0	In state provider	None	300 MEDICAL PLAZA	#B200	LOS ANGELES	CA	90095	0000	19	06037	34.06473399	-118.445865	Los Angeles County
142362	Fee-for-Service	1881388908	1881388908	1	1	REDDY, KALSHA OD	9/13/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
142363	Fee-for-Service	1225430580	1225430580	1	2	RIGHT CHOICE SENIOR LIVING	1/9/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4949 MT LONGS	None	SAN DIEGO	CA	92117	3054	37	06073	32.82561343	-117.1876982	San Diego County
142368	Fee-for-Service	1629501424	1629501424	1	1	REYES, MARIA D MD	6/27/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159506	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
142403	Fee-for-Service	1750374872	1750374872	1	1	REGENTS/UCDPBG/OTOLARYNG	6/12/2017	207Y00000X	NA	ENT/Otolaryngology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142421	Fee-for-Service	1609876341	1609876341	1	1	REISS, ROBERT A MD	3/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	61155	41	Internal Medicine	0	In state provider	None	1011 DEVONSHIRE DR	STE E	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
142450	Fee-for-Service	1730791864	1730791864	1	1	REZA SHAHBAZ, M.D. INC.	5/7/2021	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
142452	Fee-for-Service	1730682394	1730682394	1	12	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
142483	Fee-for-Service	1598762718	1598762718	1	1	REVERS, ROBERT R MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49775	41	Internal Medicine	0	In state provider	None	130 E ROMIE LN	STE D	SALINAS	CA	93901	3160	27	06053	36.66175331	-121.6541075	Monterey County
142489	Fee-for-Service	1427110113	1427110113	1	1	RAY, DEBORAH A CRNA	3/16/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
142549	Fee-for-Service	1619055480	1619055480	1	1	RAMOS, ANDRE M MD	12/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92402	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
142586	Fee-for-Service	1508123662	1508123662	1	1	REGENTS OF THE UNIVERSITY OF	8/15/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	500 UNIVERSITY AVE.	SUITE # 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
142600	Fee-for-Service	1639167695	1639167695	1	1	RYAN, JOHN E MD	1/5/2001	2086S0129X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
142608	Fee-for-Service	1780606061	1780606061	1	1	RAHBAR, FARSHID S MD	12/13/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38265	10	Gastroenterology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 1804	LOS ANGELES	CA	90067	2021	19	06037	34.05887194	-118.4122914	Los Angeles County
142617	Fee-for-Service	1114005865	1114005865	1	1	REDDY, VIJAYA L MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81027	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
142656	Fee-for-Service	1114064987	1114064987	1	1	ROSTAMI, NEJAT	8/31/1989	174400000X	NA	Other	026	PHYSICIANS	48731	01	General Practice	0	In state provider	None	2651 S WESTERN AVE	FL 3	LOS ANGELES	CA	90018	2628	19	06037	34.03130732	-118.3090362	Los Angeles County
142680	Fee-for-Service	1871584581	1871584581	1	1	RUBIN, LAURENCE R OD	8/14/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	553 N MOUNTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.1003783	-117.6703307	San Bernardino County
142682	Fee-for-Service	1174046874	1174046874	1	1	RUSSELL THOMPSON CHIROPRACTI	4/27/2020	261Q00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	629 CAMINO DE LOS MARES	104	SAN CLEMENTE	CA	92673	2829	30	06059	33.45968314	-117.65198	Orange County
142692	Fee-for-Service	1750374872	1750374872	1	1	REGENTS/UCDPBG/OTOLARYNG	5/1/1983	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142709	Fee-for-Service	1609876341	1609876341	1	1	REISS, ROBERT A MD	3/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	61155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 DEVONSHIRE DR	STE E	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
142729	Fee-for-Service	1073574885	1073574885	1	1	RICKARDS, PAUL J MD	4/1/1999	2085R0204X	NA	Other	026	PHYSICIANS	80950	02	General Surgery	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
142761	Fee-for-Service	1700081080	1700081080	1	1	RAVIENDRAN, RAVEEN T MD	12/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108610	40	Pediatrics	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
142773	Fee-for-Service	1528008588	1528008588	1	1	RASMUSSEN,RICHARD R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 WEST	None	PROVO	UT	84604	0000	00	None	40.248072	-111.6673905	Utah County
142786	Fee-for-Service	1245230523	1245230523	1	1	REGER, KENNETH M MD	6/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 N DIVISION ST	None	AUBURN	WA	98001	0000	00	None	47.308698	-122.2297715	King County
142787	Fee-for-Service	1083680532	1083680532	1	1	RIZALDY VILLEGAS MD	11/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 N DOBSON RD	STE 11	CHANDLER	AZ	85224	4412	00	None	33.308613	-111.8758005	Maricopa County
142793	Fee-for-Service	1982763694	1982763694	1	1	RODA, CAROL P NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5620 MESMER AVE	None	CULVER CITY	CA	90230	6315	19	06037	33.98561217	-118.4005283	Los Angeles County
142839	Fee-for-Service	1932427069	1932427069	1	1	ROSS EDWARD MATHIASEN M.D.	5/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
142854	Fee-for-Service	1083792709	1083792709	1	1	RUSSELL LINDSAY H DPM	9/7/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
142876	Fee-for-Service	1508123662	1508123662	1	1	REGENTS OF THE UNIVERSITY OF	6/19/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	500 UNIVERSITY AVE.	SUITE # 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
142890	Fee-for-Service	1639167695	1639167695	1	1	RYAN, JOHN E MD	1/5/2001	2086S0129X	NA	General Surgery	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
142891	Fee-for-Service	1821091133	1821091133	1	1	ROGERS, GLENN T	6/29/1995	207R00000X	NA	Other	026	PHYSICIANS	63479	41	Internal Medicine	0	In state provider	None	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	15	06029	35.392059	-119.010556	Kern County
142898	Fee-for-Service	1033521067	1033521067	1	1	ROEL, RENZO LMFT	3/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
142949	Fee-for-Service	1477710473	1477710473	1	1	RUBY J LONG, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 GRANT ST	None	GARY	IN	46402	6001	00	None	41.599755	-87.357897	Lake County
142979	Fee-for-Service	1750374872	1750374872	1	1	REGENTS/UCDPBG/OTOLARYNG	9/13/2022	207Y00000X	NA	ENT/Otolaryngology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142988	Fee-for-Service	1871852343	1871852343	1	1	RHEUMATOLOGY AND DIAGNOSTIC	11/5/2012	207RR0500X	NA	Other	026	PHYSICIANS	41889	None	None	0	In state provider	CENTER	6464 W SUNSET BLVD	STE 1010	LOS ANGELES	CA	90028	8012	19	06037	34.09796251	-118.3313115	Los Angeles County
142998	Fee-for-Service	1609876341	1609876341	1	1	REISS, ROBERT A MD	3/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	61155	13	Neurology (M.D. only)	0	In state provider	None	1011 DEVONSHIRE DR	STE E	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
143014	Fee-for-Service	1922060805	1922060805	2	1	RICE, LAWRENCE S MD	12/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	31021	18	Ophthalmology	0	In state provider	None	5565 GROSSMONT CENTER DR	BLDG 3, STE 551	LA MESA	CA	91942	3007	37	06073	32.77978322	-117.0094766	San Diego County
143017	Fee-for-Service	1073574885	1073574885	1	1	RICKARDS, PAUL J MD	4/1/1999	2085R0204X	NA	Other	026	PHYSICIANS	80950	30	Radiology	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
143071	Fee-for-Service	1205043692	1205043692	1	1	RHEE, KATHERINE S MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116047	34	Urology and Urological Surgery	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
143106	Fee-for-Service	1962528109	1962528109	1	1	RUDDY, THOMAS P CRNA	6/6/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
143131	Fee-for-Service	1265530018	1265530018	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
143163	Fee-for-Service	1508123662	1508123662	1	1	REGENTS OF THE UNIVERSITY OF	9/29/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	500 UNIVERSITY AVE.	SUITE # 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
143204	Fee-for-Service	1912145533	1912145533	1	1	RUBINO, DENISE MD	4/28/2021	208VP0014X	NA	Other	026	PHYSICIANS	56475	None	None	0	In state provider	None	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	37	06073	32.77510996	-117.1277427	San Diego County
143217	Fee-for-Service	1700027778	1700027778	1	1	RISKIN, LOREN MD	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113117	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
143247	Fee-for-Service	1609365402	1609365402	1	1	RASCHKE, ROBIN P MD	8/1/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	163808	45	Nephrology (Renal-Kidney)	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
143350	Fee-for-Service	1093291635	1093291635	1	1	RODYSILL, BRIAN MD	9/6/2023	390200000X	NA	Other	026	PHYSICIANS	165192	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
143364	Fee-for-Service	1629394697	1629394697	1	1	REESE, AMY J MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123141	01	General Practice	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
143400	Fee-for-Service	1821048695	1821048695	1	1	RIVERA, NILO I MD	5/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53902	41	Internal Medicine	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
143419	Fee-for-Service	1265530018	1265530018	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
143462	Fee-for-Service	1295759439	1295759439	1	1	RYAN, TIMOTHY M MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72433	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
143464	Fee-for-Service	1326020868	1326020868	1	2	RICHARD P CARR PHYSICAL THER	11/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	2488 DE LA CRUZ BLVD	None	SANTA CLARA	CA	95050	2923	43	06085	37.366101	-121.9414895	Santa Clara County
143470	Fee-for-Service	1447615869	1447615869	1	1	ROLLINS DIALYSIS LLC	5/16/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	15002 AMARGOSA RD	None	VICTORVILLE	CA	92394	1868	36	06071	34.52311545	-117.3303354	San Bernardino County
143477	Fee-for-Service	1558343491	1558343491	1	1	RIGHTMIER, DEBORAH S MD	4/30/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32735	41	Internal Medicine	0	In state provider	None	1040 ELM AVE	STE 204	LONG BEACH	CA	90813	3266	19	06037	33.779799	-118.1879535	Los Angeles County
143481	Fee-for-Service	1932683588	1932683588	1	1	RESENDEZ, SALVADOR LCSW	4/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
143495	Fee-for-Service	1659594935	1659594935	1	1	RIVERA, MICHELLE LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
143534	Fee-for-Service	1609365402	1609365402	1	1	RASCHKE, ROBIN P MD	8/1/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	163808	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
143568	Fee-for-Service	1134169535	1134169535	2	2	REACH AIR MEDICAL SERVICES L	11/30/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4615 HIGHLAND SPRINGS RD	None	LAKEPORT	CA	95453	9345	17	06033	38.992041	-122.9042205	Lake County
143571	Fee-for-Service	1336600196	1336600196	1	1	RIFE, ADAM DPM	9/25/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
143577	Fee-for-Service	1497172522	1497172522	1	1	RETINO, CLAIROSE B MD	8/1/2017	207P00000X	NA	Other	026	PHYSICIANS	147497	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6696	19	06037	34.05682871	-118.360716	Los Angeles County
143581	Fee-for-Service	1912285594	1912285594	1	1	RUSTIGAN, JANET A LMFT	8/6/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	659 CHERRY ST.	SUITE 203	SANTA ROSA	CA	95404	4280	49	06097	38.444841	-122.7151035	Sonoma County
143643	Fee-for-Service	1023417847	1023417847	1	1	RADAKOVIC, MARKO CRNA	10/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143647	Fee-for-Service	1437344108	1437344108	1	1	REAVES, HAROLD E MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33835	18	Ophthalmology	0	In state provider	None	420 E THIRD STREET	SUITE 603	LOS ANGELES	CA	90013	1651	19	06037	34.04702011	-118.241912	Los Angeles County
143675	Fee-for-Service	1790704518	1790704518	1	1	ROSE, K DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25578	08	Family Practice	0	In state provider	None	1310 PRENTICE DR	STE E	HEALDSBURG	CA	95448	5004	49	06097	38.626578	-122.8666945	Sonoma County
143707	Fee-for-Service	1265530018	1265530018	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
143740	Fee-for-Service	1609879204	1609879204	1	1	ROBIN L GALLOWAY, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	95 S PAGOSA BLVD	STE 100	PAGOSA SPGS	CO	81147	8329	00	None	37.25234518	-107.0771155	Archuleta County
143748	Fee-for-Service	1427209196	1427209196	1	1	RASNOW-HILL, MARINA E MD	9/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105597	08	Family Practice	0	In state provider	None	77 CADILLAC DRIVE	SUITE 230	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
143778	Fee-for-Service	1962649814	1962649814	1	1	REYNOLDS, TERI A MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100665	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
143784	Fee-for-Service	1326096165	1326096165	1	1	REGENTS OF THE UNIVERSITY OF	2/28/1988	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
143810	Fee-for-Service	1437246220	1437246220	1	1	REDDY, SURYA M	12/18/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	47916	None	None	0	In state provider	None	1001 S STATE ST	None	HEMET	CA	92543	7186	33	06065	33.731505	-116.971599	Riverside County
143813	Fee-for-Service	1417049024	1417049024	1	1	RUDER, ROBERT O MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	21536	24	Plastic Surgery	0	In state provider	None	8816 BURTON WAY	FL 1	BEVERLY HILLS	CA	90211	1715	19	06037	34.07207249	-118.3842855	Los Angeles County
143818	Fee-for-Service	1811188048	1811188048	1	1	ROSTAMI, BABAK B MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99776	08	Family Practice	0	In state provider	None	1080 N WESTERN AVENUE	None	LOS ANGELES	CA	90029	2310	19	06037	34.090281	-118.3091425	Los Angeles County
143832	Fee-for-Service	1609835438	1609835438	1	1	RENAL TREATMENT CENTERS	12/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	244 PECKHAM CT	None	LAKEPORT	CA	95453	9203	17	06033	39.02586723	-122.9172506	Lake County
143834	Fee-for-Service	1871779769	1871779769	1	1	REYZIN, GARY I MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102312	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
143848	Fee-for-Service	1790107621	1790107621	1	1	RATLIFF, SCOTT L	4/16/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30400 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1300	30	06059	33.5224708	-117.6686181	Orange County
143924	Fee-for-Service	1801955414	1801955414	1	1	RAYMALONE, CAROL L MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60450	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
143930	Fee-for-Service	1326060237	1326060237	1	1	RITE AID 5549	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12739 VAN NUYS BLVD	None	PACOIMA	CA	91331	1627	19	06037	34.27413859	-118.4111289	Los Angeles County
143945	Fee-for-Service	1356469050	1356469050	1	1	RODARTE, CHRISTOPHER MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108611	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
143955	Fee-for-Service	1487780201	1487780201	1	1	RILEY, EDWARD T MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71117	05	Anesthesiology	0	In state provider	None	110 LAS TABLAS RD	None	TEMPLETON	CA	93465	0000	40	06079	35.55332523	-120.7034842	San Luis Obispo County
143996	Fee-for-Service	1265530018	1265530018	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
144000	Fee-for-Service	1275876674	1275876674	1	1	REZAPOOR, NEDA	12/10/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	292 S LA CIENEGA BLVD	#250	BEVERLY HILLS	CA	90211	3330	19	06037	34.06283371	-118.3761195	Los Angeles County
144001	Fee-for-Service	1164775003	1164775003	1	1	RAMOS, RAFAEL I PA	9/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22660	-	NOT APPLICABLE	0	In state provider	None	910 EAST OHIO AVENUE	SUITE 104	ESCONDIDO	CA	92025	3439	37	06073	33.12703769	-117.0699017	San Diego County
144010	Fee-for-Service	1699312033	1699312033	1	1	RAZEL & RUZTIN LLC	7/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2015 MT DIABLO BLVD	None	WALNUT CREEK	CA	94596	4301	07	06013	37.89716454	-122.067731	Contra Costa County
144025	Fee-for-Service	1124178736	1124178736	1	1	RAGAZZO, JENNIFER L MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	87537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
144038	Fee-for-Service	1659660207	1659660207	1	1	RODRIGUEZ, MARIA G LCSW	10/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
144045	Fee-for-Service	1528488608	1528488608	1	1	RUE, KELLY S MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133867	18	Ophthalmology	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
144073	Fee-for-Service	1326096165	1326096165	1	1	REGENTS OF THE UNIVERSITY OF	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
144086	Fee-for-Service	1366077471	1366077471	1	1	ROSS, BENJAMIN MD	2/3/2025	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
144103	Fee-for-Service	1811188048	1811188048	1	1	ROSTAMI, BABAK B MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99776	01	General Practice	0	In state provider	None	1080 N WESTERN AVENUE	None	LOS ANGELES	CA	90029	2310	19	06037	34.090281	-118.3091425	Los Angeles County
144131	Fee-for-Service	1912147588	1912147588	1	1	ROCHLIN, MINDY H LCSW	7/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
144144	Fee-for-Service	1720434541	1720434541	1	1	ROY, DIPAYON MD	8/25/2024	207R00000X	NA	Other	026	PHYSICIANS	156401	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
144185	Fee-for-Service	1578926192	1578926192	1	1	RAHLFS, KATELYN A LMFT	2/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA U	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
144201	Fee-for-Service	1629643515	1629643515	1	1	RICHARDSON, GRANT DO	9/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22558	08	Family Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
144238	Fee-for-Service	1811034549	1811034549	1	1	ROZEN, SHAI MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
144250	Fee-for-Service	1932127800	1932127800	1	1	RENAL TREATMENT CTRS-CA	7/12/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	RED BLUFF DIALYSIS CTR	2455 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4364	52	06103	40.14849604	-122.2216034	Tehama County
144260	Fee-for-Service	1326445214	1326445214	1	1	RELIABLE HOSPICE CARE INC	10/25/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3151 CAHUENGA BLVD WEST	STE 342	LOS ANGELES	CA	90068	1749	19	06037	34.12773725	-118.346538	Los Angeles County
144269	Fee-for-Service	1366708000	1366708000	1	1	RO, MARYANN MD	7/18/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
144313	Fee-for-Service	1710065933	1710065933	1	13	RADYS CHILDRENS HOSPITAL	1/14/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDREN'S WAY	FLOOR 2 AND 4	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
144314	Fee-for-Service	1962847806	1962847806	1	1	ROYSMAN, ALISA R DO	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14026	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
144315	Fee-for-Service	1437425733	1437425733	1	1	RYAN GNESDA	3/16/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	305 S STATE ST	None	ABERDEEN	SD	57401	4527	00	None	45.461403	-98.47929349	Brown County
144318	Fee-for-Service	1174848568	1174848568	1	1	RYU, SERRA E DPM	11/6/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	266 S HARVARD BLVD	370	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
144328	Fee-for-Service	1184023053	1184023053	1	1	RIVERA SANTANA, SEZCOV LPCC	5/4/2024	103T00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
144332	Fee-for-Service	1326202540	1326202540	1	1	RAMASUBBAIAH, RASHMI MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126533	41	Internal Medicine	0	In state provider	None	3102 PORTE MORINO DRIVE	SUITE 100	CAMERON PARK	CA	95682	8287	09	06017	38.66258346	-120.967142	El Dorado County
144345	Fee-for-Service	1700847126	1700847126	1	1	ROTHSCHILD, RICHARD MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49505	None	None	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
144362	Fee-for-Service	1326096165	1326096165	1	1	REGENTS OF THE UNIVERSITY OF	3/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
144374	Fee-for-Service	1972793685	1972793685	1	1	RODRIGUEZ, DAVID MD,	8/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79225	28	Proctology (colon and rectal)	0	In state provider	None	3939 J ST	STE 250	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
144432	Fee-for-Service	1477601466	1477601466	1	1	ROMERO, RICARDO MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48804	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
144473	Fee-for-Service	1215934617	1215934617	1	1	ROBERTS, GREGG J SD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EL TORO EYE CTR	24953 PASEO DE VALENCIA	STE 24A	LAGUNA HILLS	CA	92653	4343	30	06059	33.60028568	-117.7010887	Orange County
144477	Fee-for-Service	1750510368	1750510368	1	1	RASMUSSEN, KAREN A MD	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109736	01	General Practice	0	In state provider	None	3460 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
144501	Fee-for-Service	1083741136	1083741136	1	1	RES-CARE CALIFORNIA INC	10/1/1999	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7893 FARNELL WAY	None	SACRAMENTO	CA	95823	4420	34	06067	38.470977	-121.4550585	Sacramento County
144511	Fee-for-Service	1407812399	1407812399	1	1	ROMERO, ANTONIO N MD	4/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93297	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
144519	Fee-for-Service	1396235024	1396235024	1	1	RUIZ, AMBER CNP	7/31/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
144529	Fee-for-Service	1972253276	1972253276	1	1	RUBIN, SHOSHANNAH DO	12/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22017	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
144550	Fee-for-Service	1326445214	1326445214	1	1	RELIABLE HOSPICE CARE INC	10/25/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3151 CAHUENGA BLVD WEST	STE 342	LOS ANGELES	CA	90068	1749	19	06037	34.12773725	-118.346538	Los Angeles County
144602	Fee-for-Service	1669836128	1669836128	1	1	RAMOS, ORLANDO X MD	12/27/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179660	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
144606	Fee-for-Service	1518668508	1518668508	1	1	RURAL MEDEVAC ALLIANCE INC.	8/12/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	304 SURPRISE AVE	None	YERINGTON	NV	89447	2542	00	None	38.98481946	-119.16702	Lyon County
144618	Fee-for-Service	1326202540	1326202540	1	1	RAMASUBBAIAH, RASHMI MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126533	68	Hematology	0	In state provider	None	3102 PORTE MORINO DRIVE	SUITE 100	CAMERON PARK	CA	95682	8287	09	06017	38.66258346	-120.967142	El Dorado County
144621	Fee-for-Service	1063769529	1063769529	1	1	RICH, KRISTA N PT	11/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
144645	Fee-for-Service	1720314933	1720314933	1	1	RAHMAN, AKBAR A MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110134	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
144704	Fee-for-Service	1598850083	1598850083	1	1	RAI, BALDEV MD	1/2/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	41709	13	Neurology (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	280	RIVERSIDE	CA	92505	3370	33	06065	33.90290859	-117.4941562	Riverside County
144712	Fee-for-Service	1073762480	1073762480	1	1	ROGERS, MICHELE L LMFT	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3172 WALFORD AVE	STE 2	EUREKA	CA	95503	4898	12	06023	40.77960999	-124.1378813	Humboldt County
144719	Fee-for-Service	1477601466	1477601466	1	1	ROMERO, RICARDO MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48804	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
144790	Fee-for-Service	1780617936	1780617936	1	1	RUSCHKE,DIANE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 WEST 9000 SOUTH	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
144908	Fee-for-Service	1326202540	1326202540	1	1	RAMASUBBAIAH, RASHMI MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126533	78	Neoplastic Diseases/Oncology	0	In state provider	None	3102 PORTE MORINO DRIVE	SUITE 100	CAMERON PARK	CA	95682	8287	09	06017	38.66258346	-120.967142	El Dorado County
144948	Fee-for-Service	1013385509	1013385509	1	1	RITCHIE, HEATHER LMFT	3/19/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125296	-	NOT APPLICABLE	0	In state provider	None	7208 GARFIELD AVE	None	BELL GARDENS	CA	90201	4812	19	06037	33.96601741	-118.1511575	Los Angeles County
145003	Fee-for-Service	1902660772	1902660772	1	1	RUIZ, EDWIN	4/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	426 N. IMPERIAL AVE.	None	EL CENTRO	CA	92243	2329	13	06025	32.79599732	-115.5700423	Imperial County
145017	Fee-for-Service	1174343909	1174343909	1	1	RITZ RX INC	12/5/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1121 N SAN FERNANDO BLVD	STE E	BURBANK	CA	91504	4300	19	06037	34.18848123	-118.3192167	Los Angeles County
145037	Fee-for-Service	1528084225	1528084225	1	2	REYNOLDS, JULIE	7/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2138 MARGUERITE ST	None	DOS PALOS	CA	93620	2351	24	06047	36.986775	-120.6301889	Merced County
145040	Fee-for-Service	1023242310	1023242310	1	1	ROSE, NATALIE C MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115708	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
145058	Fee-for-Service	1154873651	1154873651	1	1	RAMESH, GIRIJA LMFT	9/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19575 BRAEMAR COURT	None	SARATOGA	CA	95070	5043	43	06085	37.27352989	-122.0164897	Santa Clara County
145114	Fee-for-Service	1962562330	1962562330	1	1	ROHRER, STACEY J PHD	10/16/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
145134	Fee-for-Service	1225658784	1225658784	1	1	REACH AIR MEDICAL SERVICES L	10/14/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	LC	4050 BRIARGATE PKWY	None	COLORADO SPRINGS	CO	80920	7815	00	None	38.96600147	-104.754996	El Paso County
145152	Fee-for-Service	1508812843	1508812843	1	1	RAGI-SINGH, KASHMIRA MD	1/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	35460	41	Internal Medicine	0	In state provider	None	740 MOWRY AVE	STE 102	FREMONT	CA	94536	4117	01	06001	37.56635225	-121.9749284	Alameda County
145165	Fee-for-Service	1831261361	1831261361	2	1	RXCARE SOLUTIONS, INC.	1/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14501 MAGNOLIA ST	SUITE 100	WESTMINSTER	CA	92683	1306	30	06059	33.75188963	-117.9723601	Orange County
145177	Fee-for-Service	1912401522	1912401522	1	1	RAHMAN, MALIHA F DO	9/1/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	20518	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
145179	Fee-for-Service	1295894368	1295894368	1	1	ROBINSON, FANE L MD	5/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45990	18	Ophthalmology	0	In state provider	None	550 WASHINGTON ST	STE 723	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
145230	Fee-for-Service	1669548483	1669548483	1	1	ROBERTS, DENNIS F DO	7/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	6099	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A PROFESSIONAL CORP	81767 DR. CARREON BLVD	STE 200	INDIO	CA	92201	5559	33	06065	33.70738112	-116.237755	Riverside County
145234	Fee-for-Service	1780692673	1780692673	1	1	RAD MED GRP SN CRUZ CO I	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SPLIT RADIOLOGY	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
145267	Fee-for-Service	1407934250	1407934250	1	1	RET, ANTHONY MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63065	36	Psychiatry	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
145281	Fee-for-Service	1225547425	1225547425	1	1	ROSEN, DOUGLAS S LMFT	10/2/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91166	-	NOT APPLICABLE	0	In state provider	None	8831 VENICE BLVD	None	LOS ANGELES	CA	90034	3223	19	06037	34.03056062	-118.3863512	Los Angeles County
145309	Fee-for-Service	1700088630	1700088630	1	1	RIVA, GREGORY R	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94572	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
145313	Fee-for-Service	1821558131	1821558131	1	1	ROBLES, NANCY MD	10/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19982	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
145314	Fee-for-Service	1598129181	1598129181	1	1	RAMAKURI, MONICA MD	4/6/2021	207R00000X	NA	Other	026	PHYSICIANS	164109	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
145320	Fee-for-Service	1861599318	1861599318	1	1	ROSENTHAL, LAURA D NP	1/25/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	12605 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
145325	Fee-for-Service	1427473479	1427473479	1	1	ROTH, ALEXIS A	2/1/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145334	Fee-for-Service	1093073173	1093073173	1	1	RANDA OTHMAN	8/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
145347	Fee-for-Service	1144787425	1144787425	1	1	RAMOS, DEJA CD	5/30/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
145368	Fee-for-Service	1134166697	1134166697	1	1	RETTENMAIER, MARK A MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	32692	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
145409	Fee-for-Service	1730592791	1730592791	1	1	ROHLKE, FAITH P MD	11/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141292	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
145416	Fee-for-Service	1245440825	1245440825	1	1	RONGEY, CATHERINE A MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88342	10	Gastroenterology (M.D. only)	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145438	Fee-for-Service	1881726768	1881726768	1	1	REILLY, CHRISTOPHER M LMFT	1/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
145474	Fee-for-Service	1245383413	1245383413	1	1	REYES, RENATO A MD	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52496	None	None	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
145500	Fee-for-Service	1073626313	1073626313	2	1	ROBINSON, RHONDA L MD	12/16/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	77973	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1508 GARCES HWY STE 1	None	DELANO	CA	93215	3607	15	06029	35.76141641	-119.2369096	Kern County
145530	Fee-for-Service	1407501240	1407501240	1	1	RADICAL HOPE CENTER FOR PSYC	4/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HOTHERAPY, A CLINICAL PS	2830 I ST	UNIT 202	SACRAMENTO	CA	95816	4311	34	06067	38.574423	-121.467717	Sacramento County
145551	Fee-for-Service	1659459485	1659459485	1	1	ROZEN, BORIS A MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55776	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145600	Fee-for-Service	1871724781	1871724781	1	1	RAUT, ROBERT MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141804	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
145611	Fee-for-Service	1407922404	1407922404	1	1	ROSENBAUM, KENNETH M MD	8/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76294	40	Pediatrics	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
145623	Fee-for-Service	1629108188	1629108188	1	1	RENE, RACHELLE PSYD	12/8/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
145653	Fee-for-Service	1891086948	1891086948	1	1	REDDY, ANJANI T MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115706	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
145657	Fee-for-Service	1134166697	1134166697	1	1	RETTENMAIER, MARK A MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	32692	78	Neoplastic Diseases/Oncology	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
145674	Fee-for-Service	1295813194	1295813194	1	1	REDULA, JAMES K MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80965	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
145675	Fee-for-Service	1427518422	1427518422	1	1	REHMAN, MAHAM MD	9/11/2022	207R00000X	NA	Other	026	PHYSICIANS	176761	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
145683	Fee-for-Service	1164658894	1164658894	1	1	ROSENBERG, DEBRA A MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108142	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
145693	Fee-for-Service	1700464922	1700464922	1	1	RINEHART, REBECCA R MD	8/14/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
145726	Fee-for-Service	1518254010	1518254010	1	1	RAVEENDRAN, KRISTINA V MD	9/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156654	08	Family Practice	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
145743	Fee-for-Service	1295179620	1295179620	1	1	RAY, LORRAINE R MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150249	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
145762	Fee-for-Service	1891255246	1891255246	1	1	RANADE, ARJUN B MD	3/27/2024	2085R0204X	NA	Other	026	PHYSICIANS	184679	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
145787	Fee-for-Service	1639238231	1639238231	1	1	RAMIREZ, JOSE F MD	3/31/1985	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	42270	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
145789	Fee-for-Service	1063437648	1063437648	1	1	R S VENUTURUPALLI MD INC	12/22/2006	207RR0500X	NA	Other	026	PHYSICIANS	69893	41	Internal Medicine	0	In state provider	None	8737 BEVERLY BLVD	STE 203	WEST HOLLYWOOD	CA	90048	1840	19	06037	34.07687959	-118.381876	Los Angeles County
145817	Fee-for-Service	1407501240	1407501240	1	1	RADICAL HOPE CENTER FOR PSYC	4/2/2024	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	HOTHERAPY, A CLINICAL PS	2830 I ST	UNIT 202	SACRAMENTO	CA	95816	4311	34	06067	38.574423	-121.467717	Sacramento County
145821	Fee-for-Service	1689633844	1689633844	1	1	RUBENSTEIN, STUART I MD	12/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60587	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
145911	Fee-for-Service	1306343140	1306343140	1	1	RIDE N SAFE LLC	5/16/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9008 ELK GROVE BLVD	21	ELK GROVE	CA	95624	1945	34	06067	38.408832	-121.3665345	Sacramento County
145942	Fee-for-Service	1619067436	1619067436	1	1	RYAN VAN DE GRAAFF	10/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 N LIBERTY ST	STE 400	BOISE	ID	83704	8707	00	None	43.61322197	-116.2611151	Ada County
145951	Fee-for-Service	1720370158	1720370158	1	1	ROUBLICK, AMANDA M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122395	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
145963	Fee-for-Service	1609291970	1609291970	1	1	ROBERTSON, CLARE E MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134415	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
145964	Fee-for-Service	1174057046	1174057046	1	1	RICHMOND, STEPHEN P MD	10/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160643	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145994	Fee-for-Service	1184666802	1184666802	1	1	RIAD, MAGGY G MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69055	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
146011	Fee-for-Service	1417158353	1417158353	1	1	ROTHSCHILD, PATRICIA B LMFT	7/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2939 SUMMIT ST	STE 204	OAKLAND	CA	94609	3404	01	06001	37.81854368	-122.264813	Alameda County
146015	Fee-for-Service	1770540312	1770540312	1	1	ROBERT K SAITO MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75-5653 KUAKINI HWY	None	KAILUA KONA	HI	96740	1650	00	None	19.64127638	-155.9953077	Hawaii County
146038	Fee-for-Service	1801449970	1801449970	1	1	ROBERT E. BEER, M.D., INC.	6/23/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2221 BALFOUR RD	STE A	BRENTWOOD	CA	94513	4932	07	06013	37.92540738	-121.7392277	Contra Costa County
146055	Fee-for-Service	1972596989	1972596989	1	1	REGENTS/UCDPBG/INTERNAL	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICINE	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
146078	Fee-for-Service	1063437648	1063437648	1	1	R S VENUTURUPALLI MD INC	12/22/2006	207RR0500X	NA	Other	026	PHYSICIANS	69893	83	Rheumatology	0	In state provider	None	8737 BEVERLY BLVD	STE 203	WEST HOLLYWOOD	CA	90048	1840	19	06037	34.07687959	-118.381876	Los Angeles County
146085	Fee-for-Service	1679869556	1679869556	1	1	REED, KRISTIE L PHD	2/11/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
146127	Fee-for-Service	1528336831	1528336831	1	1	ROTCHEL, SEPEHR J MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122684	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
146140	Fee-for-Service	1720003320	1720003320	1	1	RALPHS GROCERY COMPANY	7/17/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #088	5035 PACIFIC COAST HWY	None	TORRANCE	CA	90505	5441	19	06037	33.81260394	-118.3681771	Los Angeles County
146195	Fee-for-Service	1992808992	1992808992	1	1	REDDY, THIRUPATHI K MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54174	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
146252	Fee-for-Service	1073944047	1073944047	1	1	RUSSELL, LAURA A MD INC	1/2/2014	207L00000X	NA	Other	026	PHYSICIANS	61396	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
146264	Fee-for-Service	1437186772	1437186772	1	1	ROBLES, ANTONIO E MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	37213	01	General Practice	0	In state provider	None	10414 VACCO ST	None	SOUTH EL MONTE	CA	91733	3350	19	06037	34.04731781	-118.0443923	Los Angeles County
146267	Fee-for-Service	1720083744	1720083744	1	1	RUBINSTEIN, GENNADY MD	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74924	07	Dermatology	0	In state provider	INC	3959 LAUREL CANYON BLVD	STE F	STUDIO CITY	CA	91604	3711	19	06037	34.14252659	-118.3949222	Los Angeles County
146277	Fee-for-Service	1073961280	1073961280	1	1	ROBERT J SLITER	1/25/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 N HILLSIDE ST	None	WICHITA	KS	67214	4910	00	None	37.695312	-97.29903348	Sedgwick County
146278	Fee-for-Service	1518135110	1518135110	1	1	RIZZUTO, SANDRA M	4/17/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146293	Fee-for-Service	1215960570	1215960570	1	1	RIEMAN, RAYMOND L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30813	30	Radiology	0	In state provider	None	1150 N VENTURA RD	STE A	OXNARD	CA	93030	3837	56	06111	34.21334043	-119.1944	Ventura County
146322	Fee-for-Service	1235179219	1235179219	1	1	RUBENSTEIN, DAVID J MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40548	30	Radiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
146329	Fee-for-Service	1871790543	1871790543	1	1	RODRIGO, CHRISTOPHER L LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
146348	Fee-for-Service	1770765430	1770765430	1	1	REESE, JACQUELINE B LMFT	1/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15437 ANACAPA RD	SUITE 3	VICTORVILLE	CA	92392	2458	36	06071	34.50557513	-117.3250277	San Bernardino County
146484	Fee-for-Service	1992808992	1992808992	1	1	REDDY, THIRUPATHI K MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54174	41	Internal Medicine	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
146514	Fee-for-Service	1205134343	1205134343	1	1	ROYZ INCORPORATED	4/19/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2700 E FOOTHILL BLVD	SUITE 200	PASADENA	CA	91107	3443	19	06037	34.14985464	-118.0947535	Los Angeles County
146562	Fee-for-Service	1801808266	1801808266	1	1	RAJASINGH, MOSES C MD	3/15/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45000	None	None	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
146606	Fee-for-Service	1235179219	1235179219	1	1	RUBENSTEIN, DAVID J MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40548	01	General Practice	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
146619	Fee-for-Service	1679685069	1679685069	1	1	ROBBINS, HARVARD M MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	33347	40	Pediatrics	0	In state provider	None	340 EUREKA SQ	None	PACIFICA	CA	94044	2652	41	06081	37.6328283	-122.4869304	San Mateo County
146650	Fee-for-Service	1053088294	1053088294	1	1	RILEY BENNETT, AJA LCSW	12/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146677	Fee-for-Service	1427358027	1427358027	1	1	RAMIREZ, VERONICA A MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116849	40	Pediatrics	0	In state provider	None	2828 FRESNO STREET	SUITE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
146741	Fee-for-Service	1013933613	1013933613	1	1	REEKSTIN, MATTHEW J PT	8/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
146803	Fee-for-Service	1205134343	1205134343	1	1	ROYZ INCORPORATED	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2700 E FOOTHILL BLVD	SUITE 200	PASADENA	CA	91107	3443	19	06037	34.14985464	-118.0947535	Los Angeles County
146805	Fee-for-Service	1336753573	1336753573	1	1	RED CARPET HOSPICE CARE	8/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	SUITE 313	TARZANA	CA	91356	6645	19	06037	34.17237215	-118.5354469	Los Angeles County
146808	Fee-for-Service	1477559383	1477559383	1	1	RODE,MATTHEW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	557 W WASHINGTON ST	None	BURNS	OR	97720	1441	00	None	43.58870813	-119.060725	Harney County
146816	Fee-for-Service	1548272727	1548272727	1	1	ROSENBAUM, STACEY P MD	11/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79423	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	99 N LA CIENEGA BLVD	STE 202	BEVERLY HILLS	CA	90211	2285	19	06037	34.06736471	-118.3763201	Los Angeles County
146821	Fee-for-Service	1285735274	1285735274	1	1	RESEDA PROSTHETICS	7/1/1996	332BC3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	18441 BRYANT ST	None	NORTHRIDGE	CA	91325	3309	19	06037	34.22743952	-118.535229	Los Angeles County
146901	Fee-for-Service	1710597430	1710597430	1	1	RAYMOND F LOPEZ JR MD A PROF	11/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	ESSIONAL CORPORATION	933 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19518016	-119.1893135	Ventura County
146909	Fee-for-Service	1861658379	1861658379	1	1	REICH, PHILLIP E MD	4/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111002	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
146918	Fee-for-Service	1174993943	1174993943	1	1	RAY, JOZALYNNE LMFT	3/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
146961	Fee-for-Service	1528023744	1528023744	1	1	ROBLES, IRA T MD	9/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155575	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
146980	Fee-for-Service	1205904729	1205904729	1	1	REICH, FRANCINE D LCSW	6/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
146997	Fee-for-Service	1629093224	1629093224	1	1	RALPHS GROCERY COMPANY	12/18/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #604	12470 SEAL BEACH BLVD	None	SEAL BEACH	CA	90740	2711	30	06059	33.78105	-118.069659	Orange County
147021	Fee-for-Service	1134169535	1134169535	2	31	REACH AIR MEDICAL SERVICES L	4/19/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	110 JONES ROAD	None	OCEANSIDE	CA	92058	1214	37	06073	33.21081526	-117.3539507	San Diego County
147025	Fee-for-Service	1689735433	1689735433	1	1	RYEN, LANCE M LCSW	2/5/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
147052	Fee-for-Service	1184734113	1184734113	1	1	REISS, SHELDON MD INC	2/17/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30210	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9001 WILSHIRE BLVD	STE 304	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
147073	Fee-for-Service	1013971621	1013971621	1	1	REILLY, ELIZABETH A DPM	10/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147088	Fee-for-Service	1588653547	1588653547	1	1	RONALD KORN MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E THOMPSON PEAK PKW	None	SCOTTSDALE	AZ	85255	4109	00	None	33.670791	-111.921669	Maricopa County
147093	Fee-for-Service	1336753573	1336753573	1	1	RED CARPET HOSPICE CARE	8/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	SUITE 313	TARZANA	CA	91356	6645	19	06037	34.17237215	-118.5354469	Los Angeles County
147110	Fee-for-Service	1306355540	1306355540	1	1	RIDE AID INC.	3/24/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1438 S EUCLID ST	None	ANAHEIM	CA	92802	2103	30	06059	33.81183	-117.9414205	Orange County
147157	Fee-for-Service	1811041031	1811041031	2	1	RULNICK, ADAM MD	8/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	101473	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
147189	Fee-for-Service	1477712404	1477712404	1	1	ROCKWELL, JACLYN CRNA	9/24/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
147199	Fee-for-Service	1720550056	1720550056	1	1	RENATO V. MUNGCAL, M.D., INC	12/27/2018	261QP2300X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	.	21700 GOLDEN TRIANGLE RO	SUITE 102	LOS ANGELES	CA	91350	2616	19	06037	34.41476615	-118.5151786	Los Angeles
147218	Fee-for-Service	1568445963	1568445963	1	1	RITCHIE, PAUL H MD	3/3/2021	207L00000X	NA	Other	026	PHYSICIANS	86496	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
147240	Fee-for-Service	1316076326	1316076326	1	1	ROLL, GARRETT R MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98536	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
147241	Fee-for-Service	1588922561	1588922561	1	1	RYAN D WELLS MD PC	9/2/2017	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	2438 N PONDEROSA DR	C105	CAMARILLO	CA	93010	2369	56	06111	34.24219545	-119.0227012	Ventura County
147286	Fee-for-Service	1427396779	1427396779	1	1	REGENTS OF THE UNIVERSITY OF	7/25/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 X STREET	R00M 1008	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
147318	Fee-for-Service	1881618171	1881618171	1	1	ROSALES, NOEL B MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	78012	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147346	Fee-for-Service	1215053632	1215053632	1	1	ROH, YUNI Y LMFT	9/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
147413	Fee-for-Service	1891826509	1891826509	1	1	ROSAS, OSCAR V MD	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	66042	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
147429	Fee-for-Service	1326195652	1326195652	1	1	RUNZEL, ALBERT R CNM	8/12/2011	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147442	Fee-for-Service	1609498674	1609498674	1	1	RAMIREZ, JULIA A	2/24/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
147500	Fee-for-Service	1497766166	1497766166	2	1	RUPP, TIMOTHY J MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129547	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
147534	Fee-for-Service	1881646594	1881646594	1	1	ROBERTS, LAURA W MD	10/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88744	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147554	Fee-for-Service	1386039873	1386039873	1	1	RIJHWANI, MARVI V MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156241	01	General Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
147581	Fee-for-Service	1114105053	1114105053	1	1	RAJAGOPALAN, ARUNA S OD	1/3/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94556	1639	41	06081	37.53039072	-122.2987772	San Mateo County
147583	Fee-for-Service	1144228073	1144228073	1	1	REDDY, CHALLA V MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	67303	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 SOUTH ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
147602	Fee-for-Service	1174770333	1174770333	1	1	RAFII, FLORA I MD	2/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109644	40	Pediatrics	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95185	4807	34	06067	38.596581	-121.4303535	Sacramento County
147607	Fee-for-Service	1871938779	1871938779	1	1	ROMAN FEREDE	2/26/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
147618	Fee-for-Service	1588677314	1588677314	1	1	ROSE, PATRICIA A MD	6/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76059	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
147646	Fee-for-Service	1285068783	1285068783	1	1	REGENTS OF THE UNIV OF CA	2/24/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
147647	Fee-for-Service	1396138467	1396138467	1	1	RIDGECREST MEDICAL	11/26/2018	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION	1110 W RIDGECREST BLVD	None	RIDGECREST	CA	93555	5413	15	06029	35.6225703	-117.6927399	Kern County
147663	Fee-for-Service	1962429662	1962429662	1	1	RAMAMOORTHY,CHANDRA MD	4/26/2001	207L00000X	NA	Other	026	PHYSICIANS	50575	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147677	Fee-for-Service	1588835375	1588835375	1	1	RANGI, JAIWANT K MD	5/13/2008	207RE0101X	NA	Endocrinology	026	PHYSICIANS	92729	67	Endocrinology	0	In state provider	None	3106 PONTE MORINO DRIVE	SUITE C	CAMERON PARK	CA	95682	8277	09	06017	38.66372604	-120.9664345	El Dorado County
147705	Fee-for-Service	1942442579	1942442579	1	1	REMSAI HOME SLEEP DIAGNOSTIC	10/7/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4025 CAMINO DEL RIO S	SUITE 103	SAN DIEGO	CA	92108	4107	37	06073	32.77795434	-117.1076906	San Diego County
147738	Fee-for-Service	1639386626	1639386626	1	1	RAMIN, SOROUSH A MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	60294	34	Urology and Urological Surgery	0	In state provider	None	12922 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
147807	Fee-for-Service	1972811123	1972811123	1	1	RODRIGUEZ SOHAL, JENNIFER	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109393	20	Orthopedic Surgery	0	In state provider	KAUR MD INC	2105 BEVERLY BLVD	SUITE 227	LOS ANGELES	CA	90057	2282	19	06037	34.06682861	-118.2706286	Los Angeles County
147809	Fee-for-Service	1427136019	1427136019	1	1	REDDY, KAVITA M MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52830	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
147823	Fee-for-Service	1053380634	1053380634	1	1	ROSE, RICHARD KT MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71631	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
147833	Fee-for-Service	1174951594	1174951594	1	1	RIVERSIDE COUNTY LATINO	12/7/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	COMMISSION ON ALCOHOL &	83844 HOPI AVE	None	INDIO	CA	92203	2638	33	06065	33.73345123	-116.2020725	Riverside County
147865	Fee-for-Service	1356364558	1356364558	1	1	RUGGLES, CRAIG S MD	3/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63607	None	None	0	In state provider	None	11000 OLSON DR	STE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
147924	Fee-for-Service	1649372673	1649372673	1	1	REGENTS OF THE UNIVERSITY OF	3/14/2023	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147930	Fee-for-Service	1891910105	1891910105	1	1	ROBERT SUDHIR VAIDYA,DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6777 W MAPLE RD	None	W BLOOMFIELD	MI	48322	3013	00	None	42.53823	-83.406843	Oakland County
147933	Fee-for-Service	1285068783	1285068783	1	1	REGENTS OF THE UNIV OF CA	2/24/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
148009	Fee-for-Service	1265508261	1265508261	1	1	RIBEIRO, MARIE E MD	4/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	59308	40	Pediatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 202	DALY CITY	CA	94015	2222	41	06081	37.68077723	-122.4728941	San Mateo County
148032	Fee-for-Service	1164574083	1164574083	1	1	REDWOOD PEDIATRIC MED GR	8/30/1994	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3305 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
148044	Fee-for-Service	1811912504	1811912504	1	1	RUIZ, WILLIAM S MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47785	08	Family Practice	0	In state provider	None	5400 W ROSECRANS	STE 100	LAWNDALE	CA	90260	0000	19	06037	33.901911	-118.3473293	Los Angeles County
148060	Fee-for-Service	1821632753	1821632753	1	1	RAI, MADHUMEETA NP	12/12/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
148070	Fee-for-Service	1558723502	1558723502	1	1	RAMOS, EMILIO MD	6/16/2020	207ZP0101X	NA	Other	026	PHYSICIANS	153686	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148076	Fee-for-Service	1518932219	1518932219	1	1	RITCHEY, WILLIAM J CRNA	8/22/2003	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
148081	Fee-for-Service	1316090798	1316090798	1	1	RIVERSIDE-SAN BERNARDINO COU	10/7/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	C	47001 PALA RD	None	TEMECULA	CA	92592	2925	33	06065	33.44396676	-117.0915085	Riverside County
148082	Fee-for-Service	1457534885	1457534885	1	1	REEVES, PAMELA D LMFT	6/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
148095	Fee-for-Service	1326658097	1326658097	1	1	RDR HOLDINGS LLC	7/26/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	26359 JEFFERSON AVE	STE. G	MURRIETA	CA	92562	6975	33	06065	33.53475568	-117.1791945	Riverside County
148119	Fee-for-Service	1982032660	1982032660	1	1	ROPER, AMBER	8/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
148129	Fee-for-Service	1225430580	1225430580	1	4	RIGHT CHOICE SENIOR LIVING	6/26/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	6749 RADCLIFFE DR	None	SAN DIEGO	CA	92122	2447	37	06073	32.85690476	-117.2075051	San Diego County
148156	Fee-for-Service	1508119090	1508119090	1	1	RC HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3043 GOLD CANAL DR	SUITE 220	RANCHO CORDOVA	CA	95670	6393	34	06067	38.592666	-121.26807	Sacramento County
148211	Fee-for-Service	1649372673	1649372673	1	1	REGENTS OF THE UNIVERSITY OF	9/18/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
148226	Fee-for-Service	1720189061	1720189061	1	1	ROSE EYE MEDICAL GROUP	7/20/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2400 N BROADWAY	None	LOS ANGELES	CA	90031	2219	19	06037	34.07360257	-118.2166466	Los Angeles County
148229	Fee-for-Service	1346635190	1346635190	1	1	ROWLEY, VINCENT M MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154331	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
148268	Fee-for-Service	1689861601	1689861601	1	1	RAGUPARAN, GEATA MD	10/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98840	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
148287	Fee-for-Service	1558919647	1558919647	1	1	RILEY, JUDY C LMFT	1/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	473 E CARNEGIE DR	STE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
148320	Fee-for-Service	1164574083	1164574083	1	1	REDWOOD PEDIATRIC MED GR	10/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3305 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
148355	Fee-for-Service	1700807815	1700807815	1	1	RETINAL CONSULTANTS OF	10/1/1999	174400000X	NA	Other	026	PHYSICIANS	33939	18	Ophthalmology	0	In state provider	SOUTHERN CALIFORNIA MED	1220 LA VENTA DR	STE 211	WESTLAKE VILLAGE	CA	91361	3724	56	06111	34.14891743	-118.8225621	Ventura County
148369	Fee-for-Service	1316090798	1316090798	1	1	RIVERSIDE-SAN BERNARDINO COU	10/7/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	C	47001 PALA RD	None	TEMECULA	CA	92592	2925	33	06065	33.44396676	-117.0915085	Riverside County
148407	Fee-for-Service	1811045800	1811045800	1	1	RAMANATHAN, MARGABANDHU	8/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45244	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
148411	Fee-for-Service	1902851868	1902851868	1	1	REES, SEAN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
148443	Fee-for-Service	1508119090	1508119090	1	1	RC HOSPICE CARE INC	2/25/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3043 GOLD CANAL DR	SUITE 220	RANCHO CORDOVA	CA	95670	6393	34	06067	38.592666	-121.26807	Sacramento County
148457	Fee-for-Service	1346496619	1346496619	1	1	RAMOS, DANILO C JR MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104224	05	Anesthesiology	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
148458	Fee-for-Service	1093712135	1093712135	1	1	ROBERT GATES MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 LOCUST ST	None	PITTSBURGH	PA	15219	5114	00	None	40.43680965	-79.98536742	Allegheny County
148486	Fee-for-Service	1679097612	1679097612	1	1	REINICKE, PRISCILLA PSYD	4/19/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
148495	Fee-for-Service	1134144736	1134144736	1	1	RALPHS GROCERY COMPANY	2/18/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #39	260 S LA BREA AVE	None	LOS ANGELES	CA	90036	3023	19	06037	34.07002765	-118.3440045	Los Angeles County
148502	Fee-for-Service	1649372673	1649372673	1	1	REGENTS OF THE UNIVERSITY OF	8/24/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
148554	Fee-for-Service	1982644605	1982644605	1	1	RIGGIO, JOSEPH M MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	65467	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
148594	Fee-for-Service	1235122250	1235122250	1	1	REGENTS/UCDPBG/RAD ONC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
148605	Fee-for-Service	1366883845	1366883845	1	1	ROMERO, GABRIELA M LCSW	4/20/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
148609	Fee-for-Service	1164574083	1164574083	1	1	REDWOOD PEDIATRIC MED GR	8/30/1994	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3305 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
148615	Fee-for-Service	1295994697	1295994697	1	1	R&R MEDICAL SUPPLY CORP	5/3/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	R&R MEDICAL SUPPLY CORP	17839 CHATSWORTH STREET	None	GRANADA HILLS	CA	91344	5612	19	06037	34.26492449	-118.523079	Los Angeles County
148631	Fee-for-Service	1033160049	1033160049	1	1	RUSSELLVILLE HOLDINGS, LLC	9/15/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1808 W MAIN ST	None	RUSSELLVILLE	AR	72801	2724	00	None	35.283456	-93.1502205	Pope County
148702	Fee-for-Service	1679710123	1679710123	1	1	RUSSELL W WRIGHT MD	12/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
148746	Fee-for-Service	1992331953	1992331953	1	1	RAMESH, NAVNEET K MD	12/30/2022	390200000X	NA	Other	026	PHYSICIANS	178580	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
148773	Fee-for-Service	1083915169	1083915169	1	1	RIOS, YVONNE M LMFT	2/19/2019	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
148788	Fee-for-Service	1649372673	1649372673	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
148796	Fee-for-Service	1609061498	1609061498	1	1	REVIVAMED MEDICAL CORP	3/28/2016	2086S0122X	NA	General Surgery	026	PHYSICIANS	50365	24	Plastic Surgery	0	In state provider	None	711 4TH AVENUE	STE 200	SAN DIEGO	CA	92101	6863	37	06073	32.712741	-117.1610345	San Diego County
148802	Fee-for-Service	1750328647	1750328647	1	2	RASUL, ABRAHAM T	9/20/2017	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	51132	25	Physical Medicine and Rehabilitation	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
148827	Fee-for-Service	1699112748	1699112748	1	1	REMIGIO, CHRISTIE MAE T NP	11/7/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2810 CAMINO DEL RIO S	STE 102	SAN DIEGO	CA	92108	3819	37	06073	32.77081335	-117.1316557	San Diego County
148859	Fee-for-Service	1659328458	1659328458	1	1	REDCLIFF, CANDACE L LCSW	11/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
148892	Fee-for-Service	1891148854	1891148854	1	1	RODRIGUEZ MORENO, JOSE I MD	9/23/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
148895	Fee-for-Service	1316081482	1316081482	1	1	REDLANDS COMMUNITY HOSP	6/1/1983	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
148903	Fee-for-Service	1518122324	1518122324	1	1	RAMESH, ANIL MD	10/15/2018	207R00000X	NA	Other	026	PHYSICIANS	154046	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
148916	Fee-for-Service	1033160049	1033160049	1	1	RUSSELLVILLE HOLDINGS, LLC	9/15/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1808 W MAIN ST	None	RUSSELLVILLE	AR	72801	2724	00	None	35.283456	-93.1502205	Pope County
148929	Fee-for-Service	1609534825	1609534825	1	1	REED, JESSICA LMFT	1/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	422 N SAN JACINTO ST	None	HEMET	CA	92543	3124	33	06065	33.753564	-116.9586305	Riverside County
148940	Fee-for-Service	1700831922	1700831922	1	1	ROWE, PETER H MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	16023	41	Internal Medicine	0	In state provider	None	3100 TELEGRAPH AVE	STE 3000	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
148947	Fee-for-Service	1427234558	1427234558	1	1	RAUL ARTURO PARDAVE MD A MED	7/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	ICAL CORPORATION	1530 E CHEVY CHASE DR	207	GLENDALE	CA	91206	4163	19	06037	34.150689	-118.2303855	Los Angeles County
148977	Fee-for-Service	1437896065	1437896065	1	1	REAGAN, TERESA L CNM	7/26/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
148992	Fee-for-Service	1104024140	1104024140	1	1	REYNOSO, MONICA PSYD	1/21/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
149068	Fee-for-Service	1396145116	1396145116	1	1	ROSENFELD, GINNI S MD INC	9/29/2014	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83201	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12954 S HAWTHORNE BLVD	STE 104	HAWTHORNE	CA	90250	4418	19	06037	33.91447388	-118.3523875	Los Angeles County
149129	Fee-for-Service	1801869771	1801869771	1	1	RITTENBACH, JONATHAN MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81530	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
149141	Fee-for-Service	1760884563	1760884563	1	1	ROTH, ALEXA E MD	9/9/2020	208600000X	NA	General Surgery	026	PHYSICIANS	165647	02	General Surgery	0	In state provider	None	205 E RIVER PARK CIR	STE 460	FRESNO	CA	93720	1585	10	06019	36.85456375	-119.7863981	Fresno County
149164	Fee-for-Service	1154336618	1154336618	1	1	ROHRSCHEIB, MARK MD	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
149194	Fee-for-Service	1396800728	1396800728	1	1	RALPHS GROCERY COMPANY	3/1/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #098	3350 LA SIERRA AVE	None	RIVERSIDE	CA	92503	5228	33	06065	33.8961468	-117.4703407	Riverside County
149226	Fee-for-Service	1700831922	1700831922	1	1	ROWE, PETER H MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	16023	45	Nephrology (Renal-Kidney)	0	In state provider	None	3100 TELEGRAPH AVE	STE 3000	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
149245	Fee-for-Service	1225430580	1225430580	1	3	RIGHT CHOICE SENIOR LIVING	5/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4929 MT LONGS	None	SAN DIEGO	CA	92117	3054	37	06073	32.8257	-117.1878644	San Diego County
149269	Fee-for-Service	1235113077	1235113077	1	1	ROSE, KAREN M LMFT	6/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2000 HEARST AVENUE	203A	BERKELEY	CA	94709	2260	01	06001	37.8735896	-122.2706628	Alameda County
149314	Fee-for-Service	1063651586	1063651586	1	1	ROSS, CATHERINE M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107292	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VAN OWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
149319	Fee-for-Service	1629460290	1629460290	1	1	RICHARDSON, CANDICE S LMFT	7/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
149369	Fee-for-Service	1073788832	1073788832	1	1	REDWOOD RURAL HEALTH CTR	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PO BOX 769	100 WESTCOAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11763702	-123.8131682	Humboldt County
149374	Fee-for-Service	1578543161	1578543161	1	1	ROSSI, JOHN S OD	1/31/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	615 N PALM AVE	None	ONTARIO	CA	91762	3219	36	06071	34.069761	-117.65376	San Bernardino County
149397	Fee-for-Service	1134169535	1134169535	2	34	REACH AIR MEDICAL SERVICES L	6/27/2020	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	LC.	5475 NE DAWSON CREEK DR	None	HILLSBORO	OR	97124	5797	00	None	45.54428851	-122.9267925	Washington County
149398	Fee-for-Service	1134169535	1134169535	2	6	REACH AIR MEDICAL SERVICES L	11/30/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5005 MARSH DRIVE	None	CONCORD	CA	94520	5343	07	06013	37.99862453	-122.0574458	Contra Costa County
149403	Fee-for-Service	1902914484	1902914484	1	1	REVIS, RICHARD MD	7/6/2005	207L00000X	NA	Other	026	PHYSICIANS	60362	05	Anesthesiology	0	In state provider	None	966 CASS ST	None	MONTEREY	CA	93940	4539	27	06053	36.5924291	-121.8964192	Monterey County
149439	Fee-for-Service	1770079006	1770079006	1	1	ROACH, AMY MD	11/9/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	160884	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149453	Fee-for-Service	1073178646	1073178646	1	1	RAMAHI, KHALID JAMAL MD	8/3/2023	207P00000X	NA	Other	026	PHYSICIANS	176351	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
149523	Fee-for-Service	1396862769	1396862769	1	1	ROSENTHAL, ANNE E MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82495	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
149537	Fee-for-Service	1770577892	1770577892	1	1	ROY, MICHAEL A OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	675 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94596	3860	07	06013	37.90655294	-122.0598745	Contra Costa County
149553	Fee-for-Service	1124227632	1124227632	1	1	RAVIPATI, MADHAVI L MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98168	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
149572	Fee-for-Service	1679557961	1679557961	1	1	ROBERT F BURKE, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3099 CIVIC CENTER PLAZA	None	SCOTTSDALE	AZ	85251	0000	00	None	33.483456	-111.921516	Maricopa County
149601	Fee-for-Service	1619285384	1619285384	1	1	ROWE, JENNIFER D LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	77408	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
149679	Fee-for-Service	1104378389	1104378389	1	1	RITTUE, JULIE A D	10/2/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
149687	Fee-for-Service	1871811968	1871811968	1	1	RICHIE, MEGAN B MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130658	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
149737	Fee-for-Service	1790213882	1790213882	1	1	RAMIREZ, PAULO A MD	7/2/2020	207R00000X	NA	Other	026	PHYSICIANS	164412	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
149750	Fee-for-Service	1740290212	1740290212	1	1	ROKEACH STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTENWOOD ST	None	MURRAY	UT	84157	5701	00	None	40.659588	-111.891798	Salt Lake County
149760	Fee-for-Service	1245249713	1245249713	1	1	REYERSON, ELLEN M. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
149795	Fee-for-Service	1013013218	1013013218	1	1	RASSAI, HAMID R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60998	02	General Surgery	0	In state provider	None	3903 LONE TREE WAY	STE 210	ANTIOCH	CA	94509	6270	07	06013	37.98216807	-121.8054744	Contra Costa County
149820	Fee-for-Service	1427155118	1427155118	1	1	RICKER, DENISE M MD	2/28/1990	207RN0300X	NA	Nephrology	026	PHYSICIANS	62963	41	Internal Medicine	0	In state provider	None	14020 SAN PABLO AVE	STE A	SAN PABLO	CA	94806	3604	07	06013	37.96124162	-122.3434731	Contra Costa County
149857	Fee-for-Service	1285294413	1285294413	1	1	RUIZ, SARAH K PHD	1/6/2021	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
149865	Fee-for-Service	1376066191	1376066191	1	1	RIZZOTTI, ALESSANDRA J LCSW	11/18/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
149866	Fee-for-Service	1093954497	1093954497	1	1	ROGERS, ALEXANDRA E MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55033	34	Urology and Urological Surgery	0	In state provider	None	215 PESETAS	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
149876	Fee-for-Service	1326888140	1326888140	1	1	RADIOLOGY ASSOCIATES OF SAN	6/27/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1310 LAS TABLAS RD	STE 103	TEMPLETON	CA	93465	9746	40	06079	35.55442349	-120.722643	San Luis Obispo County
149892	Fee-for-Service	1164489977	1164489977	1	1	ROTHMAN, GERALD S MD	1/4/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	20520	10	Gastroenterology (M.D. only)	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
149908	Fee-for-Service	1912439068	1912439068	1	1	RAHIMI, HAMZA	8/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187448	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
149932	Fee-for-Service	1184970600	1184970600	1	1	ROOKS, HOLLY C LMFT	10/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
149934	Fee-for-Service	1770544173	1770544173	1	1	RAMSOOK, CHRIS A MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
149962	Fee-for-Service	1154330702	1154330702	1	1	ROUX, SUSAN G MD	6/22/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	60193	30	Radiology	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
149981	Fee-for-Service	1023012374	1023012374	1	1	RASTANI, KASRA MD	8/25/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	83012	04	Otology, Laryngology, Rhinology	0	In state provider	None	490 POST ST	STE 848	SAN FRANCISCO	CA	94102	1419	38	06075	37.78812774	-122.4096884	San Francisco County
149989	Fee-for-Service	1962030114	1962030114	1	1	RAYNOR, BRITTANY DO	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	23615	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
149998	Fee-for-Service	1396130506	1396130506	1	1	ROBERTS, PETER MD	10/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158989	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
150014	Fee-for-Service	1447253125	1447253125	1	5	RIDGECREST REGIONAL HOSPITAL	12/9/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	540 PERDEW AVE	STE C&D	RIDGECREST	CA	93555	2596	15	06029	35.64893969	-117.6812071	Kern County
150036	Fee-for-Service	1811145113	1811145113	1	1	ROCILLO, GINA MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114304	01	General Practice	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
150042	Fee-for-Service	1225012644	1225012644	1	1	RENAISSANCE RADIOLOGY	9/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
150050	Fee-for-Service	1568720811	1568720811	1	1	RAJFER, REBECCA A MD	8/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156344	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	101B,102B,104B,106B,108B	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
150051	Fee-for-Service	1477811693	1477811693	1	1	ROCHELLE, MICHELE C MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105975	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
150080	Fee-for-Service	1417290529	1417290529	1	1	RUIZ, JEANETTE MD	9/4/2019	390200000X	NA	Other	026	PHYSICIANS	136181	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
150082	Fee-for-Service	1649227984	1649227984	1	1	RYAN, ANGELE MD	12/4/1986	207L00000X	NA	Other	026	PHYSICIANS	28482	05	Anesthesiology	0	In state provider	CARSON INTER COMM	415 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3326	19	06037	33.83819747	-118.3840178	Los Angeles County
150098	Fee-for-Service	1750435673	1750435673	1	1	ROBINSON, TAMITA T W MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89464	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
150107	Fee-for-Service	1427155118	1427155118	1	1	RICKER, DENISE M MD	2/28/1990	207RN0300X	NA	Nephrology	026	PHYSICIANS	62963	45	Nephrology (Renal-Kidney)	0	In state provider	None	14020 SAN PABLO AVE	STE A	SAN PABLO	CA	94806	3604	07	06013	37.96124162	-122.3434731	Contra Costa County
150112	Fee-for-Service	1992965131	1992965131	1	2	RABBANI, SHAWN S DPM INC	2/3/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	18022 PIONEER BLVD	None	ARTESIA	CA	90701	3905	19	06037	33.8669305	-118.0821	Los Angeles County
150119	Fee-for-Service	1558310557	1558310557	1	1	RESNIK, JAMIE L MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66580	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150132	Fee-for-Service	1083714455	1083714455	1	1	RAYKOV, PAUL A MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134806	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
150133	Fee-for-Service	1235631581	1235631581	1	1	RICKARDS, JENNIFER	3/20/2025	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1132 SAN MARINO DRIVE	SUITE 206	SAN MARCOS	CA	92078	0000	37	06073	33.12486539	-117.2107986	San Diego County
150167	Fee-for-Service	1801848833	1801848833	1	1	RABOW, MICHAEL W MD	6/30/1995	207R00000X	NA	Other	026	PHYSICIANS	80042	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
150285	Fee-for-Service	1598269128	1598269128	1	1	RAUT, SNEHAL H MD	8/9/2023	207L00000X	NA	Other	026	PHYSICIANS	178500	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
150302	Fee-for-Service	1841428083	1841428083	1	1	RAMASUBRAMANIAN, APARNA MD	3/14/2022	207WX0110X	NA	Ophthalmology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
150364	Fee-for-Service	1255324323	1255324323	1	1	REGENTS/UCDPBG/IM HOSP	5/25/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
150380	Fee-for-Service	1366687964	1366687964	1	1	REID, JOANNE E MD INC	12/19/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	86333	None	None	0	In state provider	None	263 N VILLA AVE	None	WILLOWS	CA	95988	2607	11	06021	39.52254122	-122.2089532	Glenn County
150382	Fee-for-Service	1790972446	1790972446	1	1	RACHEL SARAH DARLING, M.D.	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 N SMITH AVENUE	None	ST. PAUL	MN	55102	2346	00	None	44.94251219	-93.1074995	Ramsey County
150386	Fee-for-Service	1396989976	1396989976	1	1	RAO-FRISCH, ANITHA MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123999	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150403	Fee-for-Service	1659387132	1659387132	1	1	RAVINDRAN, DYANESH MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139190	78	Neoplastic Diseases/Oncology	0	In state provider	None	310 HARTNELL AVE	None	REDDING	CA	96002	1868	45	06089	40.56670901	-122.3688887	Shasta County
150417	Fee-for-Service	1013938349	1013938349	1	1	RAJAT BHATT	1/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
150449	Fee-for-Service	1790941128	1790941128	1	1	RODRIGUEZ, STEPHANY L NP	7/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150478	Fee-for-Service	1497895585	1497895585	1	1	RYBOLD, DANIEL J MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52900	08	Family Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
150486	Fee-for-Service	1285713693	1285713693	1	1	REUTER,DAVID G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	NE	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
150504	Fee-for-Service	1669840534	1669840534	1	1	RAMIREZ, DIANE L OD	4/5/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
150506	Fee-for-Service	1275584906	1275584906	1	1	RAU, CRAIG S MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	880 ALDER AVE	2ND FLOOR	INCLINE VILLAGE	NV	89451	8215	00	None	39.25092003	-119.9543846	Washoe County
150511	Fee-for-Service	1619951134	1619951134	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
150528	Fee-for-Service	1427123991	1427123991	1	1	ROSENBLATT, EUGENE M MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9060	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
150530	Fee-for-Service	1902965619	1902965619	1	1	RUSSELL, JOHN P OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	30400 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1300	30	06059	33.5224708	-117.6686181	Orange County
150568	Fee-for-Service	1457178899	1457178899	1	1	ROMERO, MILA I BIRTH DOULA	9/25/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
150574	Fee-for-Service	1316987159	1316987159	1	1	RODRIGUEZ, ESEQUIEL MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80459	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
150652	Fee-for-Service	1255324323	1255324323	1	1	REGENTS/UCDPBG/IM HOSP	5/25/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
150655	Fee-for-Service	1790290476	1790290476	1	1	REAGAN, WAYNE A	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
150693	Fee-for-Service	1659387132	1659387132	1	1	RAVINDRAN, DYANESH MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139190	68	Hematology	0	In state provider	None	310 HARTNELL AVE	None	REDDING	CA	96002	1868	45	06089	40.56670901	-122.3688887	Shasta County
150703	Fee-for-Service	1295902831	1295902831	1	1	RIMEL, BRYAN C MD	10/13/2022	207R00000X	NA	Other	026	PHYSICIANS	177954	None	None	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
150714	Fee-for-Service	1457689721	1457689721	1	1	RUTLEDGE, AIDA J	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95345	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
150721	Fee-for-Service	1972596989	1972596989	1	2	REGENTS/UCDPBG/INTERNAL	5/1/1999	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
150741	Fee-for-Service	1386941219	1386941219	1	1	ROGHANI, REZA MD	1/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126049	20	Orthopedic Surgery	0	In state provider	None	341 MAGNOLIA AVE	SUITE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
150755	Fee-for-Service	1770928954	1770928954	1	1	RUBEN, SHIVANI S MD	2/12/2021	207R00000X	NA	Other	026	PHYSICIANS	170012	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 400	SACRAMENTO	CA	95816	5243	34	06067	38.570076	-121.4657145	Sacramento County
150766	Fee-for-Service	1447475009	1447475009	1	1	ROBISON, KAY A	9/21/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2220 5TH AVE	None	OROVILLE	CA	95965	5816	04	06007	39.50224076	-121.5649012	Butte County
150785	Fee-for-Service	1487432951	1487432951	1	1	REGIS, SAMANTHA D CD	9/21/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
150795	Fee-for-Service	1275584906	1275584906	1	1	RAU, CRAIG S MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	880 ALDER AVE	2ND FLOOR	INCLINE VILLAGE	NV	89451	8215	00	None	39.25092003	-119.9543846	Washoe County
150796	Fee-for-Service	1043776453	1043776453	1	2	ROCHIOS, BRIDGET NP	5/18/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150815	Fee-for-Service	1740530385	1740530385	1	1	RIDEOUT MEDICAL ASSOCIATES	12/8/2017	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
150850	Fee-for-Service	1790796449	1790796449	1	1	ROOST, JENNIFER MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75552	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
150853	Fee-for-Service	1083754972	1083754972	1	1	REEVES, JOHN J MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
150891	Fee-for-Service	1962117440	1962117440	1	1	REVIVE PATHWAY	7/11/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	N/A	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
150905	Fee-for-Service	1073694543	1073694543	1	1	RANDOLPH, CHERYL L	8/26/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	165 ROWLAND WAY	STE 201	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
150958	Fee-for-Service	1831328988	1831328988	1	1	RAY, MANOJ K MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142837	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
150971	Fee-for-Service	1417184078	1417184078	1	1	RIAR, RAVNEET MD	9/21/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	157707	None	None	0	In state provider	None	1508 ALHAMBRA	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
150983	Fee-for-Service	1316951650	1316951650	1	1	REJACICH,NICHOLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING	JR WAY	TACOMA	WA	98405	0000	00	None	47.25960844	-122.4534238	Pierce County
151011	Fee-for-Service	1972596989	1972596989	1	2	REGENTS/UCDPBG/INTERNAL	5/14/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
151022	Fee-for-Service	1730479072	1730479072	1	1	RAI CARE CENTERS OF SOUTHERN	9/2/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA I LLC	501 SOUTH BRAND BLVD	STE 1	SAN FERNANDO	CA	91340	4929	19	06037	34.27947028	-118.4429293	Los Angeles County
151054	Fee-for-Service	1225207269	1225207269	1	1	REELE CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2340 PLAZA DEL AMO	STE 230	TORRANCE	CA	90501	3455	19	06037	33.83049748	-118.3239598	Los Angeles County
151102	Fee-for-Service	1740530385	1740530385	1	1	RIDEOUT MEDICAL ASSOCIATES	5/3/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
151139	Fee-for-Service	1902030539	1902030539	1	1	RESNICK, ALEX M MD	6/19/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	107665	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
151147	Fee-for-Service	1780980474	1780980474	1	1	RAMIREZ, ALEJANDRO LCSW	5/8/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
151171	Fee-for-Service	1568518231	1568518231	1	1	ROMERO, LARISSA MD	6/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172739	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
151182	Fee-for-Service	1962117440	1962117440	1	1	REVIVE PATHWAY	7/11/2023	261QR0405X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	N/A	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
151190	Fee-for-Service	1124076278	1124076278	1	1	REYNOLDS, KATHY L MD	2/26/2016	2080P0203X	NA	Other	026	PHYSICIANS	43697	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
151217	Fee-for-Service	1912630989	1912630989	1	1	ROBINSON, CASSIE J NP	7/21/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1665 ESPLANADE	None	CHICO	CA	95926	3312	04	06007	39.74388808	-121.8503372	Butte County
151251	Fee-for-Service	1649492166	1649492166	1	1	RASILA, KANWALDEEP K MD	1/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54884	68	Hematology	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
151265	Fee-for-Service	1982006201	1982006201	1	1	RUIZ, EDRIC	2/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155438	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
151283	Fee-for-Service	1326096165	1326096165	1	2	REGENTS OF THE UNIVERSITY OF	2/13/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
151292	Fee-for-Service	1821580028	1821580028	1	1	ROUSE, RIXON AU	4/24/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
151296	Fee-for-Service	1669092557	1669092557	1	1	RAHIMIAN, AMIR MD	8/29/2023	207P00000X	NA	Other	026	PHYSICIANS	182350	None	None	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
151314	Fee-for-Service	1194329474	1194329474	1	1	RAD CARE SERVICES INC	2/14/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1217 SOUTH ALVARADO ST	None	LOS ANGELES	CA	90006	4119	19	06037	34.04829116	-118.2820642	Los Angeles County
151329	Fee-for-Service	1912294547	1912294547	1	1	RUYLE, CLIFFORD A JR LCSW	6/27/2012	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3465 CAMINO DEL RIO SOUT	SUITE 320	SAN DIEGO	CA	92108	3909	37	06073	32.77744829	-117.1188909	San Diego County
151339	Fee-for-Service	1235207614	1235207614	1	1	RHEE, TAE R MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26795	04	Otology, Laryngology, Rhinology	0	In state provider	None	12555 GARDEN GROVE BLVD	STE 408	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
151342	Fee-for-Service	1225207269	1225207269	1	1	REELE CORPORATION	4/13/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2340 PLAZA DEL AMO	STE 230	TORRANCE	CA	90501	3455	19	06037	33.83049748	-118.3239598	Los Angeles County
151367	Fee-for-Service	1164586111	1164586111	1	1	RANKIN, BRIAN OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
151372	Fee-for-Service	1720088354	1720088354	1	1	RIDEOUT MEMORIAL HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	GROUP	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
151377	Fee-for-Service	1497868376	1497868376	1	1	ROSAASEN, AMANDA R MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85780	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
151383	Fee-for-Service	1790881357	1790881357	1	1	RYAN, CHRISTOPHER J MD	11/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80383	08	Family Practice	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
151391	Fee-for-Service	1740530385	1740530385	1	1	RIDEOUT MEDICAL ASSOCIATES	7/1/2017	261QM1300X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
151422	Fee-for-Service	1245676063	1245676063	1	1	ROSE, JANELLE LMFT	3/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151511	Fee-for-Service	1093748881	1093748881	1	1	RUO, BERNICE MD	4/25/2017	207R00000X	NA	Other	026	PHYSICIANS	75047	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
151530	Fee-for-Service	1477736262	1477736262	1	1	RODRIGUEZ, MIGUEL A DPM	11/12/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	500 N GARFIELD AVE	STE 108	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
151532	Fee-for-Service	1528179793	1528179793	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1995	225100000X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
151535	Fee-for-Service	1548291263	1548291263	1	1	RICKS, MARVIN D DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SUITE 3	1601 MCHENRY VILLAGE WAY	None	MODESTO	CA	95350	4307	50	06099	37.66743	-120.9900555	Stanislaus County
151539	Fee-for-Service	1649492166	1649492166	1	1	RASILA, KANWALDEEP K MD	1/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54884	78	Neoplastic Diseases/Oncology	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
151567	Fee-for-Service	1134169535	1134169535	2	22	REACH AIR MEDICAL SERVICES L	1/9/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	17328 PARKVIEW DR	None	BROOKINGS	OR	97415	8132	00	None	42.074226	-124.288812	Curry County
151574	Fee-for-Service	1326096165	1326096165	1	2	REGENTS OF THE UNIVERSITY OF	11/2/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
151594	Fee-for-Service	1376737213	1376737213	1	1	REMMELE, PAUL M LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
151609	Fee-for-Service	1780694372	1780694372	1	1	ROCKINGHAM MEMORIAL HOSPITAL	4/13/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	235 CANTRELL AVE	None	HARRISONBURG	VA	22801	3248	00	None	38.44000835	-78.86927181	Harrisonburg city
151610	Fee-for-Service	1225101223	1225101223	1	1	ROBERTSON, JOANNE	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
151664	Fee-for-Service	1720088354	1720088354	1	1	RIDEOUT MEMORIAL HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	GROUP	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
151669	Fee-for-Service	1043788771	1043788771	1	1	RETTIG, AMBER K CRNA	12/4/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
151682	Fee-for-Service	1336346972	1336346972	1	1	RIVERA, TANIA L MD	7/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126958	83	Rheumatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
151712	Fee-for-Service	1851719280	1851719280	1	1	REGN, RACHEL MD	7/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156537	09	Gynecology (D.O. only)	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
151716	Fee-for-Service	1063707149	1063707149	1	1	RICHARDSON, KIMBERLY J MD	9/16/2022	207R00000X	NA	Other	026	PHYSICIANS	175490	None	None	0	In state provider	None	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
151721	Fee-for-Service	1306847504	1306847504	1	1	RODRIGUEZ, MIKE E MD	10/31/1988	174400000X	NA	Other	026	PHYSICIANS	64564	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
151749	Fee-for-Service	1508801572	1508801572	1	1	RAZO, SARAH B	12/9/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
151806	Fee-for-Service	1386154706	1386154706	1	1	ROMERO, CAROLINA LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH ST W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
151820	Fee-for-Service	1386238665	1386238665	1	1	RICHARD P CARR PHYSICAL THER	2/4/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	3441 ALMA ST	STE 200	PALO ALTO	CA	94306	3508	43	06085	37.41915029	-122.124806	Santa Clara County
151824	Fee-for-Service	1063933489	1063933489	1	1	RIVERA, DAISY LCSW	9/22/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
151843	Fee-for-Service	1548677438	1548677438	1	1	RILEY, JESSICA A DO	5/4/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	16345	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
151853	Fee-for-Service	1598776650	1598776650	1	1	ROSENBLATT, ADAM MD	7/1/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	31140	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 518	SAN FRANCISCO	CA	94115	2382	38	06075	37.7904826	-122.4324477	San Francisco County
151854	Fee-for-Service	1417421207	1417421207	1	1	RAMIREZ, LEAH	10/24/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
151859	Fee-for-Service	1326096165	1326096165	1	2	REGENTS OF THE UNIVERSITY OF	3/23/2020	163WG0100X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
151873	Fee-for-Service	1801801279	1801801279	2	3	RADPARVAR, MANSOOR	1/15/2020	174400000X	NA	Other	026	PHYSICIANS	50959	15	Obstetrics (D.O. only)	0	In state provider	None	1001 N TUSTIN AVE	None	TUSTIN	CA	92780	0000	30	06059	33.75363187	-117.8341886	Orange County
151880	Fee-for-Service	1831755339	1831755339	1	1	ROUTH, SHUVODRA MD	11/6/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
151881	Fee-for-Service	1225116130	1225116130	1	1	RAJPARA, SANJAY M MD	7/28/2011	207R00000X	NA	Other	026	PHYSICIANS	92588	41	Internal Medicine	0	In state provider	None	1940 EL CAJON BOULEVARD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
151908	Fee-for-Service	1639265325	1639265325	1	1	RICHARD, ALLISON J MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80281	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
151965	Fee-for-Service	1407127152	1407127152	1	1	REHABILITATION ORTHOPEDIC PH	11/22/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	YSICAL THERAPY INC.	5301 WHITTIER BLVD	ATRIUM SUITE	LOS ANGELES	CA	90022	4038	19	06037	34.02010603	-118.1557093	Los Angeles County
151987	Fee-for-Service	1407950702	1407950702	1	1	ROBERTSON ADULT DAY	8/8/2006	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE CENTER	369 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	0000	19	06037	34.06027047	-118.3836377	Los Angeles County
152000	Fee-for-Service	1487808879	1487808879	1	1	RESENDEZ-MOLAR, MARIBEL N LC	5/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
152013	Fee-for-Service	1477558872	1477558872	1	1	ROLFES, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PROSCAN RADIOLOGY	5400 KENNEDY AVE	None	CINCINNATI	OH	45213	0000	00	None	39.17088658	-84.41994184	Hamilton County
152032	Fee-for-Service	1023588373	1023588373	1	1	ROBERTSON, KERRI R RCP	2/19/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
152044	Fee-for-Service	1104084458	1104084458	1	1	REHMAN, SHAHID U MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105312	13	Neurology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
152070	Fee-for-Service	1073753687	1073753687	1	1	RODRIGUEZ, MOIRA R	10/19/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
152102	Fee-for-Service	1205802998	1205802998	1	1	REISENAUER,CHRIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 SOUTH MAIN	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
152146	Fee-for-Service	1326096165	1326096165	1	2	REGENTS OF THE UNIVERSITY OF	3/4/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
152153	Fee-for-Service	1306162425	1306162425	1	1	REFORMAT, DEBRA	6/3/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7795 ANTELOPE ROAD	APT 25	CITRUS HEIGHTS	CA	95610	2366	34	06067	38.706588	-121.2759765	Sacramento County
152160	Fee-for-Service	1184777468	1184777468	1	1	RAJURKAR, SWAPNIL P MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89510	78	Neoplastic Diseases/Oncology	0	In state provider	None	1910 ROYALTY DRIVE	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
152162	Fee-for-Service	1801801279	1801801279	2	3	RADPARVAR, MANSOOR	1/15/2020	174400000X	NA	Other	026	PHYSICIANS	50959	09	Gynecology (D.O. only)	0	In state provider	None	1001 N TUSTIN AVE	None	TUSTIN	CA	92780	0000	30	06059	33.75363187	-117.8341886	Orange County
152203	Fee-for-Service	1568904720	1568904720	1	1	RAMOS, REA S CCC-SLP	8/15/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4300 LONG BEACH BLVD	760	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
152231	Fee-for-Service	1053499665	1053499665	1	1	ROBB, MARK F MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42745	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
152301	Fee-for-Service	1053345991	1053345991	1	1	RAHIMIFAR, MAJID MD INC	4/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	79	Neurology-Child	0	In state provider	BAKERSFIELD NEUROSCIENCE	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
152330	Fee-for-Service	1932437993	1932437993	1	1	ROSE, GABRIEL DO	10/3/2019	207P00000X	NA	Other	026	PHYSICIANS	17539	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
152335	Fee-for-Service	1134169535	1134169535	2	35	REACH AIR MEDICAL SERVICES L	8/5/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LC.	2668 HUSTED RD	None	WILLIAMS	CA	95987	5105	06	06011	39.1631753	-122.1326467	Colusa County
152358	Fee-for-Service	1194832816	1194832816	1	1	RUIZ-VILLALPANDO,	5/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92039	08	Family Practice	0	In state provider	OCTAVIO MD	735 S D ST	None	PERRIS	CA	92570	2419	33	06065	33.77857232	-117.2288086	Riverside County
152367	Fee-for-Service	1851320063	1851320063	1	1	RECABAREN, JAMES A MD	4/30/1991	208600000X	NA	General Surgery	026	PHYSICIANS	41049	02	General Surgery	0	In state provider	None	50 BELLEFONTAINE ST	STE 301	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
152370	Fee-for-Service	1083269948	1083269948	1	1	RAMIREZ, JANN	12/14/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.25641704	-119.2199387	Ventura County
152383	Fee-for-Service	1528324563	1528324563	1	1	RAD, YASER M	11/1/2022	207L00000X	NA	Other	026	PHYSICIANS	175356	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
152389	Fee-for-Service	1457364663	1457364663	1	1	REYNOLDS, PETER M MD	9/30/1991	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	38434	20	Orthopedic Surgery	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
152407	Fee-for-Service	1740453208	1740453208	1	1	RUFINO M UYTINGCO, MD, A PRO	8/30/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FESSIONAL CORPORATION	1145 GEER RD	SUITE A	TURLOCK	CA	95380	3381	50	06099	37.503729	-120.848988	Stanislaus County
152441	Fee-for-Service	1306162425	1306162425	1	1	REFORMAT, DEBRA	6/3/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7795 ANTELOPE ROAD	APT 25	CITRUS HEIGHTS	CA	95610	2366	34	06067	38.706588	-121.2759765	Sacramento County
152450	Fee-for-Service	1184777468	1184777468	1	1	RAJURKAR, SWAPNIL P MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89510	41	Internal Medicine	0	In state provider	None	1910 ROYALTY DRIVE	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
152480	Fee-for-Service	1740492925	1740492925	1	1	ROTTKAMP, DANIELE M MD	12/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111506	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152532	Fee-for-Service	1629363445	1629363445	1	1	ROWE, RICHARD A LCSW	6/3/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3576 ARLINGTON AVE.	SUITE 307	RIVERSIDE	CA	92506	3943	33	06065	33.94625192	-117.3913739	Riverside County
152537	Fee-for-Service	1124071477	1124071477	1	1	RUPAREL, HARESH M	5/31/1988	207R00000X	NA	Other	026	PHYSICIANS	42479	41	Internal Medicine	0	In state provider	None	1625 THE ALAMEDA	STE 201	SAN JOSE	CA	95126	2223	43	06085	37.3357723	-121.9172682	Santa Clara County
152545	Fee-for-Service	1114364148	1114364148	1	1	ROBINETTE, KYLE S MD	8/5/2019	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	17089	04	Otology, Laryngology, Rhinology	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
152589	Fee-for-Service	1053345991	1053345991	1	1	RAHIMIFAR, MAJID MD INC	4/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	BAKERSFIELD NEUROSCIENCE	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
152614	Fee-for-Service	1144231010	1144231010	1	1	READ, MARY E MD	4/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	42	Nuclear Medicine	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
152645	Fee-for-Service	1740208362	1740208362	1	1	RAHBAR MEDICAL GROUP INC	12/13/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38265	10	Gastroenterology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 1804	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
152655	Fee-for-Service	1851320063	1851320063	1	1	RECABAREN, JAMES A MD	4/30/1991	208600000X	NA	General Surgery	026	PHYSICIANS	41049	78	Neoplastic Diseases/Oncology	0	In state provider	None	50 BELLEFONTAINE ST	STE 301	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
152803	Fee-for-Service	1184242562	1184242562	1	1	ROBLES, QUIRINO A LMFT	4/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1109 W SAN BERNARDINO RD	150	COVINA	CA	91722	4163	19	06037	34.0887369	-117.9124702	Los Angeles County
152816	Fee-for-Service	1871750851	1871750851	1	1	RICHARDSON, DEREK K MD	6/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125845	None	None	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
152836	Fee-for-Service	1114364148	1114364148	1	1	ROBINETTE, KYLE S MD	8/5/2019	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	17089	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
152867	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	2/20/2020	207P00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
152879	Fee-for-Service	1053345991	1053345991	1	1	RAHIMIFAR, MAJID MD INC	4/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	BAKERSFIELD NEUROSCIENCE	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
152912	Fee-for-Service	1457970527	1457970527	1	1	RYAN, SEAN N PT	7/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
152921	Fee-for-Service	1538357033	1538357033	1	1	ROGAWSKI, MICHAEL A MD	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88105	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
152935	Fee-for-Service	1740208362	1740208362	1	1	RAHBAR MEDICAL GROUP INC	12/13/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38265	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1804	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
153023	Fee-for-Service	1487617718	1487617718	1	1	RICHARDS, DINSDALE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	840 E MCKELLIPS RD	STE 101	MESA	AZ	85203	9654	00	None	33.451695	-111.812508	Maricopa County
153057	Fee-for-Service	1801895974	1801895974	1	1	ROBERTSON, DANIEL T MD	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	212 ELKS POINT RD	STE 200	ZEPHYR COVE	NV	89448	9800	00	None	38.98585115	-119.9417018	Douglas County
153059	Fee-for-Service	1467673327	1467673327	1	1	RUDA, JOSEPH F JR MD	5/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	32463	18	Ophthalmology	0	In state provider	A MEDICAL CORPORATION	31671 INDIAN GUIDE RD	None	SQUAW VALLEY	CA	93675	9676	10	06019	36.74305116	-119.2338484	Fresno County
153068	Fee-for-Service	1225145915	1225145915	1	1	ROBERTS, JEFFREY N MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70062	None	None	0	In state provider	None	1720 CESAR E CHAVEZ	#1514	LOS ANGELES	CA	90033	0000	19	06037	34.04925	-118.2177405	Los Angeles County
153076	Fee-for-Service	1912001942	1912001942	1	1	ROSSI, PETER W MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87320	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
153091	Fee-for-Service	1144355918	1144355918	1	1	RAGAVAN, NILIMA M MD	1/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45370	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
153100	Fee-for-Service	1003357237	1003357237	1	1	RAJAPAKSA, SUHANKI MD	12/28/2020	207R00000X	NA	Other	026	PHYSICIANS	169490	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
153104	Fee-for-Service	1922262898	1922262898	1	1	RUDOLPH, MELISSA A MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
153114	Fee-for-Service	1417970583	1417970583	1	1	ROACH, MICHAEL O MD	8/21/2018	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	32190	08	Family Practice	0	In state provider	None	15625 IMPERIAL HWY	None	LA MIRADA	CA	90638	1627	19	06037	33.91736145	-117.9981225	Los Angeles County
153118	Fee-for-Service	1255690129	1255690129	1	1	RABEDEAUX, PAUL F MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143820	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	SUITE 201	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
153158	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	7/8/2020	207P00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
153167	Fee-for-Service	1780423244	1780423244	1	1	REDDING RANCHERIA	6/13/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ADVANCED CARE	3305 PLACER ST	B	REDDING	CA	96001	2378	45	06089	40.57539992	-122.4150037	Shasta County
153242	Fee-for-Service	1629423926	1629423926	1	1	RAAD, KAREEM N MD	2/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192355	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
153254	Fee-for-Service	1417124918	1417124918	1	1	ROSATI, JAMES J LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
153263	Fee-for-Service	1356364277	1356364277	1	1	RED STAR MEDICAL SUPPLY	7/18/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ANEIAN, ANDRANIK	13439 OSBORNE ST	STE 8	ARLETA	CA	91331	4755	19	06037	34.24235409	-118.4257747	Los Angeles County
153270	Fee-for-Service	1083680896	1083680896	1	1	ROACH, JAMES J JR MD	9/20/1979	207RP1001X	NA	Pulmonology	026	PHYSICIANS	35197	41	Internal Medicine	0	In state provider	None	3808 W RIVERSIDE DR	# 40	BURBANK	CA	91505	4325	19	06037	34.15252315	-118.3412174	Los Angeles County
153271	Fee-for-Service	1144510439	1144510439	1	1	RAMEAU, ANAIS MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122505	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
153284	Fee-for-Service	1992113419	1992113419	1	1	ROSALES REPETTO, MARIA B CCC	6/5/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	-SLP	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
153331	Fee-for-Service	1568172484	1568172484	1	1	RANCHO DIALYSIS CENTER INC	6/21/2024	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7777 MILLIKEN AVENUE	STE 110	RANCHO CUCAMONGA	CA	91730	6781	36	06071	34.10843256	-117.5570865	San Bernardino County
153347	Fee-for-Service	1639550130	1639550130	1	1	ROUBACH, MAJID MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156790	18	Ophthalmology	0	In state provider	None	1899 W MARCH LANE	None	STOCKTON	CA	95207	6402	39	06077	37.9873599	-121.3290151	San Joaquin County
153369	Fee-for-Service	1932764503	1932764503	1	1	RIVERA, DYLAN V MD	8/16/2023	207L00000X	NA	Other	026	PHYSICIANS	180460	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
153381	Fee-for-Service	1144547977	1144547977	1	1	RADULESCU, ANDREI MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157673	85	Surgery-Pediatric	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
153392	Fee-for-Service	1427391366	1427391366	1	1	ROSARIO, JONATHAN J T DO	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13664	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
153404	Fee-for-Service	1508122813	1508122813	1	1	RODRIGUEZ, JOANA C LMFT	10/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
153406	Fee-for-Service	1417970583	1417970583	1	1	ROACH, MICHAEL O MD	8/21/2018	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	32190	41	Internal Medicine	0	In state provider	None	15625 IMPERIAL HWY	None	LA MIRADA	CA	90638	1627	19	06037	33.91736145	-117.9981225	Los Angeles County
153421	Fee-for-Service	1013140276	1013140276	1	1	RAMONA SPECIALISTS INC	10/12/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44586	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
153436	Fee-for-Service	1770614992	1770614992	1	1	RUCKER, CASEY J MD	6/14/2016	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON RD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
153437	Fee-for-Service	1477050979	1477050979	1	1	REMER, JUSTIN MD	7/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182421	30	Radiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
153445	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	8/1/2023	207P00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
153457	Fee-for-Service	1780423244	1780423244	1	1	REDDING RANCHERIA	6/13/2024	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	ADVANCED CARE	3305 PLACER ST	B	REDDING	CA	96001	2378	45	06089	40.57539992	-122.4150037	Shasta County
153460	Fee-for-Service	1093893901	1093893901	1	1	ROHIRA, SUNIL K MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50888	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
153475	Fee-for-Service	1336262906	1336262906	1	1	RUBIN, JACOB N MD FACC	6/19/2007	193400000X	NA	Other	026	PHYSICIANS	53079	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
153494	Fee-for-Service	1700084381	1700084381	1	1	RUSSO, MICHAEL A MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125016	02	General Surgery	0	In state provider	None	18111 BROOKHURST ST	STE 5600	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
153544	Fee-for-Service	1912347956	1912347956	1	1	RED HEARTS HOSPICE INC	3/15/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	236 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	1738	19	06037	34.03394315	-118.151738	Los Angeles County
153562	Fee-for-Service	1467605014	1467605014	1	1	RACHAKONDA, AJAY K	2/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127675	None	None	0	In state provider	None	202 W WILLOW ST	STE 302	VISALIA	CA	93291	6238	54	06107	36.3283683	-119.29356	Tulare County
153578	Fee-for-Service	1295770287	1295770287	1	1	RIZVI, SYED MD	12/1/2003	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51073	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4850 COMMERCE DR	STE 100	BAKERSFIELD	CA	93309	0416	15	06029	35.3701588	-119.0556274	Kern County
153618	Fee-for-Service	1912084211	1912084211	2	1	RICCI, MICHAEL J MD	1/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	22485	08	Family Practice	0	In state provider	None	774 EAST AVE	None	CHICO	CA	95926	1253	04	06007	39.76083228	-121.8475127	Butte County
153634	Fee-for-Service	1790708220	1790708220	1	1	RIOS, KATHRYN E MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79251	01	General Practice	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
153711	Fee-for-Service	1013140276	1013140276	1	1	RAMONA SPECIALISTS INC	10/12/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44586	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
153716	Fee-for-Service	1235429739	1235429739	1	1	RIBAS, MABEL R LMFT	3/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	78060 CALLE ESTADO	None	LA QUINTA	CA	92253	3635	33	06065	33.67599507	-116.303034	Riverside County
153735	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	11/9/2020	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
153763	Fee-for-Service	1336262906	1336262906	1	1	RUBIN, JACOB N MD FACC	6/19/2007	193400000X	NA	Other	026	PHYSICIANS	53079	01	General Practice	0	In state provider	INC	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
153806	Fee-for-Service	1104997170	1104997170	1	1	ROY, MONA MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72526	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
153815	Fee-for-Service	1386680387	1386680387	1	1	RON ZUIDERWEG D.O	4/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6622 N 91ST AVE	STE 200	GLENDALE	AZ	85305	2569	00	None	33.532551	-112.2557625	Maricopa County
153833	Fee-for-Service	1912347956	1912347956	1	1	RED HEARTS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	236 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	1738	19	06037	34.03394315	-118.151738	Los Angeles County
153856	Fee-for-Service	1932241742	1932241742	1	1	RYAN RAHHAL	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6767 S YALE AVE	STE A	TULSA	OK	74136	3302	00	None	36.0648	-95.92204453	Tulsa County
153860	Fee-for-Service	1922021989	1922021989	1	1	ROSENCRANTZ, MARCUS A MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87746	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153898	Fee-for-Service	1265401178	1265401178	1	1	ROY, TAPASHI D MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53568	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
153985	Fee-for-Service	1427190735	1427190735	1	1	ROSNER, JEANNE L MD	2/1/1995	207LP3000X	NA	Other	026	PHYSICIANS	80180	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
154023	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	2/10/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
154098	Fee-for-Service	1063814861	1063814861	1	1	RANGARAJAN, SRIRAM S MD	11/9/2022	208600000X	NA	General Surgery	026	PHYSICIANS	142567	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
154111	Fee-for-Service	1134283179	1134283179	1	1	RIPON CONSOLIDATED FIRE	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DISTRICT AMB SERVICE	142 S STOCKTON AVE	None	RIPON	CA	95366	2759	39	06077	37.73854163	-121.1239231	San Joaquin County
154130	Fee-for-Service	1053687004	1053687004	1	1	RAMESH, SATHYADEEPAK MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142976	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
154142	Fee-for-Service	1417144049	1417144049	1	1	RIVERA, FRAIN S MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100839	05	Anesthesiology	0	In state provider	None	2105 FOREST AVENUE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
154153	Fee-for-Service	1477546430	1477546430	1	1	REGENTS/UCDPBG/PED ENDOC	5/1/1983	2080P0205X	NA	Endocrinology	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
154161	Fee-for-Service	1215228762	1215228762	1	1	ROSS, OLIVER E MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123913	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
154182	Fee-for-Service	1932347176	1932347176	1	1	RAJABALI, FRENYAL OT	4/26/2020	364SH0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
154210	Fee-for-Service	1760481006	1760481006	1	1	RIMOLOI, REYNOLD L MD	4/30/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	600 S RANCHO DR	STE 113	LAS VEGAS	NV	89106	4806	00	None	36.16385627	-115.1727818	Clark County
154224	Fee-for-Service	1821176595	1821176595	1	1	ROQUE, HENRY M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63722	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
154253	Fee-for-Service	1295780823	1295780823	1	1	RAUCH, LOREN C MD	3/1/1998	207P00000X	NA	Other	026	PHYSICIANS	55359	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
154254	Fee-for-Service	1427240860	1427240860	1	1	ROSS, GILBERT N MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19408	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA	SUITE 518	BURBANK	CA	91505	4817	19	06037	34.1577056	-118.329779	Los Angeles County
154278	Fee-for-Service	1316967185	1316967185	1	1	REFFIGIE, LESTER G MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85477	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
154307	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	3/5/2020	207P00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
154316	Fee-for-Service	1134169535	1134169535	2	26	REACH AIR MEDICAL SERVICES L	2/7/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10034 MISSILE WAY	None	MATHER	CA	95655	4002	34	06067	38.555739	-121.313709	Sacramento County
154317	Fee-for-Service	1518360627	1518360627	1	1	RAWLINGS, SONIKA	10/16/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16658 COUNTRY RANCH CT	None	VICTORVILLE	CA	92395	9569	36	06071	34.48135741	-117.3002904	San Bernardino County
154325	Fee-for-Service	1235649260	1235649260	1	3	RENEWING HOPE FAMILY COUNSEL	6/22/2021	104100000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ING CENTER, INC.	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
154406	Fee-for-Service	1376725630	1376725630	1	1	RUFFY, MAURO B MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80193	04	Otology, Laryngology, Rhinology	0	In state provider	None	625 LINCOLN AVENUE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
154481	Fee-for-Service	1790207793	1790207793	1	1	RHYMES-DANIELSON, SHAWNA A	1/27/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
154491	Fee-for-Service	1679572531	1679572531	1	1	RAYMOND G PIEDMONTE	4/2/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 E MAIN ST	None	DANVILLE	IN	46122	1948	00	None	39.762423	-86.501997	Hendricks County
154541	Fee-for-Service	1225258965	1225258965	1	1	REGENASS, HEIDI MD	1/26/2021	2086H0002X	NA	General Surgery	026	PHYSICIANS	165083	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
154578	Fee-for-Service	1255520151	1255520151	1	1	REX, DAVID E MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101776	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
154584	Fee-for-Service	1548797749	1548797749	1	1	REISER, HANNAH C MD	6/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171880	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
154597	Fee-for-Service	1447253125	1447253125	1	6	RIDGECREST REGIONAL HOSPITAL	1/28/2020	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
154600	Fee-for-Service	1750582748	1750582748	1	1	ROEDELL, JULIE T NP	11/8/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
154603	Fee-for-Service	1518360627	1518360627	1	1	RAWLINGS, SONIKA	10/16/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16658 COUNTRY RANCH CT	None	VICTORVILLE	CA	92395	9569	36	06071	34.48135741	-117.3002904	San Bernardino County
154606	Fee-for-Service	1679145700	1679145700	1	1	RIOUX, PAULINE N CRNA	9/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
154613	Fee-for-Service	1235649260	1235649260	1	3	RENEWING HOPE FAMILY COUNSEL	7/10/2020	104100000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
154625	Fee-for-Service	1083991087	1083991087	1	1	RANGAPPA, SUNIL MD INC	5/16/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	93249	41	Internal Medicine	0	In state provider	None	800 S MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
154641	Fee-for-Service	1477012292	1477012292	1	1	RJ IMAGING INC	7/25/2023	261QR0207X	NA	Other	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	24355 LYONS AVE	SUITE 230	SANTA CLARITA	CA	91321	2300	19	06037	34.37868281	-118.5605291	Los Angeles County
154649	Fee-for-Service	1952750739	1952750739	1	1	RO, TAE MD	6/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172366	None	None	0	In state provider	None	1444 FLORIDA AVE	STE 101	MODESTO	CA	95350	4400	50	06099	37.66487562	-120.9961927	Stanislaus County
154676	Fee-for-Service	1326107053	1326107053	1	1	RUBIO, RENEE L CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5620 MESMER AVENUE	None	CULVER CITY	CA	90230	6315	19	06037	33.98561217	-118.4005283	Los Angeles County
154708	Fee-for-Service	1972600880	1972600880	1	1	RODRIGUEZCOLOME, M E MD	3/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33652	41	Internal Medicine	0	In state provider	None	5836 E BEVERLY BLVD	None	LOS ANGELES	CA	90022	2824	19	06037	34.02566641	-118.1429993	Los Angeles County
154750	Fee-for-Service	1306875778	1306875778	1	1	RATCLIFFE, MARK MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77336	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
154821	Fee-for-Service	1003916016	1003916016	1	1	RODI, INGRID A MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	43042	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
154836	Fee-for-Service	1174122436	1174122436	1	2	RICHARD LIN DO INC	1/12/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	14642 NEWPORT AVE	SUITE 105	TUSTIN	CA	92780	6058	30	06059	33.73082212	-117.8293987	Orange County
154844	Fee-for-Service	1942579545	1942579545	1	1	READY, ALISHA LCSW	12/12/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERVICES	6 GOVERNORS LN	A	CHICO	CA	95926	5590	04	06007	39.75531581	-121.8582802	Butte County
154853	Fee-for-Service	1801230297	1801230297	1	1	ROJAS, STEVEN M MD	9/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132982	01	General Practice	0	In state provider	None	3177 OCEANVIEW BLVD	None	SAN DIEGO	CA	92113	1432	37	06073	32.7011883	-117.1261025	San Diego County
154873	Fee-for-Service	1316657836	1316657836	1	1	RENE LEE MEDICAL INC	7/31/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8235 ROCHESTER AVE	#120	RANCHO CUCAMONGA	CA	91730	0718	36	06071	34.103952	-117.5456935	San Bernardino County
154900	Fee-for-Service	1235649260	1235649260	1	3	RENEWING HOPE FAMILY COUNSEL	12/27/2021	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
154912	Fee-for-Service	1083991087	1083991087	1	1	RANGAPPA, SUNIL MD INC	5/16/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	93249	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	800 S MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
154914	Fee-for-Service	1790473163	1790473163	1	1	ROSE, LAURA CNP	7/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3231 WARING CT	SUITE K	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
154990	Fee-for-Service	1649322140	1649322140	1	1	REZAK, ZEBA R LMFT	5/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
155004	Fee-for-Service	1477024354	1477024354	1	1	RIVAS, MONICA L RCP	10/21/2022	2279C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
155027	Fee-for-Service	1326579707	1326579707	1	1	RAMASWAMY, TARA S MD	6/19/2023	207L00000X	NA	Other	026	PHYSICIANS	156922	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155075	Fee-for-Service	1669056107	1669056107	1	1	REYNA, ROBERTO MD	9/23/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
155127	Fee-for-Service	1174122436	1174122436	1	2	RICHARD LIN DO INC	11/30/2021	207XS0117X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	14642 NEWPORT AVE	SUITE 105	TUSTIN	CA	92780	6058	30	06059	33.73082212	-117.8293987	Orange County
155140	Fee-for-Service	1528028933	1528028933	1	1	RHEE, JAMES W MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108533	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
155143	Fee-for-Service	1285011064	1285011064	1	1	REUTER, BRIAN A MD	8/15/2018	207P00000X	NA	Other	026	PHYSICIANS	150940	None	None	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
155188	Fee-for-Service	1235649260	1235649260	1	3	RENEWING HOPE FAMILY COUNSEL	5/24/2021	104100000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
155202	Fee-for-Service	1417197195	1417197195	1	1	ROUTT DIALYSIS, LLC	1/21/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	10085 DOUBLE R BLVD	STE 160	RENO	NV	89521	4867	00	None	39.43674155	-119.758584	Washoe County
155223	Fee-for-Service	1396207486	1396207486	1	1	RYAN, EMILY E MD	7/8/2022	207ZP0101X	NA	Other	026	PHYSICIANS	177854	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155242	Fee-for-Service	1386838423	1386838423	1	1	ROBLES, THY L LCSW	5/23/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
155262	Fee-for-Service	1306109657	1306109657	1	1	RAJPUT, PALLAVI MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132925	36	Psychiatry	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
155271	Fee-for-Service	1760641013	1760641013	1	1	RAY, INDRANEIL MD	11/3/2009	207R00000X	NA	Other	026	PHYSICIANS	103487	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
155273	Fee-for-Service	1154609311	1154609311	1	1	ROSA, ELAINE CP	11/19/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
155298	Fee-for-Service	1992965131	1992965131	1	1	RABBANI, SHAWN S DPM INC	2/3/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	18909 SHERMAN WAY	SUITE B	RESEDA	CA	91335	0000	19	06037	34.20119347	-118.5451065	Los Angeles County
155328	Fee-for-Service	1386230944	1386230944	1	1	REHMAN CARE CORPORATION	4/13/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1236 D ST	None	RAMONA	CA	92065	2750	37	06073	33.03871387	-116.8721937	San Diego County
155330	Fee-for-Service	1689781361	1689781361	1	1	RANDHAWA, RAWEL S MD	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	45944	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
155350	Fee-for-Service	1790834687	1790834687	1	1	ROWE, KATHERINE J NP	11/4/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	20790 MADRONA AVE	None	TORRANCE	CA	90503	3777	19	06037	33.84145481	-118.344603	Los Angeles County
155354	Fee-for-Service	1013027770	1013027770	1	1	RALEY'S	1/9/1980	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 RALEY'S TOWN CENTER	None	ROHNERT PARK	CA	94928	2440	49	06097	38.346707	-122.7069984	Sonoma County
155367	Fee-for-Service	1861417412	1861417412	1	1	ROWLAND, JON M MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64565	22	Pathology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
155372	Fee-for-Service	1528074457	1528074457	1	1	ROBERTSON, ERIC K	11/10/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	BLDG A	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
155412	Fee-for-Service	1023126869	1023126869	2	1	RO, KYUNG K MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51432	05	Anesthesiology	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
155416	Fee-for-Service	1184848087	1184848087	1	1	REMINAJES, ALFEO V MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81031	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
155417	Fee-for-Service	1316405574	1316405574	1	1	RUIZ INIGUEZ, NORMA NP	1/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
155427	Fee-for-Service	1669170882	1669170882	1	1	RISING TIDE REFERENCE LABORA	2/26/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	TORY	495 N US HWY 17 92	UNIT 101	LONGWOOD	FL	32750	4487	00	None	28.704051	-81.325512	Seminole County
155483	Fee-for-Service	1871048454	1871048454	1	1	RINGLE, DAN CRNA	9/8/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
155492	Fee-for-Service	1013167196	1013167196	1	1	RAMOS, FREDERICK E L MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134587	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
155552	Fee-for-Service	1952925588	1952925588	1	1	RAMAYANAM, SNEHAMAYI MD	7/12/2023	208M00000X	NA	Other	026	PHYSICIANS	184840	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
155566	Fee-for-Service	1205129434	1205129434	1	1	RASTROLLO, JOSEPH S MD A	6/27/2011	193400000X	NA	Other	026	PHYSICIANS	33366	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
155570	Fee-for-Service	1780819128	1780819128	1	1	ROMERO, JULIE A MD	10/1/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158179	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 CALIFORNIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
155619	Fee-for-Service	1689781361	1689781361	1	1	RANDHAWA, RAWEL S MD	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	45944	10	Gastroenterology (M.D. only)	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
155682	Fee-for-Service	1306080577	1306080577	1	1	RICO, CLAUDIA MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115906	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
155741	Fee-for-Service	1104236157	1104236157	1	1	RATHI, POOJA DO	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15489	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
155748	Fee-for-Service	1700263159	1700263159	1	1	RODRIGUEZ, MAITI C MD	2/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152657	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
155758	Fee-for-Service	1215005491	1215005491	1	1	RUDEK, GAY L MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62965	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
155779	Fee-for-Service	1013167196	1013167196	1	1	RAMOS, FREDERICK E L MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134587	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
155788	Fee-for-Service	1932197241	1932197241	1	1	RUSSELL, JAMES L.MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	LITTLE ROCK	AR	72211	4393	00	None	0	0	None
155795	Fee-for-Service	1780078006	1780078006	1	1	REVIVE HOME HEALTH CARE, INC	8/31/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1918 W MAGNOLIA BLVD	SUITE 200	BURBANK	CA	91506	1745	19	06037	34.17375333	-118.3294159	Los Angeles County
155851	Fee-for-Service	1548286511	1548286511	1	2	RICH, WILLIAM M MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	28911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6323 N FRESNO ST	STE 105	FRESNO	CA	93710	5282	10	06019	36.82867612	-119.7814182	Fresno County
155858	Fee-for-Service	1780819128	1780819128	1	1	ROMERO, JULIE A MD	10/1/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158179	09	Gynecology (D.O. only)	0	In state provider	None	3700 CALIFORNIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
155861	Fee-for-Service	1407906456	1407906456	1	1	ROSENBERG, JEFFREY L MD	3/18/2015	174400000X	NA	Other	026	PHYSICIANS	43325	01	General Practice	0	In state provider	None	1245 WILSHIRE BLVD	STE 316	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
155876	Fee-for-Service	1730359431	1730359431	1	1	RASKIN, ELIZABETH R MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136552	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
155878	Fee-for-Service	1740691112	1740691112	1	1	RAJOULH, ADAM A MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146131	01	General Practice	0	In state provider	None	1301 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83703048	-119.7647364	Fresno County
155898	Fee-for-Service	1386624609	1386624609	1	1	ROTHMAN, VAAL P MD	1/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55553	41	Internal Medicine	0	In state provider	None	223 MOUNT HERMON RD	None	SCOTTS VALLEY	CA	95066	4086	44	06087	37.04468857	-122.02669	Santa Cruz County
155917	Fee-for-Service	1548539463	1548539463	1	1	RELYABLE HOSPICE CARE INC	7/23/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16200 VENTURA BLVD	SUITE 302	ENCINO	CA	91436	2205	19	06037	34.15659457	-118.485532	Los Angeles County
155931	Fee-for-Service	1598726424	1598726424	1	1	RASMUSSEN, TRENT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	950 S 500 W LBBY	None	BRIGHAM CITY	UT	84302	3090	00	None	41.49156616	-112.0242085	Box Elder County
155953	Fee-for-Service	1134232010	1134232010	1	1	RITCHIE, DAVID K MD	9/22/2008	207R00000X	NA	Other	026	PHYSICIANS	87368	41	Internal Medicine	0	In state provider	None	10051 LAKE BLVD	STE 4	TRUCKEE	CA	96161	4870	29	06057	39.32550268	-120.2025066	Nevada County
155957	Fee-for-Service	1487915989	1487915989	1	1	RODRIGUES, KENNETH S MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131533	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
156013	Fee-for-Service	1851455893	1851455893	1	1	RITTENBERG, STEVEN W MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	180246	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
156031	Fee-for-Service	1346297819	1346297819	1	1	RUPAREL, JYOTIRBALA N MD	6/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54356	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
156043	Fee-for-Service	1659451268	1659451268	1	1	RAJARAM, CHALAT P MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45371	41	Internal Medicine	0	In state provider	None	623 W DUARTE RD	STE 2	ARCADIA	CA	91007	7336	19	06037	34.12648672	-118.0522757	Los Angeles County
156044	Fee-for-Service	1316937717	1316937717	1	1	RYU, ROBERT K W MD	5/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
156049	Fee-for-Service	1578152047	1578152047	1	1	RANDHAWA, JASMEEN PT	11/8/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 E BULLARD AVE	102	FRESNO	CA	93710	5866	10	06019	36.82318621	-119.7562623	Fresno County
156052	Fee-for-Service	1891282141	1891282141	1	1	ROSS, KATHERINE G OD	11/8/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
156069	Fee-for-Service	1811540909	1811540909	1	1	REVOLUTION PSYCHOTHERAPY, A	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY AND MARRIAGE TH	305 MATILIJA ST	201F	OJAI	CA	93023	2768	56	06111	34.44881178	-119.2440669	Ventura County
156074	Fee-for-Service	1396961249	1396961249	1	1	RAJAN, SUDHIR S MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85191	None	None	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
156093	Fee-for-Service	1730180415	1730180415	1	4	RIVERSIDE MEDICAL CLINIC	9/12/2017	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
156148	Fee-for-Service	1780819128	1780819128	1	1	ROMERO, JULIE A MD	10/1/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158179	15	Obstetrics (D.O. only)	0	In state provider	None	3700 CALIFORNIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
156169	Fee-for-Service	1093821324	1093821324	1	1	RITCHER, DEANN R LMFT	6/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E YORBA LINDA BLVD	2-D	PLACENTIA	CA	92870	3006	30	06059	33.88937165	-117.8544856	Orange County
156200	Fee-for-Service	1275196800	1275196800	1	1	RAGAM, RADHIKA MD	11/20/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
156203	Fee-for-Service	1316345580	1316345580	1	1	ROBINETT, MARK I MFT	1/22/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5028 GEARY BLVD	None	SAN FRANCISCO	CA	94118	2814	38	06075	37.78069672	-122.473373	San Francisco County
156204	Fee-for-Service	1548539463	1548539463	1	1	RELYABLE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16200 VENTURA BLVD	SUITE 302	ENCINO	CA	91436	2205	19	06037	34.15659457	-118.485532	Los Angeles County
156249	Fee-for-Service	1528175452	1528175452	2	1	ROLLINS, DONALD	9/29/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	591 W CHANNEL ISLANDS BL	None	PORT HUENEME	CA	93041	2136	56	06111	34.1760993	-119.2154966	Ventura County
156259	Fee-for-Service	1609869627	1609869627	1	1	REGENTS/UCDPBG/SUR CARDI	5/1/1985	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
156261	Fee-for-Service	1538197660	1538197660	1	1	RICHMAN, MARK J MD	1/1/1995	207L00000X	NA	Other	026	PHYSICIANS	36856	05	Anesthesiology	0	In state provider	None	2807 LOMA VISTA RD	STE 103	VENTURA	CA	93003	1563	56	06111	34.27530458	-119.2583104	Ventura County
156272	Fee-for-Service	1063508273	1063508273	1	1	ROED, CHRISTINE M MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68518	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
156273	Fee-for-Service	1598013013	1598013013	1	1	RUIZ, DAVID MD	8/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	126579	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
156298	Fee-for-Service	1235429739	1235429739	1	2	RIBAS, MABEL R LMFT	1/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4590 MACARTHUR BLVD	500	NEWPORT BEACH	CA	92660	2030	30	06059	33.66853079	-117.8643923	Orange County
156332	Fee-for-Service	1659451268	1659451268	1	1	RAJARAM, CHALAT P MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45371	38	Geriatrics	0	In state provider	None	623 W DUARTE RD	STE 2	ARCADIA	CA	91007	7336	19	06037	34.12648672	-118.0522757	Los Angeles County
156333	Fee-for-Service	1770615270	1770615270	1	1	RYE, MARVIN C	10/22/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3995 N FRESNO ST	STE 108	FRESNO	CA	93726	4031	10	06019	36.7901137	-119.7816283	Fresno County
156362	Fee-for-Service	1992071237	1992071237	1	1	ROSITO, OLGA PHD	9/9/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
156368	Fee-for-Service	1427207497	1427207497	1	1	RITTENBACH, TRENNDA L OD	4/2/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	323 N MALTHILDA AVE	None	SUNNYVALE	CA	94085	4207	43	06085	37.38565917	-122.0317807	Santa Clara County
156371	Fee-for-Service	1548839145	1548839145	1	1	RAYNES, REUBEN JAY B OT	7/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5337 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	2807	15	06029	35.36721148	-119.0622416	Kern County
156380	Fee-for-Service	1730180415	1730180415	1	4	RIVERSIDE MEDICAL CLINIC	9/11/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
156437	Fee-for-Service	1003295544	1003295544	1	1	ROLDAN, OSCAR A MD	11/20/2019	390200000X	NA	Other	026	PHYSICIANS	162242	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
156460	Fee-for-Service	1902962830	1902962830	1	1	ROBERT VANHARE MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1036 116TH AVE NE	None	BELLEVUE	WA	98004	4603	00	None	47.6201424	-122.1855845	King County
156485	Fee-for-Service	1376563445	1376563445	1	1	REHDER, PAUL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28511	40	Pediatrics	0	In state provider	None	1150 N VENTURA RD	None	OXNARD	CA	93030	3837	56	06111	34.21334043	-119.1944	Ventura County
156500	Fee-for-Service	1912085093	1912085093	1	1	RAHN, MARK A MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61824	05	Anesthesiology	0	In state provider	None	2299 BACON ST	None	CONCORD	CA	94520	2050	07	06013	37.98199042	-122.0349518	Contra Costa County
156550	Fee-for-Service	1609194497	1609194497	1	3	REGENTS OF THE UNIVERSITY OF	2/1/2019	207V00000X	NA	Obstetrics & Gynecology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1801 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
156555	Fee-for-Service	1184325169	1184325169	1	1	RODRIGUEZ, CHERYL RCP	4/28/2023	2279P1005X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
156586	Fee-for-Service	1750464210	1750464210	1	1	RONGKAVILIT, ARADA MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107329	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
156587	Fee-for-Service	1134169535	1134169535	2	4	REACH AIR MEDICAL SERVICES L	11/30/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2360 BECKER BLVD	None	SANTA ROSA	CA	95403	1055	49	06097	38.5067719	-122.8041998	Sonoma County
156592	Fee-for-Service	1346212909	1346212909	1	1	ROBINSON, ALLISON J MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133061	02	General Surgery	0	In state provider	None	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
156644	Fee-for-Service	1134169535	1134169535	2	30	REACH AIR MEDICAL SERVICES L	12/2/2015	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1180 AIRPORT WAY	None	NORTH BEND	OR	97489	2063	00	None	43.4160524	-124.2474711	Coos County
156651	Fee-for-Service	1952008906	1952008906	1	1	RU, XIN NP	11/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
156669	Fee-for-Service	1730180415	1730180415	1	4	RIVERSIDE MEDICAL CLINIC	1/16/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
156708	Fee-for-Service	1033798194	1033798194	1	1	ROTH, THEODORE L MD	4/24/2024	207ZP0101X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
156756	Fee-for-Service	1861916959	1861916959	1	2	RABBANI, TIFFANY LCSW	10/29/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
156760	Fee-for-Service	1679897136	1679897136	1	1	ROHRER, AARON P LCSW	7/9/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1035 MARKET STREET	SUITE 400	SAN FRANCISCO	CA	94103	1665	38	06075	37.78152549	-122.4111668	San Francisco County
156781	Fee-for-Service	1629204235	1629204235	1	1	RHOADS-LARKIN, JENNIFER J DO	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
156816	Fee-for-Service	1447335880	1447335880	1	1	RODGERS, JAMES L MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	45469	41	Internal Medicine	0	In state provider	None	15725 EAST WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
156821	Fee-for-Service	1710924097	1710924097	1	1	RASSOULI, MOHAMMAD E MD SC	3/7/2014	2084N0400X	NA	Neurology	026	PHYSICIANS	50587	13	Neurology (M.D. only)	0	In state provider	None	23961 CALLE DE LA MAGDAL	SUITE 426	LAGUNA HILLS	CA	92653	3685	30	06059	33.60999658	-117.7126577	Orange County
156838	Fee-for-Service	1609194497	1609194497	1	3	REGENTS OF THE UNIVERSITY OF	2/4/2013	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1801 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
156902	Fee-for-Service	1538557459	1538557459	1	1	RICKETTS, CAROLYN B LCSW	4/3/2015	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17230 EHLE STREET	None	CASTRO VALLEY	CA	94546	3820	01	06001	37.69312003	-122.1003295	Alameda County
156907	Fee-for-Service	1962060426	1962060426	1	1	RAY, JOSEPH R MD	7/17/2022	207P00000X	NA	Other	026	PHYSICIANS	179902	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
156915	Fee-for-Service	1750466876	1750466876	1	2	RHODEN, SANDRA MD	10/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	45766	30	Radiology	0	In state provider	None	29101 HOSPITAL RD.	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
156950	Fee-for-Service	1619087376	1619087376	1	1	RALEYS	12/1/2002	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4650 NATOMAS BLVD	None	SACRAMENTO	CA	95835	1217	34	06067	38.657367	-121.5099945	Sacramento County
156957	Fee-for-Service	1730180415	1730180415	1	4	RIVERSIDE MEDICAL CLINIC	12/21/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
157028	Fee-for-Service	1841079639	1841079639	1	1	ROBERTS, DENISE ADRIANE	3/11/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1384 ROADRUNNER DRIVE	None	CORONA	CA	92881	0709	33	06065	33.82891733	-117.5515035	Riverside County
157034	Fee-for-Service	1811311863	1811311863	1	1	RIGHT CHOICE HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17728 MAGNOLIA AVENUE	SUITE A	RIVERSIDE	CA	92503	0200	33	06065	33.92026595	-117.4465724	Riverside County
157095	Fee-for-Service	1134621923	1134621923	1	1	RIVERSIDE-SAN BERNARDINO	7/13/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	170 YUCCA AVENUE	None	BARSTOW	CA	92311	3231	36	06071	34.89744949	-117.0060062	San Bernardino County
157121	Fee-for-Service	1023560604	1023560604	1	1	RAPID CARE ENTERPRISES, INC	6/6/2017	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	126 AVOCADO AVE	102	PERRIS	CA	92571	2605	33	06065	33.8102395	-117.2244465	Riverside County
157245	Fee-for-Service	1730180415	1730180415	1	4	RIVERSIDE MEDICAL CLINIC	4/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
157247	Fee-for-Service	1851317416	1851317416	1	1	RAHIM, SHAMILA MD	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91075	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
157261	Fee-for-Service	1962667444	1962667444	1	1	RANGEL, DEISY F LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
157262	Fee-for-Service	1730670811	1730670811	1	1	RADA, REBECCA C DO	5/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18832	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
157279	Fee-for-Service	1538508379	1538508379	1	1	ROCCO, NICHOLAS MD	12/15/2023	208800000X	NA	Other	026	PHYSICIANS	132753	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
157288	Fee-for-Service	1871731513	1871731513	1	1	REDOBLADO, SHERYL S LCSW	8/2/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
157315	Fee-for-Service	1841079639	1841079639	1	1	ROBERTS, DENISE ADRIANE	3/11/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1384 ROADRUNNER DRIVE	None	CORONA	CA	92881	0709	33	06065	33.82891733	-117.5515035	Riverside County
157322	Fee-for-Service	1811311863	1811311863	1	1	RIGHT CHOICE HOSPICE CARE	9/4/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17728 MAGNOLIA AVENUE	SUITE A	RIVERSIDE	CA	92503	0200	33	06065	33.92026595	-117.4465724	Riverside County
157329	Fee-for-Service	1770711277	1770711277	1	1	RAFII, BENJAMIN MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130854	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
157342	Fee-for-Service	1376624346	1376624346	1	1	ROPOHL OSORIO, JANNA B	12/27/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94513	08	Family Practice	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
157382	Fee-for-Service	1134621923	1134621923	1	1	RIVERSIDE-SAN BERNARDINO	7/13/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	170 YUCCA AVENUE	None	BARSTOW	CA	92311	3231	36	06071	34.89744949	-117.0060062	San Bernardino County
157409	Fee-for-Service	1265897029	1265897029	1	2	REDWOOD COMMUNITY SERVICES	7/23/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	THERING EXPERIENCES-H.O.	675 FIRST STREET	None	UPPER LAKE	CA	95485	9586	17	06033	39.16426454	-122.903172	Lake County
157419	Fee-for-Service	1093269573	1093269573	1	1	ROBINSON, SEAN A	11/7/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
157423	Fee-for-Service	1699061754	1699061754	1	2	RUSSO, RACHEL M MD	5/7/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	125680	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
157434	Fee-for-Service	1255471868	1255471868	2	1	R & R CLINICAL & MEDICA	9/16/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CLINICA MEDICA NUESTRA	1403 N FAIR OAKS AVE	STE 3	PASADENA	CA	91103	1876	19	06037	34.16990886	-118.1507201	Los Angeles County
157456	Fee-for-Service	1730384967	1730384967	1	1	RAMSEY, BARBARA L LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
157471	Fee-for-Service	1578328084	1578328084	1	1	RAFAELIAN, ANNA	2/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	500 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2813	19	06037	34.15937082	-118.2644042	Los Angeles County
157488	Fee-for-Service	1508968967	1508968967	1	1	REGENTS OF THE UNIVERSITY OF	10/12/2017	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
157495	Fee-for-Service	1174650394	1174650394	1	1	RSCR CALIFORNIA, INC	8/18/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	412 N GRAND AVE	None	GLENDORA	CA	91741	2413	19	06037	34.14190019	-117.8724732	Los Angeles County
157511	Fee-for-Service	1316995434	1316995434	1	1	RAROQUE, JENNIFER C MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
157515	Fee-for-Service	1427343912	1427343912	1	1	RHODES, JESSICA D MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144933	01	General Practice	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
157530	Fee-for-Service	1093876633	1093876633	1	1	RITVO, PHYLLIS F LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
157541	Fee-for-Service	1679695944	1679695944	1	1	REYES, MARISSA E MD	2/11/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100508	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
157559	Fee-for-Service	1730682394	1730682394	1	11	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
157582	Fee-for-Service	1124533427	1124533427	1	1	ROSAS, JESSICA LMFT	6/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
157605	Fee-for-Service	1679773873	1679773873	1	1	REICHERT, SONIA E MD	10/30/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	126468	68	Hematology	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
157613	Fee-for-Service	1780609958	1780609958	1	1	ROY W ZIMMER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3819 STEPHENS AVE	STE 200	MISSOULA	MT	59801	8522	00	None	46.835955	-114.0137955	Missoula County
157645	Fee-for-Service	1760721443	1760721443	1	1	RAYHANABAD, BRIAN MD	4/9/2021	207R00000X	NA	Other	026	PHYSICIANS	121751	None	None	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
157653	Fee-for-Service	1477737930	1477737930	1	1	RAM, ASHWIN T MD	11/8/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168753	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
157694	Fee-for-Service	1922832484	1922832484	1	1	REZA PIRSAHELI MD MEDICAL AN	3/1/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	D NEUROLOGICAL PROFESS	100 IRON POINT CIR	STE 103	FOLSOM	CA	95630	8599	34	06067	38.645424	-121.142178	Sacramento County
157703	Fee-for-Service	1457608721	1457608721	1	1	RODRIGUEZ, ELISA LMFT	12/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	UNIT 6	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
157706	Fee-for-Service	1417247412	1417247412	1	1	REID, RACQUEL E MD	11/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151636	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
157741	Fee-for-Service	1548764822	1548764822	1	1	ROBERSHAW, JESSICA	3/23/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
157742	Fee-for-Service	1528146339	1528146339	1	1	RUBIN, ELIZABETH P MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85647	40	Pediatrics	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
157766	Fee-for-Service	1588078968	1588078968	1	1	RASHID, MOLLIE A MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136150	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
157774	Fee-for-Service	1376740050	1376740050	1	1	ROGERS, WILLIAM M MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92106	70	Clinic (mixed specialty)	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
157777	Fee-for-Service	1508968967	1508968967	1	1	REGENTS OF THE UNIVERSITY OF	7/24/2017	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
157801	Fee-for-Service	1639492606	1639492606	1	1	RALPHS GROCERY COMPANY	3/30/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #284	10772 JEFFERSON BLVD	None	CULVER CITY	CA	90230	4933	19	06037	34.00255475	-118.3941565	Los Angeles County
157805	Fee-for-Service	1427343912	1427343912	1	1	RHODES, JESSICA D MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144933	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
157815	Fee-for-Service	1881798221	1881798221	1	1	RICHBURG, FREDERICK A MD	2/1/1999	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	54679	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
157834	Fee-for-Service	1073644704	1073644704	1	1	ROHR, MATTHEW J LMFT	12/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	547 S MARENGO AVE	None	PASADENA	CA	91101	2114	19	06037	34.13628	-118.1458855	Los Angeles County
157842	Fee-for-Service	1093243651	1093243651	1	1	RYU, JE DONG MD	11/24/2023	1223S0112X	NA	Dental Provider	026	PHYSICIANS	191751	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
157846	Fee-for-Service	1730682394	1730682394	1	11	RURAL PHYSICIANS GROUP, PC	3/1/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
157876	Fee-for-Service	1700872017	1700872017	1	1	ROSEN, KERSTIN V MD	10/31/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64008	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
157906	Fee-for-Service	1083698062	1083698062	1	1	ROBERTS, DOUGLAS E MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56980	41	Internal Medicine	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
157908	Fee-for-Service	1538761960	1538761960	1	1	RIGHT CHOICE HOSPICE &	3/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	7200 VINELAND AVE	STE 210	SUN VALLEY	CA	91352	5088	19	06037	34.2016328	-118.3703012	Los Angeles County
157909	Fee-for-Service	1023178035	1023178035	1	1	ROBERTS, TARA R	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157924	Fee-for-Service	1518539717	1518539717	1	1	RAMOS, WILTON K OT	5/23/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
157941	Fee-for-Service	1033149273	1033149273	1	1	RODMAN, ELLEN B DO	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2306	00	None	36.132948	-115.136874	Clark County
157988	Fee-for-Service	1538178538	1538178538	1	1	REINKE, BRADLEY H MD	8/31/1988	207P00000X	NA	Other	026	PHYSICIANS	58111	None	None	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
157999	Fee-for-Service	1447206644	1447206644	1	1	REDDY, SANJAY MD	5/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90051	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
158015	Fee-for-Service	1659476349	1659476349	1	1	RHEINGOLD, MARC	10/10/2001	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOPAEDIC REHAB CTR	2375 TORRANCE BLVD	None	TORRANCE	CA	90501	2541	19	06037	33.83640434	-118.3260659	Los Angeles County
158037	Fee-for-Service	1609293752	1609293752	1	1	RN HOSPICE INC	1/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6047 TAMPA AVE	SUITE 210	TARZANA	CA	91356	1199	19	06037	34.180812	-118.553488	Los Angeles County
158061	Fee-for-Service	1245293356	1245293356	1	1	RENAL TREATMENT CENTERS	8/11/2004	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2345 FOREST AVE	None	CHICO	CA	95928	7641	04	06007	39.71811448	-121.7980575	Butte County
158064	Fee-for-Service	1376740050	1376740050	1	1	ROGERS, WILLIAM M MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92106	22	Pathology (M.D. only)	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
158066	Fee-for-Service	1407964000	1407964000	1	1	RICH, PHYLLIS C MD	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79750	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVENUE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
158067	Fee-for-Service	1508968967	1508968967	1	1	REGENTS OF THE UNIVERSITY OF	9/24/1973	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158174	Fee-for-Service	1497079859	1497079859	1	1	RICE, BRIAN T MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110595	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158192	Fee-for-Service	1578738282	1578738282	1	1	RUBIN, ELYSSA M MD	12/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8846	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
158197	Fee-for-Service	1538761960	1538761960	1	1	RIGHT CHOICE HOSPICE &	3/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	7200 VINELAND AVE	STE 210	SUN VALLEY	CA	91352	5088	19	06037	34.2016328	-118.3703012	Los Angeles County
158205	Fee-for-Service	1255681433	1255681433	1	1	ROBERTA M FREDERICK	12/28/2012	164W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1944 ACADEMY AVE	None	TULARE	CA	93274	3187	54	06107	36.21322984	-119.3162192	Tulare County
158232	Fee-for-Service	1033149273	1033149273	1	1	RODMAN, ELLEN B DO	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2306	00	None	36.132948	-115.136874	Clark County
158276	Fee-for-Service	1881935807	1881935807	1	1	ROSS, DONALD B LMFT	11/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158304	Fee-for-Service	1386217115	1386217115	1	1	ROMAN, KRISTEN CRNA	8/10/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
158325	Fee-for-Service	1609293752	1609293752	1	1	RN HOSPICE INC	1/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6047 TAMPA AVE	SUITE 210	TARZANA	CA	91356	1199	19	06037	34.180812	-118.553488	Los Angeles County
158354	Fee-for-Service	1508968967	1508968967	1	1	REGENTS OF THE UNIVERSITY OF	9/1/1991	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158393	Fee-for-Service	1588862809	1588862809	1	1	ROGERS, LYNN C	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	550 W WASHINGTON	None	CRESCENT CITY	CA	95531	3150	08	06015	41.77282088	-124.2079984	Del Norte County
158395	Fee-for-Service	1699199190	1699199190	1	1	REINA, GABRIEL	1/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150362	None	None	0	In state provider	None	2575 E BIDWELL ST	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
158397	Fee-for-Service	1760424683	1760424683	1	1	ROBERTSON, SUSAN L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158436	Fee-for-Service	1871651018	1871651018	1	1	RUSKIN, DAVID A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69118	None	None	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
158445	Fee-for-Service	1205198082	1205198082	1	1	RYAN SIVERTSON	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
158541	Fee-for-Service	1760596217	1760596217	1	1	RHO, RICHARD JAI MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67643	05	Anesthesiology	0	In state provider	A MEDICAL CORPORATION	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
158587	Fee-for-Service	1093722852	1093722852	1	1	RAVAL, NIREN A	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6740	08	Family Practice	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
158602	Fee-for-Service	1134169535	1134169535	2	33	REACH AIR MEDICAL SERVICES L	12/2/2015	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	485 S ROCK BLVD	STE B	RENO	NV	89502	4171	00	None	39.50767523	-119.7636152	Washoe County
158622	Fee-for-Service	1205223351	1205223351	1	1	RATRA, ATUL K MD	4/25/2019	390200000X	NA	Other	026	PHYSICIANS	156039	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
158640	Fee-for-Service	1508968967	1508968967	1	1	REGENTS OF THE UNIVERSITY OF	3/26/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158687	Fee-for-Service	1598863193	1598863193	1	1	ROBERTS, LAWRENCE MD	1/15/2020	2086S0127X	NA	General Surgery	026	PHYSICIANS	41079	89	Surgery-Traumatic	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
158779	Fee-for-Service	1891085833	1891085833	1	1	RUTISHAUSER, RACHEL L MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124795	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158780	Fee-for-Service	1174626618	1174626618	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158785	Fee-for-Service	1235167107	1235167107	1	1	ROSENFELD, SAMUEL R MD	10/22/1997	174400000X	NA	Other	026	PHYSICIANS	37045	02	General Surgery	0	In state provider	None	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
158792	Fee-for-Service	1538274816	1538274816	1	1	RAMIREZ, PEDRO J MD	5/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105291	02	General Surgery	0	In state provider	None	6 WOODLAND RD	#302	ST HELENA	CA	94574	9501	28	06055	38.54297115	-122.4754501	Napa County
158860	Fee-for-Service	1255534160	1255534160	1	1	RUPP, RICHARD W MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111607	30	Radiology	0	In state provider	None	559 ABBOTT STREET	None	SALINAS	CA	93901	4325	27	06053	36.66284132	-121.6420108	Monterey County
158867	Fee-for-Service	1306220116	1306220116	1	1	RAOOFI, MIZIANA NP	12/6/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158881	Fee-for-Service	1851893101	1851893101	1	1	RENDON PHYSICAL THERAPY, INC	8/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	MYOFACIAL RELEASE	11306 MOUNTAIN VIEW AVE	A-100	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
158917	Fee-for-Service	1497927834	1497927834	1	1	REID, SHAUN R MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98398	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158930	Fee-for-Service	1346398211	1346398211	1	1	ROBINSON, KENNETH E MD	9/13/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
159000	Fee-for-Service	1578630588	1578630588	1	1	RAGHUNATHAN, RUKMANI MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	30536	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
159005	Fee-for-Service	1851823199	1851823199	1	1	RAMIREZ, ERNESTO M MD	11/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161273	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
159008	Fee-for-Service	1417447756	1417447756	1	1	ROJAS, CINTHIA V CNP	9/16/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3140 BALFOUR RD	SUITE C	BRENTWOOD	CA	94513	5518	07	06013	37.9252364	-121.7233035	Contra Costa County
159019	Fee-for-Service	1386051464	1386051464	1	1	RHEE, LAURA S	11/2/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVENUE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
159037	Fee-for-Service	1326216318	1326216318	1	1	ROSENSWEET, HILARY R LCSW	10/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159065	Fee-for-Service	1891085833	1891085833	1	1	RUTISHAUSER, RACHEL L MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124795	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159067	Fee-for-Service	1174626618	1174626618	1	1	REGENTS OF THE UNIVERSITY OF	9/25/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159102	Fee-for-Service	1427228873	1427228873	1	1	RATNAYAKE, ANOSHIE R MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87525	03	Allergy	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
159133	Fee-for-Service	1326461708	1326461708	1	2	REDWOOD RADIOLOGY GROUP INC	6/2/2021	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
159156	Fee-for-Service	1376615195	1376615195	1	1	ROSEN, ELIZABETH J MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	52453	04	Otology, Laryngology, Rhinology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
159207	Fee-for-Service	1609981943	1609981943	1	1	RAMIREZ, CARLOS JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34718	08	Family Practice	0	In state provider	None	3420 COACH LN	STE 2	CAMERON PARK	CA	95682	8406	09	06017	38.6581265	-120.9678255	El Dorado County
159293	Fee-for-Service	1578630588	1578630588	1	1	RAGHUNATHAN, RUKMANI MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	30536	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
159354	Fee-for-Service	1174626618	1174626618	1	1	REGENTS OF THE UNIVERSITY OF	11/15/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159385	Fee-for-Service	1043235641	1043235641	1	1	RALPHS GROCERY COMPANY	12/1/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #32	3410 W 3RD ST	None	LOS ANGELES	CA	90020	1622	19	06037	34.0690195	-118.290618	Los Angeles County
159417	Fee-for-Service	1245889310	1245889310	1	1	RANDAZZO, VICTORIA P NP	12/13/2019	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
159420	Fee-for-Service	1033221007	1033221007	1	1	REDDY, JYOTHI A MD	6/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44374	10	Gastroenterology (M.D. only)	0	In state provider	None	3975 JACKSON ST	STE 103	RIVERSIDE	CA	92503	3938	33	06065	33.92729721	-117.4413503	Riverside County
159433	Fee-for-Service	1356370209	1356370209	2	1	RAH, SHAHLA MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51993	10	Gastroenterology (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
159435	Fee-for-Service	1609303825	1609303825	1	1	RAMIREZ, JESSICA LMFT	7/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
159442	Fee-for-Service	1639222144	1639222144	1	1	RIVERSIDE-SAN BERNARDINO COU	6/9/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	23119 SOBOBA RD	None	SAN JACINTO	CA	92583	5517	33	06065	33.78557206	-116.9218852	Riverside County
159450	Fee-for-Service	1578970463	1578970463	1	1	ROMERO, ELOY MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130975	01	General Practice	0	In state provider	None	1332 NATIVIDAD RD	SUITE C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
159462	Fee-for-Service	1184751497	1184751497	1	1	RSCR CALIFORNIA, INC	9/23/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	581 BLAISDELL DR	None	CLAREMONT	CA	91711	3555	19	06037	34.11063149	-117.705168	Los Angeles County
159533	Fee-for-Service	1659394633	1659394633	1	2	RADNIA, DANIEL MD	9/28/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	92103	-	NOT APPLICABLE	0	In state provider	None	11041 E VALLEY BLVD	None	EL MONTE	CA	91731	2516	19	06037	34.07431877	-118.0338809	Los Angeles County
159546	Fee-for-Service	1548744774	1548744774	1	1	REYNOLDS, TESSA M LMFT	3/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159599	Fee-for-Service	1871179523	1871179523	1	1	REGE, SOHAM C MD	6/6/2024	208M00000X	NA	Other	026	PHYSICIANS	189595	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159617	Fee-for-Service	1356341168	1356341168	2	1	REDDY, MANORAMA M MD	2/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	39669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4533 COLLEGE AVE	None	SAN DIEGO	CA	92115	4010	37	06073	32.759334	-117.066313	San Diego County
159641	Fee-for-Service	1255406401	1255406401	1	1	RAHIMI, PONEH MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76910	10	Gastroenterology (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 707	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
159642	Fee-for-Service	1174626618	1174626618	1	1	REGENTS OF THE UNIVERSITY OF	3/1/2000	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159645	Fee-for-Service	1477546430	1477546430	1	2	REGENTS/UCDPBG/PED ENDOC	5/1/1999	2080P0205X	NA	Endocrinology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
159671	Fee-for-Service	1689011074	1689011074	1	1	RAEISI-GIGLOU, PEJMAN DO	7/3/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	18693	None	None	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
159675	Fee-for-Service	1194928739	1194928739	1	1	ROGER A COLEMAN M.D.	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
159680	Fee-for-Service	1144211749	1144211749	1	1	REDDY, MALA N MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102904	68	Hematology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
159695	Fee-for-Service	1598462590	1598462590	1	1	RMNP MEDICAL CORP	11/16/2023	193400000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	516 WILLOW ST	None	ALAMEDA	CA	94501	6132	01	06001	37.76011202	-122.2549417	Alameda County
159700	Fee-for-Service	1457436719	1457436719	1	1	RODRIGUEZ-RUST, LORNA C MD	6/11/2019	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162435	15	Obstetrics (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
159709	Fee-for-Service	1033221007	1033221007	1	1	REDDY, JYOTHI A MD	6/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44374	41	Internal Medicine	0	In state provider	None	3975 JACKSON ST	STE 103	RIVERSIDE	CA	92503	3938	33	06065	33.92729721	-117.4413503	Riverside County
159710	Fee-for-Service	1003140922	1003140922	1	1	REZVAN, KAVEH DO	3/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10932	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
159715	Fee-for-Service	1932452984	1932452984	1	1	RUEDA, ALICIA PSYD	4/11/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159730	Fee-for-Service	1639222144	1639222144	1	1	RIVERSIDE-SAN BERNARDINO COU	2/1/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	23119 SOBOBA RD	None	SAN JACINTO	CA	92583	5517	33	06065	33.78557206	-116.9218852	Riverside County
159749	Fee-for-Service	1144207671	1144207671	1	1	RUSHTON, ROBERT B MD	1/12/1993	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	844 S DORA ST	None	UKIAH	CA	95482	5711	23	06045	39.14040107	-123.2102865	Mendocino County
159754	Fee-for-Service	1992798078	1992798078	1	1	ROBERT M SEGAL MD	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2530 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4289	00	None	44.95666922	-93.262614	Hennepin County
159767	Fee-for-Service	1023484664	1023484664	1	1	RAMOS, ARIEL S NP	8/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
159774	Fee-for-Service	1205810066	1205810066	1	1	ROBINSON, PHILIP A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71821	77	Infectious Disease	0	In state provider	None	320 SUPERIOR AVE	STE 290	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
159776	Fee-for-Service	1780760421	1780760421	1	1	REDDY, JAKKIDI S MD	5/1/2002	207R00000X	NA	Other	026	PHYSICIANS	75936	41	Internal Medicine	0	In state provider	None	588 N SUNRISE AVE	STE 120	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
159777	Fee-for-Service	1467430900	1467430900	1	1	RONALD CABLE, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 N LEE AVE	None	OKLAHOMA CITY	OK	73102	1036	00	None	35.4780541	-97.52424339	Oklahoma County
159782	Fee-for-Service	1730227430	1730227430	1	1	RUHGE, KEVIN M MD	10/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65129	24	Plastic Surgery	0	In state provider	KEVIN M RUHGE, MD INC	50 ALESSANDRO PL	STE 300	PASADENA	CA	91105	4001	19	06037	34.13101049	-118.151532	Los Angeles County
159826	Fee-for-Service	1871889840	1871889840	1	1	REGINA HART	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
159856	Fee-for-Service	1114956745	1114956745	1	1	RAMAN, STEVEN S MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	80413	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
159872	Fee-for-Service	1922081843	1922081843	1	1	RICKS, RYAN F	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6200 E CANYON RIM RD	STE 111E	ANAHEIM	CA	92807	4313	30	06059	33.84364029	-117.7753552	Orange County
159905	Fee-for-Service	1356341168	1356341168	2	1	REDDY, MANORAMA M MD	2/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	39669	41	Internal Medicine	0	In state provider	None	4533 COLLEGE AVE	None	SAN DIEGO	CA	92115	4010	37	06073	32.759334	-117.066313	San Diego County
159922	Fee-for-Service	1639183932	1639183932	1	1	ROKOSKY, REBECCA NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 DALLAS ST	None	SAN ANTONIO	TX	78205	1201	00	None	29.43317376	-98.49236007	Bexar County
159937	Fee-for-Service	1477546430	1477546430	1	2	REGENTS/UCDPBG/PED ENDOC	3/15/2022	2080P0205X	NA	Endocrinology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
159944	Fee-for-Service	1366191033	1366191033	1	1	REIGN HOME HEALTH CARE, INC	9/3/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1528 CANADA BLVD	SUITE 205	GLENDALE	CA	91208	3202	19	06037	34.16934876	-118.2290174	Los Angeles County
159950	Fee-for-Service	1962435586	1962435586	1	1	ROCHA, MARTIN L MD INC	1/24/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	251 N HIGHWAY 173	STE 6	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.25458933	-117.1731769	San Bernardino County
159958	Fee-for-Service	1285818112	1285818112	1	1	REGENTS OF UNIV OF CALIF	1/1/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UCSF REG HEMOPHILIA CTR	525 PARNASSUS, PEDI M696	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.76317115	-122.4588464	San Francisco County
159959	Fee-for-Service	1376188805	1376188805	1	1	ROCHFORD, SARAH NP	10/1/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
159970	Fee-for-Service	1144211749	1144211749	1	1	REDDY, MALA N MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102904	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
159978	Fee-for-Service	1962666560	1962666560	1	1	RICHMOND, JOHN M MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120652	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
159986	Fee-for-Service	1457436719	1457436719	1	1	RODRIGUEZ-RUST, LORNA C MD	6/11/2019	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162435	09	Gynecology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
160003	Fee-for-Service	1952493082	1952493082	1	1	ROBSON, NEIL S PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
160009	Fee-for-Service	1740243930	1740243930	1	1	RISHI, RAHUL MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93374	45	Nephrology (Renal-Kidney)	0	In state provider	None	20055 LAKE CHABOT RD	STE 230	CASTRO VALLEY	CA	94546	5333	01	06001	37.69836512	-122.0873587	Alameda County
160033	Fee-for-Service	1144207671	1144207671	1	1	RUSHTON, ROBERT B MD	1/12/1993	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	844 S DORA ST	None	UKIAH	CA	95482	5711	23	06045	39.14040107	-123.2102865	Mendocino County
160036	Fee-for-Service	1285658500	1285658500	1	1	RIGBERG, DAVID A MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60026	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
160042	Fee-for-Service	1376906347	1376906347	1	1	RAMASWAMY, SUNIL R MD	8/4/2022	207RC0200X	NA	Other	026	PHYSICIANS	179855	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
160069	Fee-for-Service	1730227430	1730227430	1	1	RUHGE, KEVIN M MD	10/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65129	02	General Surgery	0	In state provider	KEVIN M RUHGE, MD INC	50 ALESSANDRO PL	STE 300	PASADENA	CA	91105	4001	19	06037	34.13101049	-118.151532	Los Angeles County
160139	Fee-for-Service	1801921952	1801921952	1	5	ROY MEDICAL GROUP INC	3/24/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	8001 LAUREL CANYON BLVD	STE 109	NORTH HOLLYWOOD	CA	91605	1400	19	06037	34.216164	-118.396559	Los Angeles County
160142	Fee-for-Service	1053490797	1053490797	2	1	RADY CHILDRENS HEALTH	7/6/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SERVICES-SAN DIEGO	3030 CHILDRENS WAY	STE 108	SAN DIEGO	CA	92123	4226	37	06073	32.798889	-117.150826	San Diego County
160180	Fee-for-Service	1598728990	1598728990	1	1	RAHMAN, HABIB MD	11/8/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	63719	None	None	0	In state provider	None	26691 PLAZA	150	MISSION VIEJO	CA	92691	6329	30	06059	33.56533763	-117.6645538	Orange County
160183	Fee-for-Service	1710239512	1710239512	1	1	RICAFRENTE, GERALD P	1/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
160202	Fee-for-Service	1033201249	1033201249	2	1	RESPIRATORYCAREPLUS	6/5/2019	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2594 FORDHAM AVE	None	FRESNO	CA	93727	8615	10	06019	36.773829	-119.6875245	Fresno County
160230	Fee-for-Service	1174189831	1174189831	1	1	RYCKMAN, KSENIA PSYD	10/20/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
160239	Fee-for-Service	1962435586	1962435586	1	1	ROCHA, MARTIN L MD INC	5/24/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	251 N HIGHWAY 173	STE 6	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.25458933	-117.1731769	San Bernardino County
160321	Fee-for-Service	1720526502	1720526502	1	2	ROLANDO A. ATIGA, M.D., A PR	4/15/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	29826 HAUN RD	314	MENIFEE	CA	92586	6546	33	06065	33.68719818	-117.1748757	Riverside County
160358	Fee-for-Service	1649665613	1649665613	1	1	RAGINS, KYLE T MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145214	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
160371	Fee-for-Service	1609225135	1609225135	1	1	RAMSIS, MATTHEUS MD	8/11/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162487	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
160385	Fee-for-Service	1265096838	1265096838	1	1	REDWOOD PSYCHOLOGICAL, INC	1/29/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	120 US HIGHWAY 101 N	None	CRESCENT CITY	CA	95531	2813	08	06015	41.83956521	-124.1438239	Del Norte County
160391	Fee-for-Service	1780425611	1780425611	1	1	REVIVAL TRANSPORTATION LLC	8/28/2024	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	521 CAPPS LN	None	UKIAH	CA	95482	7227	23	06045	39.16585947	-123.216102	Mendocino County
160421	Fee-for-Service	1396064556	1396064556	1	1	RELIANCE PERS CARE AG INC	9/1/2010	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	RELIANCE PERSONAL CARE	7892 NOMAD CIRCLE	None	HUNTINGTON BEACH	CA	92648	2363	30	06059	33.68624953	-117.9915678	Orange County
160426	Fee-for-Service	1801921952	1801921952	1	5	ROY MEDICAL GROUP INC	3/24/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	8001 LAUREL CANYON BLVD	STE 109	NORTH HOLLYWOOD	CA	91605	1400	19	06037	34.216164	-118.396559	Los Angeles County
160430	Fee-for-Service	1841407723	1841407723	1	1	RAMANUJAM, ABHIJIT V MD	8/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110934	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	STE 160	SACRAMENTO	CA	95835	2095	34	06067	38.647737	-121.510467	Sacramento County
160527	Fee-for-Service	1962435586	1962435586	1	1	ROCHA, MARTIN L MD INC	5/24/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	251 N HIGHWAY 173	STE 6	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.25458933	-117.1731769	San Bernardino County
160544	Fee-for-Service	1033246301	1033246301	1	1	ROCKCREEK INC	9/26/1990	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	120 E PALMYRA DR	None	SAN BERNARDINO	CA	92404	1613	36	06071	34.16137845	-117.284211	San Bernardino County
160559	Fee-for-Service	1104496199	1104496199	1	1	ROBLES, KARINA LMFT	9/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
160570	Fee-for-Service	1235135963	1235135963	1	1	RHONDA S SIVLEY MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1225 E WEISGARBER RD	STE 200	KNOXVILLE	TN	37909	2604	00	None	35.94683378	-84.01343542	Knox County
160577	Fee-for-Service	1952471484	1952471484	1	1	RELUCIO, KAREN I MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68866	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
160580	Fee-for-Service	1255448189	1255448189	1	1	RIKER, CATHY L MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	74920	83	Rheumatology	0	In state provider	None	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
160607	Fee-for-Service	1255813499	1255813499	1	1	RIVERA, MARIA M LMFT	2/23/2024	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
160633	Fee-for-Service	1043354111	1043354111	1	6	REDLANDS COMMUNITY HOSP	11/1/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11985 4TH STREET	STE 102	YUCAIPA	CA	92399	2727	36	06071	34.035525	-117.0518615	San Bernardino County
160671	Fee-for-Service	1073956298	1073956298	1	1	REISINGER, TESSA L MD	11/8/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159886	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
160682	Fee-for-Service	1861578379	1861578379	1	1	RABINOV, WENDY MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50237	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
160691	Fee-for-Service	1487759296	1487759296	1	1	RIDER, DEAN MD	2/1/1981	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	40124	41	Internal Medicine	0	In state provider	None	350 PARNASSUS AVE	STE 900	SAN FRANCISCO	CA	94117	3604	38	06075	37.76403932	-122.4561371	San Francisco County
160707	Fee-for-Service	1194850164	1194850164	1	1	RODRIGUEZ, RAUL	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44122	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
160726	Fee-for-Service	1396704771	1396704771	1	1	RENAL TREATMENT CENTERS	12/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	4660 CENTRAL WAY	None	FAIRFIELD	CA	94534	1803	48	06095	38.21905385	-122.1322171	Solano County
160771	Fee-for-Service	1013547124	1013547124	1	1	ROY, SANJAYA	10/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
160827	Fee-for-Service	1114259017	1114259017	1	1	RUBEL, MIRIAM LCSW	4/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
160864	Fee-for-Service	1952471484	1952471484	1	1	RELUCIO, KAREN I MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68866	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
160867	Fee-for-Service	1548202872	1548202872	1	1	REDDER-HAGA, CHERKALEYNA	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9342	None	None	0	In state provider	A DO	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
160902	Fee-for-Service	1467658385	1467658385	1	1	RIVERSIDE CNTY RUBIDOUX	9/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5256 MISSION BLVD	None	RUBIDOUX	CA	92509	4624	33	06065	33.99259607	-117.3987687	Riverside County
160934	Fee-for-Service	1477834810	1477834810	1	1	RAMAS, MARIE-ELIZABETH MD	9/9/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117842	41	Internal Medicine	0	In state provider	INC	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
160937	Fee-for-Service	1881701555	1881701555	1	1	ROBINSON, RONALD J MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74437	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
160940	Fee-for-Service	1720526502	1720526502	1	1	ROLANDO A. ATIGA, M.D., A PR	6/12/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	25405 HANCOCK AVENUE	STE. 105	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
160963	Fee-for-Service	1669422119	1669422119	1	1	RAZA,MUHAMMAD MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9310 N CENTRAL AVE	STE 1	PHOENIX	AZ	85020	2418	00	None	33.570612	-112.0742325	Maricopa County
160974	Fee-for-Service	1376783068	1376783068	1	1	ROBISON, RICHARD A	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106673	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
160982	Fee-for-Service	1346960168	1346960168	1	1	RABALAIS, CATHERINE M CNP	3/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
161002	Fee-for-Service	1275995284	1275995284	1	1	RABIEI-SAMANI, SAHAR MD	9/28/2022	207RC0200X	NA	Other	026	PHYSICIANS	161535	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
161005	Fee-for-Service	1124295027	1124295027	1	1	RAISSI SHABARI, FARSHAD MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	99160	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
161036	Fee-for-Service	1528054491	1528054491	1	1	RAINWATER, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10101 RIDGEGATE PKWY	None	LONETREE	CO	80124	5522	00	None	39.529305	-104.870799	Douglas County
161040	Fee-for-Service	1679601207	1679601207	1	1	REYNOSO, MONICA S LMFT	1/7/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1702 E BULLARD AVE	SUITE 102	FRESNO	CA	93710	5800	10	06019	36.82318447	-119.7563985	Fresno County
161071	Fee-for-Service	1184042137	1184042137	1	1	RAVI, SHASHANK MD	8/19/2019	207P00000X	NA	Other	026	PHYSICIANS	161393	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161128	Fee-for-Service	1972574739	1972574739	1	1	REYES, BRIAN A MD	7/1/2002	207R00000X	NA	Other	026	PHYSICIANS	73587	41	Internal Medicine	0	In state provider	None	100 CORTONA WAY	SUITE 140	BRENTWOOD	CA	94513	7157	07	06013	37.92663446	-121.7366493	Contra Costa County
161159	Fee-for-Service	1669420295	1669420295	1	1	REDD, CINNAMON H MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82533	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
161160	Fee-for-Service	1831158120	1831158120	1	1	ROBERTS, BRIAN K MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80557	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
161162	Fee-for-Service	1821379785	1821379785	1	1	RIDER, JAMIE ROZSA	12/31/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
161185	Fee-for-Service	1275543712	1275543712	1	1	RICHARDS, CHARLES H	1/1/1987	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	429 D ST	None	MARYSVILLE	CA	95901	5706	58	06115	39.14014224	-121.5889158	Yuba County
161244	Fee-for-Service	1366639049	1366639049	1	1	ROCAMBOLI, CHARLES M MD	11/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9291	08	Family Practice	0	In state provider	None	44469 10TH ST W	None	LANCASTER	CA	93534	3324	19	06037	34.691454	-118.148068	Los Angeles County
161309	Fee-for-Service	1497789960	1497789960	1	1	RODILES, DANIEL H MD INC	9/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24159	41	Internal Medicine	0	In state provider	None	10861 CHERRY ST	STE 302	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
161339	Fee-for-Service	1538782214	1538782214	1	1	REYES, CHRISTIAN	2/4/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 W 7TH ST	STE 3356	LOS ANGELES	CA	90017	2577	19	06037	34.05063675	-118.2635415	Los Angeles County
161391	Fee-for-Service	1134346968	1134346968	1	1	RICHARDSON, TARA M PHD	8/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
161409	Fee-for-Service	1346359270	1346359270	1	1	RYU, SUSAN MD	1/1/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41683	18	Ophthalmology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
161418	Fee-for-Service	1154442077	1154442077	1	1	ROSE, DIANE LMFT	1/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
161491	Fee-for-Service	1073560389	1073560389	1	1	ROGERS, DAVID W MD	2/28/1982	207ZC0500X	NA	Other	026	PHYSICIANS	31138	22	Pathology (M.D. only)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
161499	Fee-for-Service	1780433060	1780433060	1	1	REMEDY HOLISTIC PHARMACY INC	9/24/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 CEDAR ST	STE 103	SAN DIEGO	CA	92101	2917	37	06073	32.7220413	-117.1619031	San Diego County
161517	Fee-for-Service	1467563445	1467563445	1	1	RABAGO, JAMES R MD	1/22/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77750	08	Family Practice	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
161596	Fee-for-Service	1801234638	1801234638	1	1	REYES, JENNA M LMFT	12/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
161597	Fee-for-Service	1497789960	1497789960	1	1	RODILES, DANIEL H MD INC	9/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24159	10	Gastroenterology (M.D. only)	0	In state provider	None	10861 CHERRY ST	STE 302	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
161633	Fee-for-Service	1861576290	1861576290	1	1	REISFELD, RAFAEL MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	32774	02	General Surgery	0	In state provider	None	1125 S BEVERLY DR	STE 500	LOS ANGELES	CA	90035	1183	19	06037	34.05696658	-118.3966613	Los Angeles County
161654	Fee-for-Service	1093915407	1093915407	1	1	RAHMANI, BIJAN PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	14150 CULVER DR	STE 307	IRVINE	CA	92604	0323	30	06059	33.70834263	-117.7839373	Orange County
161703	Fee-for-Service	1063601268	1063601268	1	1	RAD, MARZBAN MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116450	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
161706	Fee-for-Service	1538705611	1538705611	1	1	REGMI, KUSUM CNP	8/17/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
161732	Fee-for-Service	1629178470	1629178470	1	1	ROBERT WOLFE MD AND ANDREW	1/1/1992	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	S WACHTEL MD A PARTNERSH	8635 W 3RD ST	STE 965W	LOS ANGELES	CA	90048	6138	19	06037	34.07361928	-118.3803143	Los Angeles County
161758	Fee-for-Service	1982059689	1982059689	1	1	RUIZ, MONICA O MD	12/29/2023	2080P0203X	NA	Other	026	PHYSICIANS	161847	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
161775	Fee-for-Service	1043271489	1043271489	1	1	RENAL TREATMENT CENTERS	2/11/2005	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	894 HARDT ST	None	SAN BERNARDINO	CA	92408	2854	36	06071	34.07265645	-117.2667015	San Bernardino County
161776	Fee-for-Service	1144356098	1144356098	2	1	RSCR CALIFORNIA INC	7/24/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	336 MARKWAY LANE	None	POMONA	CA	91767	1028	19	06037	34.10552332	-117.75311	Los Angeles County
161786	Fee-for-Service	1902821283	1902821283	1	1	RICHARDSON, JODI D MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89512	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
161802	Fee-for-Service	1902319072	1902319072	1	1	RAJEWSKI, MOLLY	1/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
161880	Fee-for-Service	1922486547	1922486547	1	1	RODRIGUEZ, VANESSA	10/12/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
161893	Fee-for-Service	1801801279	1801801279	2	2	RADPARVAR, MANSOOR	1/15/2020	174400000X	NA	Other	026	PHYSICIANS	50959	15	Obstetrics (D.O. only)	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
161916	Fee-for-Service	1437150273	1437150273	1	1	REUBEN, MICHAEL I MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	25082	40	Pediatrics	0	In state provider	None	11100 WARNER AVE	STE 102	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
161942	Fee-for-Service	1588720916	1588720916	1	2	RANDHAWA, TEJINDER S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53378	40	Pediatrics	0	In state provider	None	5043 E KINGS CANYON RD	None	FRESNO	CA	93727	3935	10	06019	36.73599961	-119.725504	Fresno County
161980	Fee-for-Service	1902470008	1902470008	1	1	RELIABLE CARE LLC	10/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	28310 ROADSIDE DRIVE	STE 122	AGOURA HILLS	CA	91301	4949	19	06037	34.14271418	-118.7432847	Los Angeles County
161990	Fee-for-Service	1114439593	1114439593	1	1	RATHMANN, DAVID P	1/23/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
161995	Fee-for-Service	1649600834	1649600834	1	1	RENAISSANCE SOUTH LA, INC	2/18/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	19401 S VERMONT AVENUE	SUITE C 100	TORRANCE	CA	90502	1029	19	06037	33.85486409	-118.2905603	Los Angeles County
162005	Fee-for-Service	1730627274	1730627274	1	1	ROYAL PHARMACY DRUGS INC	11/9/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1101 1/2 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2651	19	06037	34.16421049	-118.2800072	Los Angeles County
162012	Fee-for-Service	1629178470	1629178470	1	1	ROBERT WOLFE MD AND ANDREW	1/1/1992	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	S WACHTEL MD A PARTNERSH	8635 W 3RD ST	STE 965W	LOS ANGELES	CA	90048	6138	19	06037	34.07361928	-118.3803143	Los Angeles County
162052	Fee-for-Service	1881983765	1881983765	1	1	ROBEN, EMILY C MD	7/26/2022	2080P0204X	NA	Other	026	PHYSICIANS	171734	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162149	Fee-for-Service	1780208496	1780208496	1	1	RODRIGUEZ, HORTENSIA	11/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
162150	Fee-for-Service	1902078009	1902078009	1	1	RO, ERIC Y MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103271	84	Surgery-Head and Neck	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
162176	Fee-for-Service	1043559974	1043559974	1	1	RIGHT START SERVICES INC	3/4/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2032 KEHOE AVE	None	SAN MATEO	CA	94403	1012	41	06081	37.5654965	-122.2956315	San Mateo County
162182	Fee-for-Service	1811914377	1811914377	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2141 HIGH STREET	None	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
162184	Fee-for-Service	1801801279	1801801279	2	2	RADPARVAR, MANSOOR	1/15/2020	174400000X	NA	Other	026	PHYSICIANS	50959	09	Gynecology (D.O. only)	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
162188	Fee-for-Service	1033190657	1033190657	1	1	RICHARDS, JOHN R MD	1/31/1994	207P00000X	NA	Other	026	PHYSICIANS	79597	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
162193	Fee-for-Service	1962752675	1962752675	1	1	ROESSLER, FRIEDRICH MD INC	9/14/2015	207L00000X	NA	Other	026	PHYSICIANS	60680	05	Anesthesiology	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
162318	Fee-for-Service	1073661476	1073661476	1	1	REMINGTON, BETH E LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
162345	Fee-for-Service	1205085149	1205085149	1	1	REARDON, ANDREW P PT	12/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
162370	Fee-for-Service	1497087290	1497087290	1	1	ROBERT IMANI MD, INC.	2/5/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1505 W AVENUE J	103	LANCASTER	CA	93534	2843	19	06037	34.68945168	-118.1571066	Los Angeles County
162378	Fee-for-Service	1790864585	1790864585	1	1	ROBERTS, MARK S MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	51460	83	Rheumatology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
162467	Fee-for-Service	1124542444	1124542444	1	1	RUMMINGER, SHASTA N MD	11/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182779	None	None	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
162469	Fee-for-Service	1841382876	1841382876	1	1	RONLOV, CARSTEN S MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35029	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 PALO VERDE AVE	SUITE 202	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
162470	Fee-for-Service	1811914377	1811914377	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2141 HIGH STREET	None	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
162476	Fee-for-Service	1033190657	1033190657	1	1	RICHARDS, JOHN R MD	1/31/1994	207P00000X	NA	Other	026	PHYSICIANS	79597	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
162508	Fee-for-Service	1396402012	1396402012	1	1	RAMIREZ LOMELI, ANGEL S PT	4/4/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
162546	Fee-for-Service	1275943474	1275943474	1	1	RAKHOLIA, BHAVIKA S MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144403	08	Family Practice	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
162569	Fee-for-Service	1194192849	1194192849	1	1	ROBERTS, MATTHEW G LMFT	6/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
162575	Fee-for-Service	1407906902	1407906902	1	1	REDDY, MAKALA N MD	7/4/1983	174400000X	NA	Other	026	PHYSICIANS	32615	02	General Surgery	0	In state provider	None	18523 CORWIN RD	None	APPLE VALLEY	CA	92307	2338	36	06071	34.54095703	-117.2601143	San Bernardino County
162589	Fee-for-Service	1649680935	1649680935	1	1	ROMERO, JACQUELINE MD	7/17/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
162591	Fee-for-Service	1184165508	1184165508	1	1	RAMANI, BISWARATHAN MD	7/9/2021	207ZN0500X	NA	Other	026	PHYSICIANS	160197	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162631	Fee-for-Service	1134169535	1134169535	2	21	REACH AIR MEDICAL SERVICES L	7/1/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2131 NW AVIATION DR	STE 4	ROSEBURG	OR	97470	6521	00	None	43.237746	-123.3563445	Douglas County
162636	Fee-for-Service	1548623796	1548623796	1	1	RAVI, DEEPAK MD	7/15/2019	207R00000X	NA	Other	026	PHYSICIANS	155519	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
162649	Fee-for-Service	1558381095	1558381095	1	2	RAAS INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	266 MONTEREY ROAD	SUITE E	SOUTH PASADENA	CA	91030	3558	19	06037	34.11158817	-118.1701383	Los Angeles County
162700	Fee-for-Service	1972651339	1972651339	1	1	RICHARD H HAVUNJIAN MD A PRO	4/1/2000	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ALIFORNIA	1510 S CENTRAL AVE	530	GLENDALE	CA	91204	2542	19	06037	34.12709764	-118.2577911	Los Angeles County
162720	Fee-for-Service	1972691343	1972691343	1	1	REMBA, MATILDA MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	72833	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162742	Fee-for-Service	1063786341	1063786341	1	1	RAZO, STEVEN M PSYD	11/2/2019	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2060 KNOLL DRIVE	102	VENTURA	CA	93003	7328	56	06111	34.25414027	-119.2204231	Ventura County
162757	Fee-for-Service	1811914377	1811914377	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2141 HIGH STREET	None	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
162808	Fee-for-Service	1952409682	1952409682	1	1	ROZELLE, WENDY D LMFT	7/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23550 LYONS AVE	SUITE 211	NEWHALL	CA	91321	5745	19	06037	34.37938495	-118.5458635	Los Angeles County
162829	Fee-for-Service	1962660167	1962660167	1	1	ROGO-GUPTA, LISA MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112537	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
162833	Fee-for-Service	1104932045	1104932045	1	1	ROSS GOLDBERG MD	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
162890	Fee-for-Service	1801801279	1801801279	2	1	RADPARVAR, MANSOOR	1/15/2020	246ZC0007X	NA	Other	026	PHYSICIANS	50959	09	Gynecology (D.O. only)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
162901	Fee-for-Service	1134169535	1134169535	2	15	REACH AIR MEDICAL SERVICES L	3/15/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18708 READINESS ST	BLDG 720 STE 100	VICTORVILLE	CA	92394	7984	36	06071	34.593561	-117.3720375	San Bernardino County
162929	Fee-for-Service	1902861297	1902861297	1	1	REGENTS OF THE UCLA	7/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
162985	Fee-for-Service	1134169535	1134169535	2	7	REACH AIR MEDICAL SERVICES L	11/30/2009	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	86-400 LIGHTNING ST	HANGER D	THERMAL	CA	92274	9576	33	06065	33.6384023	-116.16228	Riverside County
162989	Fee-for-Service	1326305541	1326305541	1	1	RONAGHI, REZA MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131996	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
162997	Fee-for-Service	1699228866	1699228866	1	1	RAUDABAUGH, BENJAMIN NP	7/13/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
163000	Fee-for-Service	1508646159	1508646159	1	1	ROBINSON RESIDENTIAL LLC	1/7/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6723 6TH AVE	None	LOS ANGELES	CA	90043	4407	19	06037	33.97751025	-118.3236307	Los Angeles County
163047	Fee-for-Service	1811914377	1811914377	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2141 HIGH STREET	None	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
163089	Fee-for-Service	1669542742	1669542742	1	1	ROSEN, EMANUEL H MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71392	36	Psychiatry	0	In state provider	None	9850 GENESEE AVE	STE 910	LA JOLLA	CA	92037	1220	37	06073	32.882913	-117.226341	San Diego County
163090	Fee-for-Service	1487962593	1487962593	1	1	RAY, ANDREW L MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120016	05	Anesthesiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
163100	Fee-for-Service	1346311313	1346311313	1	1	RIEMER, KENNETH D MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24726	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163112	Fee-for-Service	1013411222	1013411222	1	1	ROSS, KATHERINE MD	5/1/2023	207P00000X	NA	Other	026	PHYSICIANS	165760	None	None	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
163117	Fee-for-Service	1962660167	1962660167	1	1	ROGO-GUPTA, LISA MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
163138	Fee-for-Service	1336109115	1336109115	1	1	REMICK, KRISTY M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	817 COURT ST	STE 10	JACKSON	CA	95642	2156	03	06005	38.35288237	-120.7662416	Amador County
163139	Fee-for-Service	1366903502	1366903502	1	1	RAUCH, SAMUEL A MD	5/25/2022	207R00000X	NA	Other	026	PHYSICIANS	176142	None	None	0	In state provider	None	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
163147	Fee-for-Service	1063733590	1063733590	1	1	ROCHA, SUSAN G PT	8/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
163157	Fee-for-Service	1538223144	1538223144	1	1	ROSE, BONNIE R LMFT	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 LOS ENCINOS RD	# 28	OJAI	CA	93023	9732	56	06111	34.42263816	-119.3061784	Ventura County
163175	Fee-for-Service	1801801279	1801801279	2	1	RADPARVAR, MANSOOR	1/15/2020	246ZC0007X	NA	Other	026	PHYSICIANS	50959	15	Obstetrics (D.O. only)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
163188	Fee-for-Service	1669544417	1669544417	1	1	RAHMAN, ARIFA C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53814	36	Psychiatry	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
163190	Fee-for-Service	1134169535	1134169535	2	37	REACH AIR MEDICAL SERVICES L	4/24/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LC.	1864 WEST RIVER SPRINGS	None	PORTERVILLE	CA	93257	6775	54	06107	36.05748945	-119.0568833	Tulare County
163199	Fee-for-Service	1558793042	1558793042	1	1	ROKNI, LALEH LMFT	3/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
163212	Fee-for-Service	1801911409	1801911409	1	1	REID, SHEREEN A LCSW	4/6/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	9718	50	06099	37.70451024	-121.0709696	Stanislaus County
163216	Fee-for-Service	1902861297	1902861297	1	1	REGENTS OF THE UCLA	7/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
163234	Fee-for-Service	1639512668	1639512668	1	1	RUIZ, LIZETTE D MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
163277	Fee-for-Service	1477996643	1477996643	1	1	RAWSON, DAVID W MD	8/4/2022	208M00000X	NA	Other	026	PHYSICIANS	177053	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
163280	Fee-for-Service	1013035716	1013035716	1	3	REGENTS OF THE UNIVERSITY OF	10/13/2016	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	8910 VILLA LA JOLLA DR	STE 110	LA JOLLA	CA	92037	1701	37	06073	32.87058261	-117.2338797	San Diego County
163332	Fee-for-Service	1659513224	1659513224	1	1	RUTH, AMANDA MD	6/27/2023	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
163355	Fee-for-Service	1114026275	1114026275	1	1	RICHTER, SUSAN LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 GRANADA ST	STE N	CAMARILLO	CA	93010	7866	56	06111	34.21527102	-119.0535007	Ventura County
163496	Fee-for-Service	1750871869	1750871869	1	1	RAYAN, NICOLE C MD	11/8/2022	207P00000X	NA	Other	026	PHYSICIANS	175487	None	None	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
163512	Fee-for-Service	1790364156	1790364156	1	1	RAMSEY, CLAUDIA N MD	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	191467	40	Pediatrics	0	In state provider	None	8910 VILLA LA JOLLA DR	STE 110	LA JOLLA	CA	92037	1701	37	06073	32.87058261	-117.2338797	San Diego County
163521	Fee-for-Service	1912317165	1912317165	1	1	ROSS, LINDSEY B MD	2/20/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	126185	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
163529	Fee-for-Service	1639190275	1639190275	1	1	REYNOSA, MANUEL S MD	8/30/1995	207L00000X	NA	Other	026	PHYSICIANS	76600	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
163556	Fee-for-Service	1164186599	1164186599	1	1	RIGHTHOME HEALTH CARE INC	1/26/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	UNIT 498	ENCINO	CA	91436	2914	19	06037	34.15524484	-118.4756687	Los Angeles County
163581	Fee-for-Service	1174924633	1174924633	1	1	RUIZ BARROS, VIVIANA F MD	9/1/2021	390200000X	NA	Other	026	PHYSICIANS	168667	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
163608	Fee-for-Service	1699035717	1699035717	1	1	ROBERT YOO	2/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
163622	Fee-for-Service	1750961843	1750961843	1	1	ROBERTS, MARSHALL C MD	10/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189192	08	Family Practice	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
163624	Fee-for-Service	1831137744	1831137744	1	1	RAO, DINESH MD	4/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89461	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
163645	Fee-for-Service	1700976586	1700976586	1	1	RODRIGUEZ, CLAUDETTE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13677 W MCDOWELL RD	None	GOODYEAR	AZ	85395	2635	00	None	33.461982	-112.3535475	Maricopa County
163665	Fee-for-Service	1861409724	1861409724	1	1	ROSE, ANTOINETTE E MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69823	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
163681	Fee-for-Service	1750519401	1750519401	1	1	RESOLUTION IMAGING MEDICAL	8/4/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CORPORATION	2336 SANTA MONICA BLVD	SUITE 206	SANTA MONICA	CA	90404	2938	19	06037	34.03136627	-118.4766854	Los Angeles County
163719	Fee-for-Service	1265447734	1265447734	1	1	REICHARD, KAREN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
163732	Fee-for-Service	1316372519	1316372519	1	2	REYNAGA, NATALIE J LCSW	10/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8350 ARCHIBALD AVE	#100	RANCHO CUCAMONGA	CA	91730	0000	36	06071	34.10202623	-117.5935082	San Bernardino County
163769	Fee-for-Service	1245388537	1245388537	1	1	RAYMOND W. M. CHEUNG, M. D.,	12/27/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	A PROFESSIONAL MEDICAL	1048 S GARFIELD AVE	201	ALHAMBRA	CA	91801	4768	19	06037	34.083009	-118.123041	Los Angeles County
163772	Fee-for-Service	1881863504	1881863504	2	1	RSCR CALIFORNIA INCORPORATED	2/28/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1130 LAURISTON DRIVE	None	SAN DIEGO	CA	92154	3325	37	06073	32.57538726	-117.0715977	San Diego County
163779	Fee-for-Service	1326601485	1326601485	1	1	ROARK, TRAVIS J MD	5/16/2023	207R00000X	NA	Other	026	PHYSICIANS	180317	None	None	0	In state provider	None	320 SANTA FE DRIVE	107-B	ENCINITAS	CA	92024	1334	37	06073	33.038847	-117.285579	San Diego County
163784	Fee-for-Service	1649284712	1649284712	1	1	ROBERT P MONTENEGRO	1/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10 4TH AVE SE	None	GLENWOOD	MN	56334	1820	00	None	45.64674465	-95.38934053	Pope County
163802	Fee-for-Service	1619199593	1619199593	1	1	RAMIREZ, AUGUSTIN R DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1155 N VERMONT AVE	STE 200	LOS ANGELES	CA	90029	1728	19	06037	34.092549	-118.2917875	Los Angeles County
163880	Fee-for-Service	1750439543	1750439543	1	1	RICHARDSON, HAL E MD	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	52543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
163884	Fee-for-Service	1952326555	1952326555	1	1	RALPHS GROCERY COMPANY	3/8/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #111	2201 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3626	19	06037	33.88573494	-118.3179502	Los Angeles County
163913	Fee-for-Service	1902869357	1902869357	1	1	RENAL TREATEMNT CTRS CA	12/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	MOUNTAIN VIEW DIALYSIS	4041 N. UNIVERSITY PKWY	STE B	SAN BERNARDINO	CA	92407	1823	36	06071	34.16540286	-117.3326866	San Bernardino County
163982	Fee-for-Service	1558304733	1558304733	1	1	REINHART, GLENN A MD	8/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75349	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
164008	Fee-for-Service	1497770978	1497770978	1	1	RASMUSSEN, MERWIN CRNA	11/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
164015	Fee-for-Service	1912205642	1912205642	1	1	RAMOS, PATRICK M MD	5/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116045	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
164094	Fee-for-Service	1669620647	1669620647	1	1	RECHT, BRIAN R MD	3/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101169	01	General Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
164097	Fee-for-Service	1407091820	1407091820	1	1	RAMCHANDRAN, KAVITHA J MD	8/10/2010	207R00000X	NA	Other	026	PHYSICIANS	94704	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164100	Fee-for-Service	1447718499	1447718499	1	1	REYES, MARIO A CRNA	9/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
164107	Fee-for-Service	1245627942	1245627942	1	1	RAVID, NOGA L MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126721	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
164177	Fee-for-Service	1285015511	1285015511	1	1	RADILLO, SOFIA MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146676	01	General Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	5480	19	06037	34.2206967	-118.5342638	Los Angeles County
164196	Fee-for-Service	1992783021	1992783021	1	1	ROBEY, EDWIN L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 INDEPENDENCE BLVD	None	VIRGINIA BCH	VA	23455	6005	00	None	36.86771335	-76.13267801	Virginia Beach city
164197	Fee-for-Service	1770841108	1770841108	1	1	RATHE, JENNIFER A MD	7/27/2021	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	173103	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164210	Fee-for-Service	1780620021	1780620021	1	1	RO, JOHN D MD	9/13/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54681	08	Family Practice	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
164218	Fee-for-Service	1154839678	1154839678	1	1	R&R SURGICAL INSTITUTE	5/22/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	21250 HAWTHORNE BLVD	STE 435	TORRANCE	CA	90503	5504	19	06037	33.83566432	-118.3531683	Los Angeles County
164221	Fee-for-Service	1619021235	1619021235	1	1	REVELES, ADA I LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
164266	Fee-for-Service	1972821817	1972821817	1	1	REDDY, GEETHA G MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113178	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
164324	Fee-for-Service	1174676670	1174676670	1	3	RIVERSIDE-SAN BERNARDINO	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11980 MOUNT VERNON AVE	None	GRAND TERRACE	CA	92313	5172	36	06071	34.036353	-117.3136565	San Bernardino County
164362	Fee-for-Service	1174971170	1174971170	1	1	RAGHID, MEHMIYA MD	3/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181049	None	None	0	In state provider	None	1111 W 4TH ST	STE A	MADERA	CA	93637	4474	20	06039	36.95563823	-120.0735861	Madera County
164374	Fee-for-Service	1689905325	1689905325	1	1	RANCHO PHYSICAL THERAPY, INC	12/4/2019	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.	11276 5TH ST	STE 400	RANCHO CUCAMONGA	CA	91730	0921	36	06071	34.0809351	-117.559021	San Bernardino County
164392	Fee-for-Service	1225430580	1225430580	1	1	RIGHT CHOICE SENIOR LIVING	1/9/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	6354 CASCADE ST	None	SAN DIEGO	CA	92122	2421	37	06073	32.85458086	-117.208619	San Diego County
164436	Fee-for-Service	1437511433	1437511433	1	1	ROBERTS, TYLER P MD	8/2/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171883	None	None	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
164445	Fee-for-Service	1124034467	1124034467	1	1	RYAN, ANN I MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87694	None	None	0	In state provider	None	200 MED PLAZA	# 365, 420, 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
164448	Fee-for-Service	1659581957	1659581957	1	1	RAHM, AMY L MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108244	33	Thoracic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
164462	Fee-for-Service	1346233368	1346233368	1	1	REGENTS/UCDPBG/UROLOGY	5/1/1983	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
164477	Fee-for-Service	1558475814	1558475814	1	1	RICHARDSON-TE, CAROL A	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89382	41	Internal Medicine	0	In state provider	None	354 S VERMONT AVE	None	LOS ANGELES	CA	90020	1807	19	06037	34.06759719	-118.2916018	Los Angeles County
164491	Fee-for-Service	1346286507	1346286507	2	1	ROBINSON, MARK I MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33491	41	Internal Medicine	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
164499	Fee-for-Service	1346878717	1346878717	1	1	RAFATNIA, ALI MD	11/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191713	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
164522	Fee-for-Service	1174540660	1174540660	1	1	RICHARDS, JEROME R MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48920	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
164578	Fee-for-Service	1710189865	1710189865	1	1	RX STAFFING & HOME CARE	9/1/2000	251E00000X	NA	Other	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4640 MARCONI AVE	STE 1	SACRAMENTO	CA	95821	4355	34	06067	38.617164	-121.3560405	Sacramento County
164596	Fee-for-Service	1710366695	1710366695	1	1	RINALDO, LORENZO MD	5/31/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	177211	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164613	Fee-for-Service	1174676670	1174676670	1	3	RIVERSIDE-SAN BERNARDINO	6/9/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11980 MOUNT VERNON AVE	None	GRAND TERRACE	CA	92313	5172	36	06071	34.036353	-117.3136565	San Bernardino County
164624	Fee-for-Service	1336229657	1336229657	1	1	ROSTOVTSEVA, YULIYA P MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93627	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
164646	Fee-for-Service	1043776453	1043776453	1	1	ROCHIOS, BRIDGET NP	5/18/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
164665	Fee-for-Service	1689905325	1689905325	1	1	RANCHO PHYSICAL THERAPY, INC	12/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	11276 5TH ST	STE 400	RANCHO CUCAMONGA	CA	91730	0921	36	06071	34.0809351	-117.559021	San Bernardino County
164677	Fee-for-Service	1114281961	1114281961	1	1	RILEY, SARAH D LMFT	6/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
164685	Fee-for-Service	1508384884	1508384884	1	1	RODRIGUEZ, CESAR R LMFT	5/18/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
164702	Fee-for-Service	1417939158	1417939158	1	1	REIBER, GREGORY D MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	48802	90	Pathology-Forensic	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
164721	Fee-for-Service	1669939930	1669939930	1	1	RICHMOND, THERESA CRNA	2/17/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
164773	Fee-for-Service	1811320252	1811320252	1	1	RAMIREZ, ARACELI LMFT	10/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING CENTER	16820 PONDEROSA LN	None	RIVERSIDE	CA	92504	6228	33	06065	33.87622866	-117.3694523	Riverside County
164774	Fee-for-Service	1861682627	1861682627	1	1	RAWLINGS, LUKE M MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96735	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
164776	Fee-for-Service	1346286507	1346286507	2	1	ROBINSON, MARK I MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33491	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
164777	Fee-for-Service	1952489866	1952489866	1	1	RAO, BOLAR RAMA MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41071	30	Radiology	0	In state provider	None	1722 E HAMMER LN	None	STOCKTON	CA	95210	4120	39	06077	38.0207937	-121.2912444	San Joaquin County
164778	Fee-for-Service	1487702338	1487702338	1	1	RESSA, AMES D MD	7/8/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55284	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
164779	Fee-for-Service	1447360193	1447360193	1	1	RALEY'S	8/11/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 MARCONI AVE	None	SACRAMENTO	CA	95821	5302	34	06067	38.616921	-121.3819335	Sacramento County
164831	Fee-for-Service	1659329290	1659329290	1	1	RESPIRATORY MEDICAL GRP	5/17/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	130 LA CASA VIA	STE 2-208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
164883	Fee-for-Service	1528327632	1528327632	1	1	ROUSSOS TORRES, EVANTHIA T M	1/8/2020	207RX0202X	NA	Oncology	026	PHYSICIANS	166224	90	Pathology-Forensic	0	In state provider	D	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
164898	Fee-for-Service	1588737597	1588737597	1	1	RODRIGUEZ, ARIEL	1/31/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
164929	Fee-for-Service	1154435758	1154435758	1	1	RADFAR, FEREYDOON D MD	9/23/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167272	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
164942	Fee-for-Service	1689104440	1689104440	1	1	RUVALCABA, ARIANA LCSW	8/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
164955	Fee-for-Service	1447289178	1447289178	1	1	REBECCA L ROBERTS, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5325 FARAON ST	None	SAINT JOSEPH	MO	64506	3488	00	None	39.77271	-94.770648	Buchanan County
164980	Fee-for-Service	1043202427	1043202427	1	1	RANIERI, LEEANN M NP	2/8/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164991	Fee-for-Service	1417939158	1417939158	1	1	REIBER, GREGORY D MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	48802	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
165016	Fee-for-Service	1811652688	1811652688	1	1	RONALD J. OSTROM, P.C. CORPO	12/16/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER, P.C.	3900 COFFEE RD	SUITE 3	BAKERSFIELD	CA	93308	5050	15	06029	35.39498227	-119.0921227	Kern County
165032	Fee-for-Service	1902983851	1902983851	1	1	REZAEE, ALI MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74647	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
165062	Fee-for-Service	1811320252	1811320252	1	1	RAMIREZ, ARACELI LMFT	10/10/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING CENTER	16820 PONDEROSA LN	None	RIVERSIDE	CA	92504	6228	33	06065	33.87622866	-117.3694523	Riverside County
165118	Fee-for-Service	1811979727	1811979727	1	1	ROHRA, SRIKRISHIN MD	6/1/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50848	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2222 EAST ST	STE 260	CONCORD	CA	94520	2074	07	06013	37.98125538	-122.0329375	Contra Costa County
165122	Fee-for-Service	1124745906	1124745906	1	1	RRSH MEDICAL INC	11/10/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	540 E VIRGINIA WAY	103	BARSTOW	CA	92311	3910	36	06071	34.88811047	-117.01989	San Bernardino County
165151	Fee-for-Service	1700807815	1700807815	1	2	RETINAL CONSULTANTS OF	7/5/2016	193400000X	NA	Other	026	PHYSICIANS	33939	18	Ophthalmology	0	In state provider	SOUTHERN CALIFORNIA MED	12304 SANTA MONICA BLVD	STE 117	LOS ANGELES	CA	90025	2586	19	06037	34.03948285	-118.4656304	Los Angeles County
165168	Fee-for-Service	1750357158	1750357158	1	1	REPIQUE BIETZ, LORELEI J MD	12/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67129	None	None	0	In state provider	None	6432 WASHINGTON ST	None	YOUNTVILLE	CA	94599	1408	28	06055	38.39659858	-122.3569364	Napa County
165220	Fee-for-Service	1174858583	1174858583	1	1	RAMOS, ABEL DO	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11277	01	General Practice	0	In state provider	None	1117 E DEVONSHIRE AVENUE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
165225	Fee-for-Service	1063569721	1063569721	1	2	REICHERTER, DARYN S MD	12/26/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	80353	-	NOT APPLICABLE	0	In state provider	None	2400 MOORPARK AVE	STE 300	SAN JOSE	CA	95128	2680	43	06085	37.3160785	-121.937121	Santa Clara County
165267	Fee-for-Service	1164594248	1164594248	1	1	ROY BREEN MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
165300	Fee-for-Service	1497234058	1497234058	1	1	RUFINO, MAYA R LCSW	7/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 BRADFORD	STE 270	REDWOOD CITY	CA	94063	1571	41	06081	37.48799425	-122.2320157	San Mateo County
165310	Fee-for-Service	1649328659	1649328659	1	1	ROBINSON, NGUYEN-THI MD	7/26/2004	207R00000X	NA	Other	026	PHYSICIANS	83850	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
165322	Fee-for-Service	1619961059	1619961059	1	2	ROYALE HOME HEALTH	10/11/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	2626 FOOTHILL BLVD	STE 280	LA CRESCENTA	CA	91214	4570	19	06037	34.22187547	-118.2363189	Los Angeles County
165361	Fee-for-Service	1588778435	1588778435	1	1	REDDY, KIRAN M MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55459	41	Internal Medicine	0	In state provider	None	7215 N FRESNO ST	STE 102	FRESNO	CA	93720	2969	10	06019	36.84149009	-119.7829064	Fresno County
165383	Fee-for-Service	1093201162	1093201162	1	1	RAO, SHIKHA	1/22/2024	207ND0101X	NA	Dermatology	026	PHYSICIANS	192032	None	None	0	In state provider	None	2210 DEL PASO RD	None	SACRAMENTO	CA	95834	9671	34	06067	38.655189	-121.5091575	Sacramento County
165412	Fee-for-Service	1477757375	1477757375	1	1	ROBERTS, RACHEL M MD	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104970	None	None	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
165456	Fee-for-Service	1578686853	1578686853	1	1	REBELE, CHRISTOPHER S	1/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
165460	Fee-for-Service	1356327597	1356327597	1	1	RAOUFI, RAHIM A MD	12/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
165464	Fee-for-Service	1235687518	1235687518	1	1	RHYNE, SUSAN M LMFT	9/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
165479	Fee-for-Service	1740609775	1740609775	1	1	RIVERON, ALEXANDER K MD	8/12/2021	2086S0127X	NA	General Surgery	026	PHYSICIANS	169527	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
165523	Fee-for-Service	1629335237	1629335237	1	1	RUSTAD, KRISTINE MD	10/20/2020	208200000X	NA	General Surgery	026	PHYSICIANS	127857	24	Plastic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
165556	Fee-for-Service	1962459537	1962459537	1	2	RESPIRATORY TECHNOLOGIES INC	7/26/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	5905 NATHAN LANE NORTH	SUITE 200	PLYMOUTH	MN	55442	1619	00	None	45.06090025	-93.40883584	Hennepin County
165567	Fee-for-Service	1386630747	1386630747	1	1	ROBINSON'S PHARMACY &	7/21/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLIES INC	1261 BROADWAY	None	PLACERVILLE	CA	95667	5901	09	06017	38.73146877	-120.7847648	El Dorado County
165590	Fee-for-Service	1659371581	1659371581	2	1	REYNA, TROY M MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	87971	40	Pediatrics	0	In state provider	None	455 SOUTH MAIN STREET	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
165606	Fee-for-Service	1235649260	1235649260	1	1	RENEWING HOPE FAMILY COUNSEL	5/24/2021	103T00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
165662	Fee-for-Service	1720355712	1720355712	1	1	ROGERS, KRISTEN D MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117030	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
165679	Fee-for-Service	1932940319	1932940319	1	1	RADLOFF, IAN NP	8/6/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2100 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
165686	Fee-for-Service	1093911471	1093911471	1	1	ROSSI, JENNIFER D LMFT	2/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
165716	Fee-for-Service	1770616716	1770616716	1	1	ROCCO, AUDREY K MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65998	41	Internal Medicine	0	In state provider	WOMEN'S HEALTH PAVILION	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
165718	Fee-for-Service	1760017651	1760017651	1	1	RIVERS, KANDICE NP	12/25/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
165753	Fee-for-Service	1821047499	1821047499	1	1	RIVERSIDE SURGERY CENTER	7/6/1998	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	2801 PARK MARINA DR	None	REDDING	CA	96001	2822	45	06089	40.5736108	-122.3737048	Shasta County
165764	Fee-for-Service	1710083753	1710083753	1	1	REZAIE, KAMBIZ K MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87657	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
165807	Fee-for-Service	1942278866	1942278866	1	1	ROBERT STROTH	11/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6644 E BAYWOOD AVE	None	MESA	AZ	85206	1747	00	None	33.411159	-111.688686	Maricopa County
165822	Fee-for-Service	1275681611	1275681611	2	1	RICKE, TRACY L MD	1/16/2020	2080P0204X	NA	Other	026	PHYSICIANS	159924	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
165823	Fee-for-Service	1144274184	1144274184	1	1	REDDY, GUNDALA S MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71290	05	Anesthesiology	0	In state provider	None	2848 PARK AVE	STE B	MERCED	CA	95348	3375	24	06047	37.31338491	-120.4725729	Merced County
165838	Fee-for-Service	1194389205	1194389205	1	1	RENDER-TEIXEIRA, CAROLINE L	4/9/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161933	08	Family Practice	0	In state provider	MD	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
165845	Fee-for-Service	1811932957	1811932957	1	1	REICHEL, STEVEN D MD	4/30/1993	207P00000X	NA	Other	026	PHYSICIANS	60584	66	Emergency Medicine (Urgent Care)	0	In state provider	None	508 E HICKORY AVE	None	LOMPOC	CA	93436	7337	42	06083	34.63568383	-120.4522776	Santa Barbara County
165866	Fee-for-Service	1093274821	1093274821	1	1	ROZO, SANTIAGO MD	11/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180680	None	None	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
165867	Fee-for-Service	1780611533	1780611533	1	1	ROCHA, RONALD E MD	10/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	76988	22	Pathology (M.D. only)	0	In state provider	None	3701 SOUTH HIGUERA ST	None	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
165868	Fee-for-Service	1134624737	1134624737	1	1	ROSERO, ROMINA M LMFT	9/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
165890	Fee-for-Service	1275643199	1275643199	1	1	ROSS, ALESSANDRA A MD	9/27/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	128009	20	Orthopedic Surgery	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
165892	Fee-for-Service	1235649260	1235649260	1	1	RENEWING HOPE FAMILY COUNSEL	4/6/2020	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ING CENTER, INC.	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
165895	Fee-for-Service	1013398528	1013398528	1	1	REYES, JOSE MD	7/28/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184897	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
165942	Fee-for-Service	1144240698	1144240698	1	1	RAGHAVAN, RAVI MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82573	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
165948	Fee-for-Service	1720355712	1720355712	1	1	ROGERS, KRISTEN D MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117030	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
165984	Fee-for-Service	1891791786	1891791786	1	1	RUSSO, JOSEPH S DO	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	6637	08	Family Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
165993	Fee-for-Service	1932143559	1932143559	1	1	RHEE, RICHARD B MD	9/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68434	30	Radiology	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
166112	Fee-for-Service	1275681611	1275681611	2	1	RICKE, TRACY L MD	1/16/2020	2080P0204X	NA	Other	026	PHYSICIANS	159924	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
166141	Fee-for-Service	1669431672	1669431672	1	1	REBECCA L SENTMAN MD	8/23/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4700 WATERS AVE	None	SAVANNAH	GA	31404	6220	00	None	32.030406	-81.088569	Chatham County
166146	Fee-for-Service	1215903141	1215903141	1	1	ROGOFF, WALTER A MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	42624	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
166147	Fee-for-Service	1821871278	1821871278	1	1	RUTINWA, JACQUELINE NP	1/20/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
166151	Fee-for-Service	1558411553	1558411553	1	1	REED, MICHAEL A MD	6/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166956	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1625 STOCKTON BLVD	205	SACRAMENTO	CA	95816	7092	34	06067	38.56554	-121.4664615	Sacramento County
166177	Fee-for-Service	1235649260	1235649260	1	1	RENEWING HOPE FAMILY COUNSEL	4/6/2020	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
166196	Fee-for-Service	1396914545	1396914545	1	1	RANSOM, PHILIS D MD	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100123	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	249 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3707	36	06071	34.13591253	-117.280809	San Bernardino County
166263	Fee-for-Service	1336103480	1336103480	1	1	RUSHAKOFF, ROBERT JAY MD	8/21/1996	207RE0101X	NA	Endocrinology	026	PHYSICIANS	51859	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2211 POST ST	None	SAN FRANCISCO	CA	94115	3464	38	06075	37.78446663	-122.4382772	San Francisco County
166292	Fee-for-Service	1548877012	1548877012	1	1	REES, KATIE E LCSW	3/28/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
166303	Fee-for-Service	1770157463	1770157463	1	1	RAMIREZ GARCIA, KAYLEEN LMF	3/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
166307	Fee-for-Service	1558311811	1558311811	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
166357	Fee-for-Service	1619146388	1619146388	1	1	RAMIREZ, RENE M MD	4/4/2008	208600000X	NA	General Surgery	026	PHYSICIANS	83626	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
166372	Fee-for-Service	1710902044	1710902044	1	1	REED, SHARON L MD	5/31/1982	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40122	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
166389	Fee-for-Service	1558894048	1558894048	1	1	RODRIGUEZ, KRISTINA A MD	9/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158311	08	Family Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
166412	Fee-for-Service	1871522136	1871522136	1	1	ROTTER, JEROME I MD	7/3/1997	174400000X	NA	Other	026	PHYSICIANS	27687	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
166434	Fee-for-Service	1104845676	1104845676	1	1	RAYBURN, KEITH S MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50145	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
166435	Fee-for-Service	1841579489	1841579489	1	1	ROUHANI SISAN, MEHRAN MD	10/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126959	41	Internal Medicine	0	In state provider	None	4314 W SLAUSON AVENUE	None	LOS ANGELES	CA	90043	2808	19	06037	33.98885257	-118.3509655	Los Angeles County
166452	Fee-for-Service	1003345281	1003345281	1	1	RINCON, ANGELA M LMFT	7/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	1	Border provider	None	187 WARM SPRINGS	SUITE B157	LAS VEGAS	NV	89119	4110	00	None	36.05690954	-115.164216	Clark County
166462	Fee-for-Service	1902061955	1902061955	1	1	RIORDAN, MARGARET A MD	7/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137141	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
166469	Fee-for-Service	1235649260	1235649260	1	1	RENEWING HOPE FAMILY COUNSEL	4/6/2020	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ING CENTER, INC.	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
166519	Fee-for-Service	1063999431	1063999431	1	1	ROGELIO DRENNING-MANRIQUEZ M	5/11/2023	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	.D., INC.	49617 CESAR CHAVEZ ST	SUITE B	COACHELLA	CA	92236	1535	33	06065	33.68797107	-116.1818005	Riverside County
166551	Fee-for-Service	1336103480	1336103480	1	1	RUSHAKOFF, ROBERT JAY MD	8/21/1996	207RE0101X	NA	Endocrinology	026	PHYSICIANS	51859	67	Endocrinology	0	In state provider	None	2211 POST ST	None	SAN FRANCISCO	CA	94115	3464	38	06075	37.78446663	-122.4382772	San Francisco County
166615	Fee-for-Service	1417944802	1417944802	1	1	RICHARD M ERNST, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10229 N 92ND ST	SUITE I-103	SCOTTSDALE	AZ	85258	4562	00	None	33.579099	-111.878703	Maricopa County
166622	Fee-for-Service	1316784002	1316784002	1	1	ROSEMEAD PHARMACY INC	8/30/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8150 GARVEY AVE	STE 107	ROSEMEAD	CA	91770	2472	19	06037	34.06261847	-118.09134	Los Angeles County
166652	Fee-for-Service	1730633694	1730633694	1	1	RAMIREZ, ANTHONY LCSW	3/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
166675	Fee-for-Service	1063587376	1063587376	1	1	RODEMS, JEANNINE M MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81126	08	Family Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
166717	Fee-for-Service	1811331903	1811331903	1	1	REN, ALYSSA F MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141628	01	General Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
166755	Fee-for-Service	1235649260	1235649260	1	1	RENEWING HOPE FAMILY COUNSEL	4/6/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ING CENTER, INC.	11840 MAGNOLIA	STE C	RIVERSIDE	CA	92503	7112	33	06065	33.89540021	-117.4902651	Riverside County
166784	Fee-for-Service	1013245315	1013245315	1	2	ROYER, JONATHAN D LMFT	12/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3175 SUNSET BLVD	STE 104	ROCKLIN	CA	95677	3091	31	06061	38.78584705	-121.2496644	Placer County
166875	Fee-for-Service	1710208897	1710208897	1	1	RIZO, JOSE C JR PT	8/21/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
166890	Fee-for-Service	1184042368	1184042368	1	1	ROTH, JESSICA C MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151130	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
166893	Fee-for-Service	1639210727	1639210727	1	1	ROYAL HEALTH HOMECARE AGENCY	10/30/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, INC	1272 CENTER COURT DRIVE	STE 204-205	COVINA	CA	91724	3667	19	06037	34.07289566	-117.864007	Los Angeles County
166921	Fee-for-Service	1700049111	1700049111	1	1	RELIANT HOME HEALTHCARE	3/8/2010	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	8880 BENSON AVENUE	UNIT 118	MONTCLAIR	CA	91763	1651	36	06071	34.09317481	-117.6809466	San Bernardino County
166948	Fee-for-Service	1336285956	1336285956	2	2	ROLLING OAKS PHARMACY INC	9/7/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	325 E ROLLING DR	140A	THOUSAND OAKS	CA	91361	1077	56	06111	34.17440716	-118.8715691	Ventura County
167010	Fee-for-Service	1639361231	1639361231	1	1	REYES, MARIAH R NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
167015	Fee-for-Service	1215023056	1215023056	1	2	REDWOOD ORTHOPAEDIC SURGERY	5/30/2002	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES AMC	208 CONCOURSE BLVD	1	SANTA ROSA	CA	95403	8210	49	06097	38.51255309	-122.7884839	Sonoma County
167022	Fee-for-Service	1285044073	1285044073	1	1	RAJANI, MOHSIN DO	1/8/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14467	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
167048	Fee-for-Service	1477091361	1477091361	1	1	ROBINSON, JENNIFER C LMFT	10/7/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	115271	-	NOT APPLICABLE	0	In state provider	None	8665 GIBBS DR	STE 150	SAN DIEGO	CA	92123	1739	37	06073	32.81043091	-117.1419105	San Diego County
167085	Fee-for-Service	1629296272	1629296272	1	1	RESEDA HORIZONS	10/13/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17831 SAN JOSE ST	None	GRANADA HILLS	CA	91344	5925	19	06037	34.2613132	-118.522789	Los Angeles County
167102	Fee-for-Service	1235117672	1235117672	1	1	RICHESON, ROBERT B III MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
167129	Fee-for-Service	1285941195	1285941195	1	1	REITER, SAMUEL J MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134996	18	Ophthalmology	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
167190	Fee-for-Service	1144275959	1144275959	1	1	RACE, MARK C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2539 MEDICAL DR	STE 110	ALAMOGORDO	NM	88310	8720	00	None	32.92257173	-105.9325965	Otero County
167231	Fee-for-Service	1972883155	1972883155	1	1	RAZ, EYTAN	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
167243	Fee-for-Service	1255785291	1255785291	1	1	RUIZ, BETSABE V LMFT	4/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
167261	Fee-for-Service	1073712402	1073712402	1	1	RAMIREZ, MARIA G LCSW	4/9/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
167287	Fee-for-Service	1871711416	1871711416	1	1	RAINBOW HORIZONS INC	7/8/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8723 HASKELL AVE	None	NORTH HILLS	CA	91343	4907	19	06037	34.228998	-118.476417	Los Angeles County
167312	Fee-for-Service	1417009648	1417009648	1	1	ROXAS, LEAH L MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97032	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
167325	Fee-for-Service	1083797435	1083797435	1	1	RIOS, DAVID N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32921	08	Family Practice	0	In state provider	None	24432 MUIRLANDS BLVD	STE 123	EL TORO	CA	92630	3990	30	06059	33.62755212	-117.7028876	Orange County
167347	Fee-for-Service	1285993030	1285993030	1	1	RIGGS, LAURA LCSW	8/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
167351	Fee-for-Service	1881782647	1881782647	1	1	RAMINENI, NEELAKANTAN MD	5/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41289	41	Internal Medicine	0	In state provider	None	4537 COLLEGE AVE	None	SAN DIEGO	CA	92115	4010	37	06073	32.759334	-117.066313	San Diego County
167393	Fee-for-Service	1235117672	1235117672	1	1	RICHESON, ROBERT B III MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
167398	Fee-for-Service	1336125020	1336125020	1	1	RAMIREZ, GABRIEL MD	2/1/1996	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	81222	None	None	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
167413	Fee-for-Service	1528242757	1528242757	1	1	RAMACHANDRAN, RAVI MD	7/1/2018	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	119166	20	Orthopedic Surgery	0	In state provider	None	2330 E BIDWELL ST	100	FOLSOM	CA	95630	3875	34	06067	38.666529	-121.1407065	Sacramento County
167442	Fee-for-Service	1760560833	1760560833	1	1	RADIGAN, JEFFREY J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35516	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
167471	Fee-for-Service	1659491611	1659491611	1	1	RIVERA-HO, SHAWN M LMFT	12/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17332 IRVINE BLVD STE 23	None	TUSTIN	CA	92780	3063	30	06059	33.748125	-117.8297258	Orange County
167480	Fee-for-Service	1225329683	1225329683	1	1	REDDY, SHIVANI K DO	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14815	77	Infectious Disease	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
167548	Fee-for-Service	1629453808	1629453808	1	1	ROUEL ENTERPRISES INC	2/18/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	860 JAMACHA RD	STE 107	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
167603	Fee-for-Service	1720394711	1720394711	1	1	REGENTS OF THE UNIVERSITY OF	12/20/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CALIFORNIA	2400 DEL PASO RD	STE 145	SACRAMENTO	CA	95834	9629	34	06067	38.654838	-121.516983	Sacramento County
167626	Fee-for-Service	1609194497	1609194497	1	2	REGENTS OF THE UNIVERSITY OF	2/4/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
167633	Fee-for-Service	1386761476	1386761476	1	1	ROSENTHAL, AMANDA J LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
167657	Fee-for-Service	1881642551	1881642551	1	1	REYNOLDS, GLENN T MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63930	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
167675	Fee-for-Service	1801821855	1801821855	1	1	REDDY, VIMALA T MD INC	10/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54465	08	Family Practice	0	In state provider	None	4950 BARRANCA PKWY	STE 103B	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
167679	Fee-for-Service	1235117672	1235117672	1	1	RICHESON, ROBERT B III MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
167680	Fee-for-Service	1407042914	1407042914	1	1	ROSEQUIST, LISA A PHD	3/14/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
167685	Fee-for-Service	1811351992	1811351992	1	1	RANU, PAULINDER S MD	9/27/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157613	40	Pediatrics	0	In state provider	None	5557 E KINGS CANYON RD	None	FRESNO	CA	93727	4528	10	06019	36.73596559	-119.7021794	Fresno County
167706	Fee-for-Service	1902890320	1902890320	1	1	REDDY, USHA R MD	12/30/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67304	08	Family Practice	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
167716	Fee-for-Service	1659627602	1659627602	1	1	RETINA ORANGE COUNTY, INC	11/30/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	117865	18	Ophthalmology	0	In state provider	None	16100 SAND CANYON AVENUE	STE 385	IRVINE	CA	92618	3716	30	06059	33.6632187	-117.7721984	Orange County
167718	Fee-for-Service	1659311314	1659311314	1	1	ROBERT T STEINBOCK	5/13/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4000 KRESGE WAY	None	LOUISVILLE	KY	40207	4605	00	None	38.23923389	-85.63896565	Jefferson County
167731	Fee-for-Service	1255441929	1255441929	1	1	RALEYS	5/11/1989	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2325 MYERS ST	None	OROVILLE	CA	95966	5476	04	06007	39.50609869	-121.5507664	Butte County
167733	Fee-for-Service	1831139534	1831139534	1	1	REN, CHAUN Y MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	57169	05	Anesthesiology	0	In state provider	None	301 N NEWPORT BLVD	None	NEWPORT BEACH	CA	92663	4120	30	06059	33.6242782	-117.9284249	Orange County
167777	Fee-for-Service	1841212289	1841212289	1	1	RICHEY, DONNA A MD	12/28/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63581	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4201 TORRANCE BLVD	STE 350	TORRANCE	CA	90503	4573	19	06037	33.8375955	-118.358748	Los Angeles County
167797	Fee-for-Service	1316966450	1316966450	1	1	RALPHS GROCERY COMPANY	5/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #289	5601 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	3701	19	06037	34.06238435	-118.3509491	Los Angeles County
167812	Fee-for-Service	1043354111	1043354111	1	4	REDLANDS COMMUNITY HOSP	11/1/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	STE 104B	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
167836	Fee-for-Service	1629453808	1629453808	1	1	ROUEL ENTERPRISES INC	2/18/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	69	Unknown	0	In state provider	None	860 JAMACHA RD	STE 107	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
167837	Fee-for-Service	1275669376	1275669376	1	1	RSCR CALIFORNIA, INC	2/4/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	509 S GROVE AVE	None	ANAHEIM	CA	92805	4806	30	06059	33.83351754	-117.8978445	Orange County
167841	Fee-for-Service	1952454274	1952454274	1	1	REYES, JOSE K MD	11/30/2018	207R00000X	NA	Other	026	PHYSICIANS	53379	41	Internal Medicine	0	In state provider	None	1625 TULLY RD	STE A	SAN JOSE	CA	95122	2533	43	06085	37.32091407	-121.8281894	Santa Clara County
167852	Fee-for-Service	1700211414	1700211414	1	1	ROSALES, ELVIS A LCSW	4/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88293	-	NOT APPLICABLE	0	In state provider	None	20630 CHATSWORTH ST	None	CHATSWORTH	CA	91311	1631	19	06037	34.26447565	-118.5830859	Los Angeles County
167869	Fee-for-Service	1366828790	1366828790	1	1	RANDALL, DERRICK R MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137743	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
167870	Fee-for-Service	1073955332	1073955332	1	1	RAPHAEL, YANIV R MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135610	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
167879	Fee-for-Service	1952602732	1952602732	1	1	RAMIREZ, ADELINA C LCSW	6/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
167892	Fee-for-Service	1720394711	1720394711	1	1	REGENTS OF THE UNIVERSITY OF	9/12/2022	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	2400 DEL PASO RD	STE 145	SACRAMENTO	CA	95834	9629	34	06067	38.654838	-121.516983	Sacramento County
167909	Fee-for-Service	1659707693	1659707693	1	1	RICHARDS, KATE M MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	144793	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
167920	Fee-for-Service	1356304109	1356304109	1	1	RAJA, KUMARA S MD INC	11/30/1986	207RS0012X	NA	Other	026	PHYSICIANS	26451	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17822 BEACH BLVD	STE 321	HUNTINGTON BEACH	CA	92647	7170	30	06059	33.70331388	-117.9890471	Orange County
167954	Fee-for-Service	1659468999	1659468999	1	1	RUSSELL, GAIL F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61646	08	Family Practice	0	In state provider	None	470 S AUBURN ST	STE B	GRASS VALLEY	CA	95945	7292	29	06057	39.21060459	-121.0619793	Nevada County
168002	Fee-for-Service	1700969128	1700969128	1	1	RONALD SHAW	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
168008	Fee-for-Service	1053340927	1053340927	1	1	RALPH MANCHESTER	12/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	738 LIBRARY RD	None	ROCHESTER	NY	14627	0617	00	None	43.127982	-77.6273625	Monroe County
168009	Fee-for-Service	1457593535	1457593535	1	1	RONALD JOHN GARVIN	7/1/2009	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7513 LINDALE DR	None	SACRAMENTO	CA	95828	3913	34	06067	38.492694	-121.4211015	Sacramento County
168020	Fee-for-Service	1841636198	1841636198	1	1	ROSAASEN FAMILY MEDICINE INC	8/25/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	430 E AVENIDA DE LOS ARB	STE 204	THOUSAND OAKS	CA	91360	3017	56	06111	34.21786948	-118.8693896	Ventura County
168025	Fee-for-Service	1295198455	1295198455	1	1	RAZON, NA'AMAH MD	5/15/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152346	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
168030	Fee-for-Service	1093317059	1093317059	1	1	REED, SAVONNA S PT	11/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
168060	Fee-for-Service	1689783003	1689783003	1	1	RITE AID #6195	1/16/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	9000 MING AVE	STE A	BAKERSFIELD	CA	93311	1319	15	06029	35.33989328	-119.1034715	Kern County
168086	Fee-for-Service	1750466876	1750466876	1	1	RHODEN, SANDRA MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	45766	30	Radiology	0	In state provider	None	35800 BOB HOPE DRIVE	STE 150B	RANCHO MIRAGE	CA	92270	1722	33	06065	33.790527	-116.4058645	Riverside County
168096	Fee-for-Service	1326117144	1326117144	1	1	RICHARD S MUNSEN JR. M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	None	SEATTLE	WA	98195	0001	00	None	47.65080692	-122.3081828	King County
168124	Fee-for-Service	1629453808	1629453808	1	1	ROUEL ENTERPRISES INC	2/18/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	860 JAMACHA RD	STE 107	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
168128	Fee-for-Service	1306053566	1306053566	1	1	REBECCA MARSH M.D.	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
168143	Fee-for-Service	1134169535	1134169535	2	3	REACH AIR MEDICAL SERVICES L	11/30/2009	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4555 W AVENUE G	None	LANCASTER	CA	93536	8402	19	06037	34.742997	-118.2115215	Los Angeles County
168152	Fee-for-Service	1003934803	1003934803	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168187	Fee-for-Service	1447386362	1447386362	1	1	RES-CARE CALIFORNIA, INC	9/18/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8141 CHIMANGO CT	None	ANTELOPE	CA	95843	5332	34	06067	38.717433	-121.350186	Sacramento County
168195	Fee-for-Service	1659707693	1659707693	1	1	RICHARDS, KATE M MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	144793	08	Family Practice	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
168223	Fee-for-Service	1952301392	1952301392	1	1	REGENTS OF THE UNIVERSITY OF	12/15/2017	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	601 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	1364	19	06037	34.06739422	-118.4451349	Los Angeles County
168229	Fee-for-Service	1184828527	1184828527	1	1	REDDY, HARI R	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98225	41	Internal Medicine	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
168300	Fee-for-Service	1548943996	1548943996	1	1	RAMOS, DELIA PT	10/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
168327	Fee-for-Service	1154524395	1154524395	1	1	RAFIQ, TARIQ A MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97185	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
168409	Fee-for-Service	1952629743	1952629743	1	1	RATCLIFF, REBECCA C CNP	5/17/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
168413	Fee-for-Service	1700350345	1700350345	1	1	RAMM, THOMAS M CPO	1/16/2019	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	10132 ARTESIA PL	None	BELLFLOWER	CA	90706	6729	19	06037	33.87478742	-118.1185792	Los Angeles County
168427	Fee-for-Service	1003934803	1003934803	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168520	Fee-for-Service	1952319816	1952319816	1	1	RETHERFORD, RALPH E MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	24305	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16050 VIA ESTE RD	None	SONORA	CA	95370	8428	55	06109	37.98313623	-120.2907755	Tuolumne County
168532	Fee-for-Service	1215027446	1215027446	1	3	RABIN BERAL DPM A PODIATRY C	12/3/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ORPORATION	1141 W REDONDO BEACH BLV	STE 302	GARDENA	CA	90247	3583	19	06037	33.89247036	-118.2941482	Los Angeles County
168549	Fee-for-Service	1629193255	1629193255	1	1	RADZIK, MARI PHD	6/23/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
168588	Fee-for-Service	1942388624	1942388624	1	1	RODKIEWICZ, TOMASZ MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50874	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
168605	Fee-for-Service	1275526295	1275526295	1	2	REGENTS/UCDPBG/ORTHO SUR	5/1/1999	207X00000X	NA	Orthopedic Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
168620	Fee-for-Service	1609804848	1609804848	1	1	ROSENBERG, JAY H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17059	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
168673	Fee-for-Service	1962549295	1962549295	1	2	RECOVERY HOMES OF AMERICA IN	7/11/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	FORNIA	13671 & 13681 ROSALIND	None	TUSTIN	CA	92780	1924	30	06059	33.76432968	-117.8262094	Orange County
168700	Fee-for-Service	1134169535	1134169535	2	14	REACH AIR MEDICAL SERVICES L	3/6/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5400 WILLOWS RD	None	ALPINE	CA	91901	1628	37	06073	32.84232646	-116.6965059	San Diego County
168703	Fee-for-Service	1114044310	1114044310	1	1	RIOS, SIOBHAN LMFT	9/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
168725	Fee-for-Service	1356528640	1356528640	1	1	RBB HEALTHCARE, INC	7/1/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GLADSTONE CARE & REHAB	435 E GLADSTONE ST	None	GLENDORA	CA	91740	5159	19	06037	34.11396648	-117.8564895	Los Angeles County
168761	Fee-for-Service	1093893711	1093893711	1	1	RABOWSKY, JEFFREY H MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67950	61	Unknown	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
168774	Fee-for-Service	1184681991	1184681991	1	1	ROKOS, IVAN C S MD	5/31/1996	207P00000X	NA	Other	026	PHYSICIANS	78882	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
168789	Fee-for-Service	1780709295	1780709295	1	1	ROSEN, MAYA K MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86374	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
168791	Fee-for-Service	1235460510	1235460510	1	1	ROJAS, ARBIS MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114775	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITES 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
168808	Fee-for-Service	1770528226	1770528226	1	1	ROQUE, KATHERINE I MD	4/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92731	40	Pediatrics	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
168827	Fee-for-Service	1891741989	1891741989	1	1	REVER, LINDA J MD	8/6/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	56940	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
168867	Fee-for-Service	1457623969	1457623969	1	1	REICHERT, CHRISTINA M	4/30/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	573009	-	NOT APPLICABLE	0	In state provider	None	10603 DOWNEY AVE	10607, 10615 AND 10621	DOWNEY	CA	90241	3426	19	06037	33.94617788	-118.1295872	Los Angeles County
168875	Fee-for-Service	1790042190	1790042190	1	1	RAYGOZA, JUAN M LMFT	6/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
168894	Fee-for-Service	1275526295	1275526295	1	2	REGENTS/UCDPBG/ORTHO SUR	8/24/2020	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
168895	Fee-for-Service	1366197956	1366197956	1	1	RAMESH MOOLANI, MD INC	3/9/2022	261QX0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	855 THIRD AVE	STE 3330	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
168901	Fee-for-Service	1831290345	1831290345	1	1	REDDING PAIN MEDICINE	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65834	None	None	0	In state provider	None	1238 WEST ST	None	REDDING	CA	96001	0415	45	06089	40.58551548	-122.3983748	Shasta County
168906	Fee-for-Service	1609804848	1609804848	1	1	ROSENBERG, JAY H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17059	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
168924	Fee-for-Service	1316586696	1316586696	1	1	REXROTH, EMILY D CCC-SLP	4/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 MARCONI AVE	None	SACRAMENTO	CA	95821	5309	34	06067	38.618109	-121.380255	Sacramento County
168934	Fee-for-Service	1245838671	1245838671	1	1	RAAZI CLINICAL LABORATORY LL	10/11/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	C	7171 HIGHWAY 6 N	STE 112	HOUSTON	TX	77095	2422	00	None	29.881548	-95.6478195	Harris County
168946	Fee-for-Service	1598438699	1598438699	1	1	REDDIC, SHALAINE NP	8/22/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
168954	Fee-for-Service	1699863621	1699863621	1	1	ROTHENBERG, PETER M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47158	41	Internal Medicine	0	In state provider	INC	657 CAMINO DE LOS MARES	STE 137	SAN CLEMENTE	CA	92673	2810	30	06059	33.4575611	-117.6492697	Orange County
168985	Fee-for-Service	1134169535	1134169535	2	20	REACH AIR MEDICAL SERVICES L	12/8/2016	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2360 BECKER BLVD	None	SANTA ROSA	CA	95403	8270	49	06097	38.5067719	-122.8041998	Sonoma County
169012	Fee-for-Service	1215500061	1215500061	1	1	RELOS, ALYSSA C NP	10/1/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
169030	Fee-for-Service	1841215449	1841215449	1	1	RALPHS GROCERY COMPANY	10/20/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #127	19781 RINALDI ST	None	NORTHRIDGE	CA	91326	4143	19	06037	34.27487793	-118.5639704	Los Angeles County
169058	Fee-for-Service	1649364084	1649364084	1	1	RANDALL, DONNA PT	12/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5255 EL CAMINO REAL	SUITE C	ATASCADERO	CA	93422	3351	40	06079	35.49280107	-120.6762923	San Luis Obispo County
169062	Fee-for-Service	1992821474	1992821474	1	1	REDDY, SUSHMA MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110135	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
169098	Fee-for-Service	1649533712	1649533712	1	1	ROCHE, BAILEY M MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127556	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
169171	Fee-for-Service	1164503744	1164503744	1	1	RICE, JOSHUA L MD	12/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87543	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
169211	Fee-for-Service	1366462913	1366462913	1	1	RICHARD G HALL, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	975 CHAMBERS ST	None	SOUTH OGDEN	UT	84403	4591	00	None	41.16481831	-111.9531191	Weber County
169214	Fee-for-Service	1962549295	1962549295	1	1	RECOVERY HOMES OF AMERICA IN	5/13/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	FORNIA	13672 & 13682 YORBA STR	None	TUSTIN	CA	92780	1831	30	06059	33.764328	-117.827021	Orange County
169216	Fee-for-Service	1174663157	1174663157	1	1	RIENHOFF, HUGH Y MD	5/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50543	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
169243	Fee-for-Service	1366544256	1366544256	1	1	RINDENAU, JAY MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61332	05	Anesthesiology	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
169294	Fee-for-Service	1548544166	1548544166	1	1	RAMA THIRU PATHI MD INC.	10/11/2021	207XS0106X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18145 US HIGHWAY 18	SUITE D	APPLE VALLEY	CA	92307	2210	36	06071	34.5404119	-117.2678454	San Bernardino County
169295	Fee-for-Service	1679905897	1679905897	1	1	ROSSIGNOL, CYNTHIA AU	12/20/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
169312	Fee-for-Service	1922009752	1922009752	1	1	RASHID, SAQIB MD	2/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96384	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	450 N GREENFIELD AVE	None	HANFORD	CA	93230	0000	16	06031	36.328968	-119.6582195	Kings County
169321	Fee-for-Service	1376787333	1376787333	2	1	ROKADIA, HAALA K MD	5/3/2023	207RC0200X	NA	Other	026	PHYSICIANS	170761	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
169327	Fee-for-Service	1780126029	1780126029	1	1	ROH, AHRA	6/25/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
169332	Fee-for-Service	1326092552	1326092552	1	1	REIMAN, CHARLES B MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	16465	05	Anesthesiology	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
169387	Fee-for-Service	1700412798	1700412798	1	1	RENSCHLER, KELSEY M MD	8/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	188674	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
169402	Fee-for-Service	1437323169	1437323169	1	1	REYNOLDS, PAUL Q MD	3/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
169442	Fee-for-Service	1881356947	1881356947	1	1	REINECK, KEVIN P OT	11/21/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
169457	Fee-for-Service	1164503744	1164503744	1	1	RICE, JOSHUA L MD	12/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87543	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
169462	Fee-for-Service	1851358717	1851358717	1	1	RESPICIO, S G OD APC	10/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY BY THE BAY	500 ALFRED NOBEL DR	STE 117	HERCULES	CA	94547	1839	07	06013	38.01799847	-122.2743374	Contra Costa County
169521	Fee-for-Service	1396053765	1396053765	1	1	REBECCA R THORESON PNP	6/18/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
169541	Fee-for-Service	1912043738	1912043738	1	1	ROBERT GILLESPIE	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
169577	Fee-for-Service	1255893731	1255893731	1	1	RUSS, TIFFANY J DO	5/30/2023	207L00000X	NA	Other	026	PHYSICIANS	21027	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
169580	Fee-for-Service	1548544166	1548544166	1	1	RAMA THIRU PATHI MD INC.	10/11/2021	207XS0106X	NA	Orthopedic Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18145 US HIGHWAY 18	SUITE D	APPLE VALLEY	CA	92307	2210	36	06071	34.5404119	-117.2678454	San Bernardino County
169598	Fee-for-Service	1194344507	1194344507	1	1	ROPER, THEODORE S MD	9/18/2024	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	178771	08	Family Practice	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
169600	Fee-for-Service	1922009752	1922009752	1	1	RASHID, SAQIB MD	2/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96384	43	Pediatric Allergy	0	In state provider	None	450 N GREENFIELD AVE	None	HANFORD	CA	93230	0000	16	06031	36.328968	-119.6582195	Kings County
169602	Fee-for-Service	1437227808	1437227808	1	1	RIVERA, FRANCISCO MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75431	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
169613	Fee-for-Service	1093943011	1093943011	1	1	ROJANO JENKINS, NATALIE M LC	1/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
169620	Fee-for-Service	1326092552	1326092552	1	1	REIMAN, CHARLES B MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	16465	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
169731	Fee-for-Service	1952637050	1952637050	1	2	REGENTS OF THE UNIVERSITY OF	3/27/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	THE REGENTS OF THE UNIVE	477 N EL CAMINO REAL	BLDG D STE 204	ENCINITAS	CA	92024	1370	37	06073	33.05700866	-117.262449	San Diego County
169744	Fee-for-Service	1164503744	1164503744	1	1	RICE, JOSHUA L MD	12/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1245 WILSHIRE BLVD	STE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
169753	Fee-for-Service	1265151260	1265151260	1	1	RTH MEDCARE	12/23/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8953 WOODMAN AVE	SUITE 203	ARLETA	CA	91331	6481	19	06037	34.23249056	-118.4383491	Los Angeles County
169757	Fee-for-Service	1235212044	1235212044	1	1	RAUSA, KATHERINE MD	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118168	None	None	0	In state provider	None	2905 TELEGRAPH AVENUE	None	BERKELEY	CA	94705	2017	01	06001	37.85736641	-122.2594952	Alameda County
169797	Fee-for-Service	1609222496	1609222496	1	1	RODRIGUEZ, EVELYN G	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	482 N ROSEMEAD BLVD	STE 103	PASADENA	CA	91107	3000	19	06037	34.15457831	-118.078192	Los Angeles County
169799	Fee-for-Service	1023188026	1023188026	1	1	RADFORD, JAMES A DO	3/31/2020	390200000X	NA	Other	026	PHYSICIANS	17662	08	Family Practice	0	In state provider	None	1117 E DEVONSHIRE AVENUE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
169864	Fee-for-Service	1679886451	1679886451	1	1	RYAN SPILMAN	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
169904	Fee-for-Service	1962813899	1962813899	1	1	RAMREDDY, NITYA R MD	6/15/2023	207RR0500X	NA	Other	026	PHYSICIANS	185287	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169932	Fee-for-Service	1548625296	1548625296	1	1	RAFIQ LTD LLC	6/28/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6633 COYLE AVENUE	STE 1	CARMICHAEL	CA	95608	6346	34	06067	38.668275	-121.3097265	Sacramento County
170021	Fee-for-Service	1952637050	1952637050	1	2	REGENTS OF THE UNIVERSITY OF	3/27/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	THE REGENTS OF THE UNIVE	477 N EL CAMINO REAL	BLDG D STE 204	ENCINITAS	CA	92024	1370	37	06073	33.05700866	-117.262449	San Diego County
170081	Fee-for-Service	1265737365	1265737365	1	1	REINBOLD, CHRISTOPHER T	11/2/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
170086	Fee-for-Service	1255562054	1255562054	1	1	RUSSIN, JONATHAN J MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103488	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
170124	Fee-for-Service	1639222326	1639222326	1	1	READ-ROCKWELL, TRUDIE N OT	11/20/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
170161	Fee-for-Service	1033154448	1033154448	1	1	ROGANOVIC, MIRA MD	3/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54026	41	Internal Medicine	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
170187	Fee-for-Service	1801922679	1801922679	1	1	RAO, REMA A MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111210	22	Pathology (M.D. only)	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
170193	Fee-for-Service	1386706117	1386706117	1	1	RAMOS, CARLOS E LCSW	12/16/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
170226	Fee-for-Service	1134169535	1134169535	2	28	REACH AIR MEDICAL SERVICES L	12/24/2015	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	655 SOUTH ROCK BLVD	None	RENO	NV	89502	4118	00	None	39.50240767	-119.7628465	Washoe County
170259	Fee-for-Service	1114925682	1114925682	1	1	ROBERT T. MORRISON M.D.	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	30 E APPLE ST	STE NW3300	DAYTON	OH	45409	2939	00	None	39.7465384	-84.18635983	Montgomery County
170263	Fee-for-Service	1073802955	1073802955	1	1	RINELLA, CARLA OT	1/28/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
170265	Fee-for-Service	1306197611	1306197611	1	1	RECALDE, VIOLETA M MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132599	01	General Practice	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
170299	Fee-for-Service	1770662447	1770662447	1	1	RAPHAEL, KATHRYN E MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	44101	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
170313	Fee-for-Service	1528179793	1528179793	1	2	REGENTS OF THE UNIVERSITY OF	5/28/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
170415	Fee-for-Service	1205167798	1205167798	1	1	RAO, VIDYA K MD	11/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
170447	Fee-for-Service	1750379947	1750379947	1	1	RIEGLER, FRANCIS X MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78520	05	Anesthesiology	0	In state provider	None	1220 E AVENUE S	STE C	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
170448	Fee-for-Service	1003402884	1003402884	2	1	ROBERT AZIZI MD, INC.	5/3/2023	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	8218 GARFIELD AVE	None	BELL GARDENS	CA	90201	6212	19	06037	33.95628913	-118.1603818	Los Angeles County
170493	Fee-for-Service	1851981047	1851981047	1	1	RIOS, MELISSA LMFT	11/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
170502	Fee-for-Service	1437316445	1437316445	1	1	RODRIGUEZ, ELIZABETH M LMFT	10/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	30 E SAN JOAQUIN ST	102	SALINAS	CA	93901	2945	27	06053	36.65855693	-121.6578301	Monterey County
170506	Fee-for-Service	1306137252	1306137252	1	1	RAJ, SEAN D	9/30/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182345	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
170515	Fee-for-Service	1457850661	1457850661	1	1	RAVI RAMACHANDRAN MD INC	7/1/2018	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	2330 E BIDWELL ST	100	FOLSOM	CA	95630	3875	34	06067	38.666529	-121.1407065	Sacramento County
170531	Fee-for-Service	1407027097	1407027097	1	1	RADHAKRISHNA, SUHAS M MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101007	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
170534	Fee-for-Service	1225125826	1225125826	1	1	REARDON, DEANNA B PSYD	10/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	224 MAIN ST	None	NEVADA CITY	CA	95959	2603	29	06057	39.26358807	-121.0175993	Nevada County
170561	Fee-for-Service	1285887489	1285887489	1	1	RESOURCES FOR INDEP CTRL VLY	3/9/2009	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	RESOURCES FOR INDEP CTRL	3008 N. FRESNO STREET	None	FRESNO	CA	93703	1124	10	06019	36.777735	-119.7815105	Fresno County
170582	Fee-for-Service	1134355787	1134355787	1	1	ROY, GULMOHOR D MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124646	13	Neurology (M.D. only)	0	In state provider	None	4053 LONE TREE WAY	SUITE 200	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
170584	Fee-for-Service	1750865812	1750865812	1	1	REGENTS OF THE UNIVERSITY OF	6/4/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	H	16950 VIA TAZON	1B	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
170595	Fee-for-Service	1497778385	1497778385	2	1	ROBERTSON, ROBERT FORBES MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
170598	Fee-for-Service	1134223415	1134223415	1	1	REDLANDS PATHOLOGY MED	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
170629	Fee-for-Service	1134780828	1134780828	1	1	ROTKIS, LAUREN NP	10/3/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
170647	Fee-for-Service	1649377763	1649377763	1	1	ROGERS, FRANK R MD	10/1/1983	208200000X	NA	General Surgery	026	PHYSICIANS	31389	01	General Practice	0	In state provider	None	205 S WEST ST	STE C	VISALIA	CA	93291	6112	54	06107	36.329031	-119.296782	Tulare County
170680	Fee-for-Service	1417474404	1417474404	1	1	RUSSELL, BONITA	1/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
170692	Fee-for-Service	1609815281	1609815281	1	1	RICHARD A SHRADER MED CO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28894	20	Orthopedic Surgery	0	In state provider	None	3640 LOMITA BLVD	STE 102	TORRANCE	CA	90505	3984	19	06037	33.81475516	-118.3486533	Los Angeles County
170699	Fee-for-Service	1568890622	1568890622	1	1	RIVERSIDE COUNTY LATINO	12/7/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	COMMISSION ON ALCOHOL	83385 ROSA AVENUE	None	THERMAL	CA	92274	9506	33	06065	33.64846105	-116.2093774	Riverside County
170704	Fee-for-Service	1205167798	1205167798	1	1	RAO, VIDYA K MD	11/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111922	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
170756	Fee-for-Service	1639162332	1639162332	1	1	REAGAN, BRIAN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85875	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9339 GENESEE AVE	None	SAN DIEGO	CA	92121	2119	37	06073	32.87610483	-117.2139185	San Diego County
170782	Fee-for-Service	1144583360	1144583360	1	1	REINKING, JESSE A DO	11/9/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15812	36	Psychiatry	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
170795	Fee-for-Service	1770640450	1770640450	1	1	RAMONA UNIFIED SCH DIST	1/18/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	720 9TH ST	None	RAMONA	CA	92065	2348	37	06073	33.0389069	-116.8638919	San Diego County
170810	Fee-for-Service	1245443258	1245443258	1	1	ROSENTHAL, ARON D MD	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94087	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170815	Fee-for-Service	1508938499	1508938499	1	1	RAMIREZ, EDDIE A MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61452	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
170820	Fee-for-Service	1295995256	1295995256	1	1	RANDLE, CHRISTOPHER C LAC	6/20/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
170828	Fee-for-Service	1427168186	1427168186	1	1	RALEYS	10/16/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3550 NORTH G ST	None	MERCED	CA	95340	0691	24	06047	37.3308291	-120.4690837	Merced County
170865	Fee-for-Service	1053823260	1053823260	1	1	ROBINSON, CHRISTOPHER	4/10/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
170884	Fee-for-Service	1497778385	1497778385	2	1	ROBERTSON, ROBERT FORBES MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
170907	Fee-for-Service	1083176911	1083176911	1	1	RITCHIE, KALEIGH M DO	3/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22269	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
170911	Fee-for-Service	1861433450	1861433450	1	1	RUBIN, STANLEY W MD	7/27/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	28516	68	Hematology	0	In state provider	None	15651 IMPERIAL HWY	STE 105	LA MIRADA	CA	90638	1600	19	06037	33.91736136	-117.9972197	Los Angeles County
170996	Fee-for-Service	1053300798	1053300798	1	1	ROY-BURMAN, ARUP MD	9/27/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54828	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
171026	Fee-for-Service	1447645742	1447645742	1	1	RYAN, KYLE J MD	11/1/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	170177	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
171046	Fee-for-Service	1639162332	1639162332	1	1	REAGAN, BRIAN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85875	24	Plastic Surgery	0	In state provider	None	9339 GENESEE AVE	None	SAN DIEGO	CA	92121	2119	37	06073	32.87610483	-117.2139185	San Diego County
171070	Fee-for-Service	1992868368	1992868368	1	1	RAHBAR, MARYAM MD	7/24/2024	207LP2900X	NA	Other	026	PHYSICIANS	80577	05	Anesthesiology	0	In state provider	None	17822 BEACH BLVD	152	HUNTINGTON BEACH	CA	92647	7102	30	06059	33.70331388	-117.9890471	Orange County
171098	Fee-for-Service	1487699922	1487699922	1	1	RINEHART, LEON CRNA	7/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
171119	Fee-for-Service	1851823181	1851823181	1	1	RAVI, DIVYA MD	7/10/2020	207R00000X	NA	Other	026	PHYSICIANS	166517	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
171129	Fee-for-Service	1588747430	1588747430	1	1	RUTHERFORD, SHELLEY R MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88854	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
171130	Fee-for-Service	1457753964	1457753964	1	1	RAM, ARLEEN A MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145245	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
171131	Fee-for-Service	1548318405	1548318405	1	1	REDFERN, SALLIE L MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39465	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
171133	Fee-for-Service	1548203748	1548203748	1	1	REYES, KIM MARIE MD	4/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71574	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1624 W OLIVE	STE E	BURBANK	CA	91506	2459	19	06037	34.1673422	-118.3229985	Los Angeles County
171144	Fee-for-Service	1285607994	1285607994	1	1	RUDLEY, RALPH M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16970 SN FRNND MSSN BLVD	STE 3	GRANADA HILLS	CA	91344	0000	19	06037	34.29229369	-118.516363	Los Angeles County
171172	Fee-for-Service	1497778385	1497778385	2	1	ROBERTSON, ROBERT FORBES MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25716	41	Internal Medicine	0	In state provider	None	17075 DEVONSHIRE STREET	SUITE 205	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
171199	Fee-for-Service	1861433450	1861433450	1	1	RUBIN, STANLEY W MD	7/27/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	28516	41	Internal Medicine	0	In state provider	None	15651 IMPERIAL HWY	STE 105	LA MIRADA	CA	90638	1600	19	06037	33.91736136	-117.9972197	Los Angeles County
171214	Fee-for-Service	1295230951	1295230951	1	1	RAVI, AKSHAY MD	2/28/2022	207R00000X	NA	Other	026	PHYSICIANS	166183	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171230	Fee-for-Service	1790111086	1790111086	1	1	ROBERTS, DAIRIAN M OT	12/2/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
171283	Fee-for-Service	1053300798	1053300798	1	1	ROY-BURMAN, ARUP MD	9/27/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54828	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
171297	Fee-for-Service	1407994551	1407994551	1	1	RAMKUMAR, HAMSA MD INC	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43445	40	Pediatrics	0	In state provider	None	2250 W WHITTIER BLVD	STE 100	LA HABRA	CA	90631	3403	30	06059	33.93979053	-117.971073	Orange County
171309	Fee-for-Service	1033315718	1033315718	1	1	REBECCA ANDES	1/6/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
171332	Fee-for-Service	1154458701	1154458701	1	1	RSCR CALIFORNIA, INC	10/25/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CHUPARROSA ST HOME	60 CHUPARROSA DR	None	SAN LUIS OBISPO	CA	93401	7412	40	06079	35.24494179	-120.6763974	San Luis Obispo County
171363	Fee-for-Service	1598785669	1598785669	1	1	RUMAN, ANGELA D MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61260	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA SUITE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
171375	Fee-for-Service	1265637474	1265637474	1	1	RALPHS GROCERY COMPANY	8/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #022	645 W 9TH ST	None	LOS ANGELES	CA	90015	1640	19	06037	34.0454919	-118.2608885	Los Angeles County
171384	Fee-for-Service	1003804170	1003804170	1	1	RAWAL, MANOJ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13128 N 94TH DR, #100	None	PEORIA	AZ	85381	0000	00	None	33.603219	-112.2630345	Maricopa County
171389	Fee-for-Service	1568429058	1568429058	1	1	REN, QIANFANG MD	9/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100838	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
171418	Fee-for-Service	1568448116	1568448116	1	1	RICHARD, JOHN D MD	1/17/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	96329	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
171448	Fee-for-Service	1902166564	1902166564	1	1	RAVANBAKHSH, SAMINE MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128640	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
171457	Fee-for-Service	1578529426	1578529426	1	1	ROOKE, JAMES D MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	41310	67	Endocrinology	0	In state provider	None	3132 W MARCH LN	None	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
171459	Fee-for-Service	1053782912	1053782912	1	1	ROBARD BIONICS INC	12/20/2019	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	12865 POINTE DEL MAR WAY	STE 140	DEL MAR	CA	92014	3858	37	06073	32.93310886	-117.2428542	San Diego County
171491	Fee-for-Service	1861433450	1861433450	1	1	RUBIN, STANLEY W MD	7/27/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	28516	78	Neoplastic Diseases/Oncology	0	In state provider	None	15651 IMPERIAL HWY	STE 105	LA MIRADA	CA	90638	1600	19	06037	33.91736136	-117.9972197	Los Angeles County
171531	Fee-for-Service	1427118678	1427118678	1	1	RAFF, NINA F LCSW	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
171545	Fee-for-Service	1841228350	1841228350	1	1	RUTSTEIN, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	34TH + CIVIC CTR BLVD	None	PHILADELPHIA	PA	19104	0000	00	None	39.94709074	-75.19535506	Philadelphia County
171562	Fee-for-Service	1497742084	1497742084	1	1	RUBEN, MARK A MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75891	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
171567	Fee-for-Service	1669715256	1669715256	1	1	ROJANAPAIRAT, ORAGUN K MD	12/13/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	135607	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
171570	Fee-for-Service	1215215801	1215215801	1	1	RAPOPORT, REBECCA E NP	3/30/2017	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171620	Fee-for-Service	1679568273	1679568273	1	1	RELIANT MEDICAL GROUP	2/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RELIANT PULMONARY & MED	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
171625	Fee-for-Service	1659907970	1659907970	1	1	REMIGIO-MAURER, ANA ROSE LC	3/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
171630	Fee-for-Service	1407990575	1407990575	1	1	REDLANDS COMMUNITY HOSPITAL	11/30/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	0742	36	06071	34.03717616	-117.2046115	San Bernardino County
171659	Fee-for-Service	1003015785	1003015785	1	1	ROGERS, RYAN W MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75315	18	Ophthalmology	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
171670	Fee-for-Service	1164632535	1164632535	1	1	RENFRO, TERRALYN N PSYD	8/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
171675	Fee-for-Service	1790761112	1790761112	1	1	ROSELLI, LAURIE E NP	4/23/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
171677	Fee-for-Service	1407121239	1407121239	1	1	RATRA, SHILPI OD	6/21/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
171690	Fee-for-Service	1891796710	1891796710	1	2	REEDSBURG AREA MEDICAL	9/9/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER INC	2000 N DEWEY AVE	None	REEDSBURG	WI	53959	1049	00	None	43.54981221	-89.99460742	Sauk County
171742	Fee-for-Service	1578529426	1578529426	1	1	ROOKE, JAMES D MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	41310	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	None	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
171747	Fee-for-Service	1598255705	1598255705	1	1	RECOVERY INNOVATIONS, INC	2/4/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	71687 HIGHWAY 111	STE. 106	RANCHO MIRAGE	CA	92270	4515	33	06065	33.74279697	-116.4137932	Riverside County
171797	Fee-for-Service	1528269925	1528269925	1	1	RAMAPRASAD, CHARULATA MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116517	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
171825	Fee-for-Service	1265510366	1265510366	1	1	RACAH, ELIA J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48037	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
171862	Fee-for-Service	1427062850	1427062850	1	1	RICHARD ROTNICKI DO	11/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1100 HOUBOLT RD	None	JOLIET	IL	60431	9063	00	None	41.50197098	-88.16879273	Will County
171878	Fee-for-Service	1043354111	1043354111	1	5	REDLANDS COMMUNITY HOSP	4/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	802 W COLTON AVE	STE D	REDLANDS	CA	92374	2905	36	06071	34.06290649	-117.1918845	San Bernardino County
171908	Fee-for-Service	1679568273	1679568273	1	1	RELIANT MEDICAL GROUP	2/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	RELIANT PULMONARY & MED	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
171915	Fee-for-Service	1528000213	1528000213	1	1	RELIABLE MEDICAL ASSOCIATES	12/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	600 S SAN VICENTE BLVD	100	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
171978	Fee-for-Service	1891796710	1891796710	1	2	REEDSBURG AREA MEDICAL	9/9/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER INC	2000 N DEWEY AVE	None	REEDSBURG	WI	53959	1049	00	None	43.54981221	-89.99460742	Sauk County
172073	Fee-for-Service	1710083654	1710083654	1	1	ROLNIK, NANCY E MD	4/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79371	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
172084	Fee-for-Service	1225316151	1225316151	1	2	RHEE, JAYNE E MD	2/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67067	None	None	0	In state provider	None	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	8714	30	06059	33.61235015	-117.8704573	Orange County
172107	Fee-for-Service	1235386277	1235386277	1	1	RAINEY, KAREN M LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3045	33	06065	33.904782	-117.469323	Riverside County
172171	Fee-for-Service	1174562870	1174562870	1	1	RIELAND, TRIS L MD	9/1/2000	207P00000X	NA	Other	026	PHYSICIANS	69889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
172187	Fee-for-Service	1417731514	1417731514	1	1	RENI, TAMARA NP	1/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
172196	Fee-for-Service	1689669277	1689669277	1	1	RIVERA, MIGUEL A MD	6/28/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	33515	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
172203	Fee-for-Service	1528000213	1528000213	1	1	RELIABLE MEDICAL ASSOCIATES	12/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	600 S SAN VICENTE BLVD	100	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
172239	Fee-for-Service	1699800029	1699800029	1	1	REISS, ALLAN MD	11/1/1997	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53873	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
172260	Fee-for-Service	1629402466	1629402466	1	1	ROBERTSON, ANNA DO	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13679	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
172279	Fee-for-Service	1982601167	1982601167	1	1	ROMIE LANE PEDIATRIC GROUP	1/4/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	A MEDICAL CORPORATION	610 E ROMIE LANE	SUITE 2	SALINAS	CA	93901	4209	27	06053	36.65952777	-121.6444287	Monterey County
172283	Fee-for-Service	1356357412	1356357412	1	1	RUZICH, JEFFERY MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
172285	Fee-for-Service	1831259746	1831259746	1	1	ROSARIO, NELSON R LCSW	1/15/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
172295	Fee-for-Service	1932223286	1932223286	1	1	RADIS, RACHAEL LCSW	2/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
172302	Fee-for-Service	1396166997	1396166997	1	1	ROSENHECK, RACHEL E MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128119	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
172333	Fee-for-Service	1255325734	1255325734	1	1	RAYBOULD, DAVID MD	10/16/1989	207L00000X	NA	Other	026	PHYSICIANS	46615	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
172355	Fee-for-Service	1528254133	1528254133	1	1	RASKIN, DAMON MD	8/13/2024	207R00000X	NA	Other	086	MEDICAL DIRECTORS	81334	-	NOT APPLICABLE	0	In state provider	None	2100 PIERPONT BLVD	None	VENTURA	CA	93001	3861	56	06111	34.26711733	-119.2746188	Ventura County
172371	Fee-for-Service	1669929873	1669929873	1	1	REYES, NICOLE LPCC	8/23/2024	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
172407	Fee-for-Service	1053532424	1053532424	1	1	ROMERO, BYRON M	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
172411	Fee-for-Service	1366499592	1366499592	1	1	REBECCA B BLOCH M.D.	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22 BRAMHALL ST	None	PORTLAND	ME	04102	3134	00	None	43.652448	-70.2755415	Cumberland County
172427	Fee-for-Service	1447711221	1447711221	1	1	REED, SAMANTHA A MD	10/31/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181777	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
172465	Fee-for-Service	1952308124	1952308124	1	1	RAPEPORT, KEVIN B MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43603	41	Internal Medicine	0	In state provider	None	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
172494	Fee-for-Service	1881850568	1881850568	1	1	RAMM, OLGA A MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123504	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
172502	Fee-for-Service	1205089661	1205089661	1	1	RYAN THOMAS DONNELLY M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCCHI DR	None	SALT LAKE CITY	UT	84141	3021	00	None	40.77048596	-111.8394574	Salt Lake County
172508	Fee-for-Service	1164547055	1164547055	1	1	RAMIREZ, MARIA B MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	73879	01	General Practice	0	In state provider	None	25285 MADISON AVE	STE 101	MURRIETA	CA	92562	8955	33	06065	33.55369902	-117.1965543	Riverside County
172751	Fee-for-Service	1952308124	1952308124	1	1	RAPEPORT, KEVIN B MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43603	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
172765	Fee-for-Service	1326173642	1326173642	1	1	RANGASWAMI, ARUN A MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77258	68	Hematology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
172821	Fee-for-Service	1194898064	1194898064	1	1	RAISZADEH, MAHINDOKHT MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	34656	01	General Practice	0	In state provider	None	5222 BALBOA AVE	STE 45	SAN DIEGO	CA	92117	6941	37	06073	32.81873589	-117.1838368	San Diego County
172857	Fee-for-Service	1962491001	1962491001	1	1	RYAN, DANIEL J OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2437 BUHNE ST	None	EUREKA	CA	95501	3206	12	06023	40.78597343	-124.1405296	Humboldt County
172862	Fee-for-Service	1629088281	1629088281	1	1	ROSE, THEODORE MD	10/31/1995	174400000X	NA	Other	026	PHYSICIANS	24727	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
172896	Fee-for-Service	1306825237	1306825237	1	1	RAMA, NATESAN S MD	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31206	40	Pediatrics	0	In state provider	None	530 W EATON AVE	STE B	TRACY	CA	95376	3454	39	06077	37.74328351	-121.433886	San Joaquin County
172921	Fee-for-Service	1104170844	1104170844	1	1	REZAEI-HOMAMI, LALEH NP	4/16/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
172974	Fee-for-Service	1588746150	1588746150	1	1	REISS, ROBERT A MD	9/22/2022	207R00000X	NA	Other	026	PHYSICIANS	32383	None	None	0	In state provider	None	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
173005	Fee-for-Service	1922388743	1922388743	1	1	RAZZAGHMANESH, ROZ LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
173018	Fee-for-Service	1629312368	1629312368	1	1	RECORD, ROBERT E PSYD	4/23/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	875 N BREA BLVD	None	BREA	CA	92821	2606	30	06059	33.93434103	-117.8932895	Orange County
173036	Fee-for-Service	1205247525	1205247525	1	1	REYNOLDS, CINDY C MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138436	40	Pediatrics	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
173052	Fee-for-Service	1326173642	1326173642	1	1	RANGASWAMI, ARUN A MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77258	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
173102	Fee-for-Service	1053406355	1053406355	1	1	RINGOLD, ALAN L MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	24386	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
173116	Fee-for-Service	1518413087	1518413087	1	1	RODGERS-BLANKENSHIP, MAUNA-L	11/21/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	OA M NP	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
173148	Fee-for-Service	1124167820	1124167820	1	1	ROSEN, BRADLEY S MD	4/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77262	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
173266	Fee-for-Service	1275936544	1275936544	1	1	REICHHOLD, JOANNA LMFT	4/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	547 UREN ST	None	NEVADA CITY	CA	95959	2360	29	06057	39.26841435	-121.0124412	Nevada County
173318	Fee-for-Service	1093913147	1093913147	1	1	RAWAL, MILAN G MD	1/6/2014	207R00000X	NA	Other	026	PHYSICIANS	89954	41	Internal Medicine	0	In state provider	None	3650 SOUTH ST	STE 310	LAKEWOOD	CA	90712	1519	19	06037	33.86019847	-118.149255	Los Angeles County
173325	Fee-for-Service	1063728673	1063728673	1	1	RAJA, MUHAMMAD W MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141916	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	440 PLUMAS BLVD	None	YUBA CITY	CA	95991	5071	51	06101	39.13140416	-121.6141951	Sutter County
173356	Fee-for-Service	1871784462	1871784462	1	1	RAMACHANDRA, PUNEETA MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115272	34	Urology and Urological Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
173399	Fee-for-Service	1184132078	1184132078	1	1	RICHARDSON, LATOYA T	1/23/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	152 W 115TH ST.	None	LOS ANGELES	CA	90061	1802	19	06037	33.93003788	-118.275896	Los Angeles County
173408	Fee-for-Service	1639397219	1639397219	1	1	RABINOWITZ, SOLOMON F MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63272	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	911 E SAN ANTONIO DR	STE 8	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
173414	Fee-for-Service	1649811985	1649811985	1	1	RACKER, RACHEL CRNA	3/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
173477	Fee-for-Service	1578716288	1578716288	1	1	RADLAUER, GERALD MD INC	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87597	41	Internal Medicine	0	In state provider	None	18523 CORWIN RD	STE I	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
173480	Fee-for-Service	1346328937	1346328937	1	1	RAO,VIVEK A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69600	13	Neurology (M.D. only)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
173483	Fee-for-Service	1831241066	1831241066	1	1	RECORD, MICHELLE R MD	2/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62447	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
173487	Fee-for-Service	1235149436	1235149436	1	1	RUBENSTEIN-MEDINA, LAURIE A	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40369	40	Pediatrics	0	In state provider	MD	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
173511	Fee-for-Service	1396844395	1396844395	1	1	RAFIE, NIUSHA MD	10/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96782	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2299	43	06085	37.43304542	-122.1759654	Santa Clara County
173537	Fee-for-Service	1043354111	1043354111	1	2	REDLANDS COMMUNITY HOSP	4/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11985 4TH ST	STE 116	YUCAIPA	CA	92399	2727	36	06071	34.035525	-117.0518615	San Bernardino County
173539	Fee-for-Service	1659337525	1659337525	1	1	RIDER,RYAN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 NORTH FANT ST	None	ANDERSON	SC	29621	0000	00	None	34.51140542	-82.64743236	Anderson County
173554	Fee-for-Service	1629049978	1629049978	1	1	REINHART,JASON C DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10474 W THUNDERBIRD #200	None	SUN CITY	AZ	85351	0000	00	None	33.60555	-112.284072	Maricopa County
173559	Fee-for-Service	1134835226	1134835226	1	1	RAPPAPORT, ROBERT W	3/9/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1354 FITZGERALD DRIVE	None	PINOLE	CA	94564	2249	07	06013	37.98783649	-122.3112838	Contra Costa County
173566	Fee-for-Service	1285771360	1285771360	1	1	RODRICKS, PAUL MD	2/8/2015	207LP2900X	NA	Other	026	PHYSICIANS	84064	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
173575	Fee-for-Service	1629145446	1629145446	1	1	ROBINSON, MARIO A MD	6/11/1998	208800000X	NA	Other	026	PHYSICIANS	56174	02	General Surgery	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
173582	Fee-for-Service	1083145122	1083145122	1	1	ROOTS COMMUNITY HEALTH	4/16/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	1898 THE ALAMEDA	None	SAN JOSE	CA	95126	1733	43	06085	37.34062947	-121.9227747	Santa Clara County
173589	Fee-for-Service	1497448336	1497448336	1	1	RIVERA, ANGELES	10/25/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23521 PASEO DE VALENCIA	SUITE 302A	LAGUNA HILLS	CA	92653	3107	30	06059	33.61113028	-117.7126684	Orange County
173601	Fee-for-Service	1548213929	1548213929	1	1	RODGERS-SIMPKINS SHARLIT	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	58118	40	Pediatrics	0	In state provider	None	211 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	1412	19	06037	33.965136	-118.3439955	Los Angeles County
173607	Fee-for-Service	1952430449	1952430449	1	1	RED BLUFF JOINT UHSD	4/2/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1525 DOUGLAS ST	None	RED BLUFF	CA	96080	2506	52	06103	40.17816402	-122.2524037	Tehama County
173608	Fee-for-Service	1093913147	1093913147	1	1	RAWAL, MILAN G MD	1/6/2014	207R00000X	NA	Other	026	PHYSICIANS	89954	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3650 SOUTH ST	STE 310	LAKEWOOD	CA	90712	1519	19	06037	33.86019847	-118.149255	Los Angeles County
173689	Fee-for-Service	1881709699	1881709699	1	1	RUSTAGI, PRADIP K MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83670	68	Hematology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
173694	Fee-for-Service	1639397219	1639397219	1	1	RABINOWITZ, SOLOMON F MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63272	41	Internal Medicine	0	In state provider	None	911 E SAN ANTONIO DR	STE 8	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
173698	Fee-for-Service	1184132078	1184132078	1	1	RICHARDSON, LATOYA T	1/23/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	152 W 115TH ST.	None	LOS ANGELES	CA	90061	1802	19	06037	33.93003788	-118.275896	Los Angeles County
173712	Fee-for-Service	1811200652	1811200652	1	1	RUBENZIK, TAMARA T MD	6/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119245	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
173752	Fee-for-Service	1720403850	1720403850	1	1	ROLDAN, DAVID A MD	11/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153394	08	Family Practice	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
173759	Fee-for-Service	1750302261	1750302261	1	1	RHA, JANICE J MD	4/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67130	None	None	0	In state provider	None	120 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4305	19	06037	34.01583858	-118.0994486	Los Angeles County
173774	Fee-for-Service	1831241066	1831241066	1	1	RECORD, MICHELLE R MD	2/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62447	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
173804	Fee-for-Service	1629002381	1629002381	1	1	ROGERS, IAN S MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107147	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
173838	Fee-for-Service	1831263045	1831263045	1	1	RAI CARE CTRS NO CA II	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1738 OCEAN AVE	None	SAN FRANCISCO	CA	94112	1737	38	06075	37.72488897	-122.4607834	San Francisco County
173881	Fee-for-Service	1053425959	1053425959	1	1	RHO, YANNI C MD	10/5/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53043	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173885	Fee-for-Service	1720213119	1720213119	1	1	RUDIN, ROBYNNE M PHD	3/24/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
173893	Fee-for-Service	1952430449	1952430449	1	1	RED BLUFF JOINT UHSD	11/25/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1525 DOUGLAS ST	None	RED BLUFF	CA	96080	2506	52	06103	40.17816402	-122.2524037	Tehama County
173900	Fee-for-Service	1033572086	1033572086	1	1	REVILLA, NATASHA A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	8714	33	06065	33.74675899	-116.9651207	Riverside County
173902	Fee-for-Service	1750541827	1750541827	1	1	RUPALKUNVERBA GOHIL M.D.	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 ULUKAHIKI ST	None	KAILUA	HI	96734	4454	00	None	21.38090913	-157.758388	Honolulu County
173907	Fee-for-Service	1376557629	1376557629	1	1	ROYAL MEDICAL SUPPLY	5/10/1994	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1024 MISSION ST	None	SAN FRANCISCO	CA	94103	2813	38	06075	37.78055489	-122.4092685	San Francisco County
173922	Fee-for-Service	1912922766	1912922766	1	1	REM DIAGNOSTICS INC	2/27/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	218 WEST CARMEN LANE	SUITE 110	SANTA MARIA	CA	93458	7773	42	06083	34.9247937	-120.4385604	Santa Barbara County
173931	Fee-for-Service	1619056181	1619056181	1	1	ROPE, ALAN F MD	5/25/2023	207SG0201X	NA	Other	026	PHYSICIANS	161932	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
173934	Fee-for-Service	1912927906	1912927906	1	1	ROTH, BENNETT E MD	1/30/1978	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24258	22	Pathology (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	None	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
173970	Fee-for-Service	1679574693	1679574693	1	1	RAY, LEENA S MD	3/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84526	45	Nephrology (Renal-Kidney)	0	In state provider	None	112 LA CASA VIA	STE 210	WALNUT CREEK	CA	94598	3011	07	06013	37.91229899	-122.0423696	Contra Costa County
173976	Fee-for-Service	1043354111	1043354111	1	1	REDLANDS COMMUNITY HOSP	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
173979	Fee-for-Service	1881709699	1881709699	1	1	RUSTAGI, PRADIP K MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83670	41	Internal Medicine	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
174005	Fee-for-Service	1770846784	1770846784	1	1	REIBER, KARL E MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129159	40	Pediatrics	0	In state provider	None	7777 SUNRISE BLVD	SUITE 2500	CITRUS HEIGHTS	CA	95610	2372	34	06067	38.706561	-121.2731145	Sacramento County
174018	Fee-for-Service	1396932182	1396932182	1	1	RYDER, NANCY K CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NANCY'S ACUPUNCTURE & HE	3855 PCH HWY	STE 5A	TORRANCE	CA	90505	5948	19	06037	33.80610618	-118.3536072	Los Angeles County
174117	Fee-for-Service	1982040283	1982040283	1	1	ROMO, KIMBERLY A LMFT	4/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
174123	Fee-for-Service	1548486699	1548486699	1	1	RUPP, SONIA N MD	8/23/1995	174400000X	NA	Other	026	PHYSICIANS	55852	26	Psychiatry (child)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
174132	Fee-for-Service	1093840142	1093840142	1	1	RAVINDRANATH, DIVY MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121262	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
174157	Fee-for-Service	1346290772	1346290772	1	1	RHEE, BRIAN S MD	3/8/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78285	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
174192	Fee-for-Service	1851314660	1851314660	1	1	RICHARD C RICHLEY MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25110	20	Orthopedic Surgery	0	In state provider	None	3405 KENYON ST	STE 3	SAN DIEGO	CA	92110	5003	37	06073	32.74866031	-117.2135544	San Diego County
174221	Fee-for-Service	1912927906	1912927906	1	1	ROTH, BENNETT E MD	1/30/1978	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24258	10	Gastroenterology (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	None	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
174228	Fee-for-Service	1942296025	1942296025	1	1	REYES, JOSE A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	54673	05	Anesthesiology	0	In state provider	None	531 W COLLEGE ST	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
174265	Fee-for-Service	1043354111	1043354111	1	1	REDLANDS COMMUNITY HOSP	6/1/1983	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
174275	Fee-for-Service	1316014707	1316014707	1	1	REID, JOANNE E MD	4/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86333	04	Otology, Laryngology, Rhinology	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
174378	Fee-for-Service	1407856404	1407856404	1	1	REDD, JOE W DO	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4541	08	Family Practice	0	In state provider	None	19764 YORBA LINDA BLVD	None	YORBA LINDA	CA	92886	2801	30	06059	33.88921973	-117.7889668	Orange County
174379	Fee-for-Service	1962859934	1962859934	1	1	ROLF, CYNTHIA L LMFT	6/6/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5445 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91607	4661	19	06037	34.169886	-118.396528	Los Angeles County
174437	Fee-for-Service	1215598453	1215598453	1	1	RAAD, SAMANTHA MD	9/12/2023	390200000X	NA	Other	026	PHYSICIANS	180799	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
174473	Fee-for-Service	1861441586	1861441586	1	1	RUDICK, BRIAN P MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99504	66	Emergency Medicine (Urgent Care)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
174562	Fee-for-Service	1154784437	1154784437	1	1	RANA, PRACHI MD	9/3/2024	207RT0003X	NA	Other	026	PHYSICIANS	151522	10	Gastroenterology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
174565	Fee-for-Service	1376688226	1376688226	1	1	ROBERTSON, PAMELA C CSW	2/25/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2200 PACIFIC COAST HWY	STE 102	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
174575	Fee-for-Service	1194819011	1194819011	1	1	RIVER OAKS MEDICAL GROUP	1/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	77 CADILLAC DR	STE 240	SACRAMENTO	CA	95825	8328	34	06067	38.572551	-121.4181585	Sacramento County
174663	Fee-for-Service	1679507271	1679507271	1	1	ROBERT URBAN,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S COULTER ST	None	AMARILLO	TX	79106	1786	00	None	35.200422	-101.924559	Potter County
174666	Fee-for-Service	1720129497	1720129497	1	1	RATHI, SHRADHA MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108609	01	General Practice	0	In state provider	None	2210 E ILLINOIS AVE	STE 508	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
174667	Fee-for-Service	1407856404	1407856404	1	1	REDD, JOE W DO	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4541	01	General Practice	0	In state provider	None	19764 YORBA LINDA BLVD	None	YORBA LINDA	CA	92886	2801	30	06059	33.88921973	-117.7889668	Orange County
174668	Fee-for-Service	1831247824	1831247824	1	1	RAWAT, SUMATI MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69462	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
174684	Fee-for-Service	1508171513	1508171513	1	1	REYNOLDS, PATERESE M LMFT	10/23/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133864	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVE	1ST FLOOR	SAN LUIS OBISPO	CA	93401	4513	40	06079	35.27488974	-120.6468257	San Luis Obispo County
174731	Fee-for-Service	1780939587	1780939587	1	1	RIVERO GUTIERREZ, ANA SOFIA	9/11/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	MD	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
174830	Fee-for-Service	1962117440	1962117440	1	2	REVIVE PATHWAY	9/20/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
174853	Fee-for-Service	1972539989	1972539989	1	1	RUBINSTEIN, ANDREA L MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72039	05	Anesthesiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
174865	Fee-for-Service	1194819011	1194819011	1	1	RIVER OAKS MEDICAL GROUP	1/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	77 CADILLAC DR	STE 240	SACRAMENTO	CA	95825	8328	34	06067	38.572551	-121.4181585	Sacramento County
174913	Fee-for-Service	1487846481	1487846481	1	1	REDDY, UTTAM G MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102346	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
174953	Fee-for-Service	1518131481	1518131481	1	1	RHYNE, NATALIE V LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 SKY PARK DR	STE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
174956	Fee-for-Service	1063425619	1063425619	1	1	REDA, MARCY L LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
174998	Fee-for-Service	1710474358	1710474358	1	1	RARA ENTERPRISES INC	12/10/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19331 BUSINESS CENTER DR	STE. 100	NORTHRIDGE	CA	91324	3529	19	06037	34.23134428	-118.5551514	Los Angeles County
175002	Fee-for-Service	1639561582	1639561582	1	1	RELIEVE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 206	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
175056	Fee-for-Service	1912939828	1912939828	1	1	ROBERT E SALAZAR	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1485 S HIGHWAY 40	STE G	HEBER CITY	UT	84032	3522	00	None	40.490019	-111.4061895	Wasatch County
175088	Fee-for-Service	1245684802	1245684802	1	1	REDDY, SANDHYA MD	8/3/2020	207R00000X	NA	Other	026	PHYSICIANS	161327	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
175118	Fee-for-Service	1962117440	1962117440	1	2	REVIVE PATHWAY	9/20/2023	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
175119	Fee-for-Service	1962847848	1962847848	1	1	RATHE, ROBIN M MD	1/28/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168490	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
175136	Fee-for-Service	1538121769	1538121769	2	1	ROSTYKUS, PAUL MD	6/22/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
175176	Fee-for-Service	1730467424	1730467424	1	1	RAHEEL, SEEMA K MD	8/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116560	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
175193	Fee-for-Service	1487846481	1487846481	1	1	REDDY, UTTAM G MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102346	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
175196	Fee-for-Service	1891824744	1891824744	1	1	RAMIREZ-ALVAREZ, NORMA C LMF	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175205	Fee-for-Service	1053924456	1053924456	1	1	RMD SERVICES INCORPORATED	3/23/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4612 BELLE DR	None	ANTIOCH	CA	94509	4312	07	06013	38.00438456	-121.854447	Contra Costa County
175216	Fee-for-Service	1780604850	1780604850	1	1	ROSS, DAVID J MD	10/8/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	56225	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
175240	Fee-for-Service	1245301167	1245301167	1	1	RUBIN, AARON L MD	4/30/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46094	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175251	Fee-for-Service	1710463492	1710463492	1	1	ROGEL, BRYANA LCSW	3/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
175262	Fee-for-Service	1124265657	1124265657	1	1	RUMERMAN, STACEY M PHD	4/2/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	225 W MADISON AVE	STE 1	EL CAJON	CA	92020	3454	37	06073	32.80066448	-116.9642655	San Diego County
175290	Fee-for-Service	1639561582	1639561582	1	1	RELIEVE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 206	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
175359	Fee-for-Service	1134242167	1134242167	1	1	REDDY, PATRICIA M CNM	12/18/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	1	Border provider	None	560 CATALINA DR	STE 200	ASHLAND	OR	97520	1605	00	None	42.20632356	-122.7238679	Jackson County
175376	Fee-for-Service	1730507302	1730507302	1	1	RANA, ARSHIYA R MD	1/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
175389	Fee-for-Service	1972518348	1972518348	1	1	ROGER H PHELPS OD INC	6/1/2000	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	216 E MATILIJA ST	None	OJAI	CA	93023	2722	56	06111	34.44887248	-119.244724	Ventura County
175393	Fee-for-Service	1366146755	1366146755	1	1	RADX IMAGING PARTNERS, INC.	3/19/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5606	35	06069	36.83504962	-121.3858245	San Benito County
175416	Fee-for-Service	1326240557	1326240557	1	1	RUBENZIK, MARC K MD	8/23/2010	390200000X	NA	Other	026	PHYSICIANS	112347	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
175427	Fee-for-Service	1780848507	1780848507	1	1	ROSS, ETHAN M MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104876	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
175471	Fee-for-Service	1437931623	1437931623	1	1	RENTERIA, AXEL E MD	10/31/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	191679	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175477	Fee-for-Service	1891719035	1891719035	1	1	ROOD,LISA D MD	4/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81020	40	Pediatrics	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
175519	Fee-for-Service	1821397381	1821397381	1	1	RAGO-ROSE, DAWN M NP	7/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1977	19	06037	34.095582	-118.290195	Los Angeles County
175590	Fee-for-Service	1306263546	1306263546	1	1	RIDDELL, JASON R LMFT	6/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
175604	Fee-for-Service	1184772196	1184772196	1	1	RUTMAN, ROSE J LMFT	10/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1480 LINCOLN AVE	None	SAN RAFAEL	CA	94901	2085	21	06041	37.98053839	-122.5224871	Marin County
175753	Fee-for-Service	1356502744	1356502744	1	1	RIVERA LARA, LUCIA A MD	4/30/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	165037	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175785	Fee-for-Service	1023166824	1023166824	1	1	RAMOS, VERA B MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8924	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
175801	Fee-for-Service	1558419549	1558419549	1	1	RODRIGUEZ, HILDA E MD	11/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77435	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
175825	Fee-for-Service	1982751715	1982751715	1	1	ROBERTS, JUDITHANN LMFT	11/17/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	232 W MAIN ST	SUITE 103	TUSTIN	CA	92780	7712	30	06059	33.74205326	-117.8256506	Orange County
175835	Fee-for-Service	1407035728	1407035728	1	1	REDDING SCHOOL DISTRICT	9/13/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5885 E BONNYVIEW RD	None	REDDING	CA	96001	4535	45	06089	40.53201424	-122.3726989	Shasta County
175856	Fee-for-Service	1245694306	1245694306	1	1	REEDLEY COMMUNITY HOSPITAL	10/26/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1040 7TH STREET	None	WASCO	CA	93280	1934	15	06029	35.59425949	-119.337498	Kern County
175865	Fee-for-Service	1295901239	1295901239	1	1	ROSENTHAL, EFRAT MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151660	40	Pediatrics	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
175906	Fee-for-Service	1275096976	1275096976	1	1	RAMAN, KAAVYA R MD	11/24/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182349	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
175915	Fee-for-Service	1730256652	1730256652	1	1	REYES, ABRAHAM L MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74384	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
175922	Fee-for-Service	1104900828	1104900828	1	1	REBECCA S DUKE MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 E JEFFERSON ST	STE 570	SEATTLE	WA	98122	5698	00	None	47.60620395	-122.3110128	King County
175923	Fee-for-Service	1265082838	1265082838	1	1	ROSS, JESSICA L NP	1/28/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
175978	Fee-for-Service	1013123827	1013123827	1	1	ROQUE, NINA J MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109149	40	Pediatrics	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
175986	Fee-for-Service	1003513706	1003513706	1	1	RAMSEY, CATHERINE LMFT	4/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
176001	Fee-for-Service	1477787794	1477787794	1	1	RAINA, ASHUTOSH MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107713	79	Neurology-Child	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
176006	Fee-for-Service	1043694987	1043694987	1	1	RUHELA, ASIM MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153577	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
176007	Fee-for-Service	1073648523	1073648523	1	1	RANGEL, KRISTIN L LCSW	6/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24813	-	NOT APPLICABLE	0	In state provider	None	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	19	06037	34.05373818	-118.3839685	Los Angeles County
176010	Fee-for-Service	1780188755	1780188755	1	1	RUIZ, CALVIN J MD	4/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174162	None	None	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
176037	Fee-for-Service	1902890130	1902890130	1	1	RUDDY, JOHN MD	4/23/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	58800	41	Internal Medicine	0	In state provider	None	400 EL CERRO BLVD	SUITE 107	DANVILLE	CA	94526	1731	07	06013	37.82888506	-122.0021827	Contra Costa County
176101	Fee-for-Service	1184063711	1184063711	1	1	REESE, ELIZABETH PSYD	4/22/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
176102	Fee-for-Service	1033191457	1033191457	1	1	RANA, DEBORAH T MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88347	40	Pediatrics	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
176137	Fee-for-Service	1316062474	1316062474	1	1	REYES, YVONNE T LCSW	11/7/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
176143	Fee-for-Service	1245694306	1245694306	1	1	REEDLEY COMMUNITY HOSPITAL	1/8/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1040 7TH STREET	None	WASCO	CA	93280	1934	15	06029	35.59425949	-119.337498	Kern County
176171	Fee-for-Service	1396796264	1396796264	1	1	RANDALL, DENNIS L MD	1/1/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	28644	30	Radiology	0	In state provider	None	17400 IRVINE BLVD	STE I	TUSTIN	CA	92780	3030	30	06059	33.74814651	-117.828558	Orange County
176229	Fee-for-Service	1013113257	1013113257	1	1	REIDY, PETER C MD	11/16/2010	207R00000X	NA	Other	026	PHYSICIANS	112386	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
176254	Fee-for-Service	1649324310	1649324310	1	1	RATHAN, CHEDDI S LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
176269	Fee-for-Service	1427166685	1427166685	1	1	RHA, HANA OD	3/30/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2160 W GRANT LINE ROAD	SUITE 100	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
176273	Fee-for-Service	1669474987	1669474987	1	1	ROZE ROOM HOSPICE	4/24/2003	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	OF THE VALLEY INC	18107 SHERMAN WAY	SUITE 200	RESEDA	CA	91335	8802	19	06037	34.20122046	-118.527669	Los Angeles County
176293	Fee-for-Service	1467496505	1467496505	1	1	ROY, ATULKUMAR T MD	2/28/1988	207RN0300X	NA	Nephrology	026	PHYSICIANS	44403	41	Internal Medicine	0	In state provider	None	3752 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
176308	Fee-for-Service	1275779332	1275779332	1	1	ROBBINS, DIANA M PHD	4/13/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3420 KENYON ST	None	SAN DIEGO	CA	92110	5001	37	06073	32.74894593	-117.2139252	San Diego County
176318	Fee-for-Service	1598941825	1598941825	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	811 E 11TH STREET	None	REEDLEY	CA	93654	2926	10	06019	36.60347345	-119.4404912	Fresno County
176328	Fee-for-Service	1508985656	1508985656	1	1	RICHARDSON, KIMBERLY A LCSW	5/17/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1101 STANDIFORD AVE	STE B2	MODESTO	CA	95350	0981	50	06099	37.68934851	-121.009653	Stanislaus County
176353	Fee-for-Service	1285416388	1285416388	1	1	ROSEVIEW TERRACE, LLC	12/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15607 S. VISALIA AVENUE	None	COMPTON	CA	90220	3338	19	06037	33.89051743	-118.261547	Los Angeles County
176354	Fee-for-Service	1134847353	1134847353	1	1	ROYAL DREAMS MARRIAGE AND FA	2/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24910 WASHINGTON AVE	301	MURRIETA	CA	92562	9283	33	06065	33.55228335	-117.2126509	Riverside County
176433	Fee-for-Service	1245694306	1245694306	1	1	REEDLEY COMMUNITY HOSPITAL	9/30/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1040 7TH STREET	None	WASCO	CA	93280	1934	15	06029	35.59425949	-119.337498	Kern County
176458	Fee-for-Service	1396796264	1396796264	1	1	RANDALL, DENNIS L MD	1/1/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	28644	01	General Practice	0	In state provider	None	17400 IRVINE BLVD	STE I	TUSTIN	CA	92780	3030	30	06059	33.74814651	-117.828558	Orange County
176523	Fee-for-Service	1851421812	1851421812	1	1	REYES-RAMIREZ, EMMA Y LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	BLDG 4	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
176546	Fee-for-Service	1497320865	1497320865	1	1	RUIZ, JESSICA L PT	1/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
176557	Fee-for-Service	1811047681	1811047681	1	1	RETAJCZYK, CHRIS T	10/31/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	81169	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
176560	Fee-for-Service	1669474987	1669474987	1	1	ROZE ROOM HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	OF THE VALLEY INC	18107 SHERMAN WAY	SUITE 200	RESEDA	CA	91335	8802	19	06037	34.20122046	-118.527669	Los Angeles County
176581	Fee-for-Service	1467496505	1467496505	1	1	ROY, ATULKUMAR T MD	2/28/1988	207RN0300X	NA	Nephrology	026	PHYSICIANS	44403	45	Nephrology (Renal-Kidney)	0	In state provider	None	3752 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
176594	Fee-for-Service	1255356572	1255356572	1	1	ROGOSIN, SHAHNA G MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52070	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176606	Fee-for-Service	1598941825	1598941825	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	811 E 11TH STREET	None	REEDLEY	CA	93654	2926	10	06019	36.60347345	-119.4404912	Fresno County
176611	Fee-for-Service	1295488914	1295488914	1	1	ROBINSON, BYANQA J NP	3/16/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
176612	Fee-for-Service	1619126018	1619126018	1	1	ROJAS, GLORIA L LCSW	10/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
176633	Fee-for-Service	1285834846	1285834846	1	1	ROZANSKY, ALISON J MD	6/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103944	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
176634	Fee-for-Service	1710344361	1710344361	1	1	ROYAL GARDENS HEALTHCARE	1/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	2339 W VALLEY BLVD	None	ALHAMBRA	CA	91803	1931	19	06037	34.07706598	-118.1494542	Los Angeles County
176668	Fee-for-Service	1902066301	1902066301	1	1	RAMOS, MARIE NP	3/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
176716	Fee-for-Service	1164774790	1164774790	1	1	RILEA, BRYAN L	5/24/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
176721	Fee-for-Service	1245694306	1245694306	1	1	REEDLEY COMMUNITY HOSPITAL	9/30/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1040 7TH STREET	None	WASCO	CA	93280	1934	15	06029	35.59425949	-119.337498	Kern County
176737	Fee-for-Service	1588841340	1588841340	1	1	RASOOL, SHUJA MD	8/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102284	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVENUE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
176743	Fee-for-Service	1013463637	1013463637	1	1	ROBERTS, ADAM MD	7/1/2019	208M00000X	NA	Other	026	PHYSICIANS	156400	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
176797	Fee-for-Service	1770153892	1770153892	1	1	RAMIREZ, ADRIENNE LMFT	9/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19 WILLIAMSBURG LN	None	CHICO	CA	95926	2225	04	06007	39.7525191	-121.8551479	Butte County
176850	Fee-for-Service	1407580335	1407580335	1	1	ROMO, LUCY A	2/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
176858	Fee-for-Service	1356432256	1356432256	1	1	RAAB, ELISABETH L MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88845	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
176895	Fee-for-Service	1598941825	1598941825	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	811 E 11TH STREET	None	REEDLEY	CA	93654	2926	10	06019	36.60347345	-119.4404912	Fresno County
176896	Fee-for-Service	1639255151	1639255151	1	1	ROTH, JACOB W MD	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87747	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
176938	Fee-for-Service	1598903189	1598903189	1	1	ROSTAMI, NAHID MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125207	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
176952	Fee-for-Service	1841752219	1841752219	1	1	REEF, DANIEL K MD	6/27/2022	208M00000X	NA	Other	026	PHYSICIANS	178603	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176957	Fee-for-Service	1326071762	1326071762	1	1	RATNARATHORN, MONTHAKAN	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68760	20	Orthopedic Surgery	0	In state provider	MD	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
176959	Fee-for-Service	1205129855	1205129855	1	1	ROSEN, BRETT A MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129276	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
176974	Fee-for-Service	1922376037	1922376037	1	1	RODELO, LISA M MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119244	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
176990	Fee-for-Service	1922499615	1922499615	1	1	RYCHLOCK, RACHEL LAC	3/15/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
177001	Fee-for-Service	1003988833	1003988833	1	1	ROMERO-HIRAHARA, A MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55028	40	Pediatrics	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
177020	Fee-for-Service	1427014778	1427014778	1	1	RAM, SUNIL K MD	1/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	95875	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
177031	Fee-for-Service	1568620532	1568620532	1	1	RASSI, ADRIANA I MD	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
177033	Fee-for-Service	1215376884	1215376884	1	1	ROCHA, MARIO LMFT	4/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
177059	Fee-for-Service	1528179793	1528179793	1	3	REGENTS OF THE UNIVERSITY OF	6/28/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
177061	Fee-for-Service	1134169535	1134169535	2	27	REACH AIR MEDICAL SERVICES L	5/15/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	801 MURRAY WAY	None	ELKO	NV	89801	7813	00	None	40.82909252	-115.7798081	Elko County
177136	Fee-for-Service	1285722033	1285722033	1	1	REINHERZ, VERONICA E MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91984	40	Pediatrics	0	In state provider	None	1285 S STATE ST	None	HEMET	CA	92543	7076	33	06065	33.727887	-116.971567	Riverside County
177149	Fee-for-Service	1356432256	1356432256	1	1	RAAB, ELISABETH L MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88845	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
177171	Fee-for-Service	1295996874	1295996874	1	1	RHEE, EUNICE H MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115971	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
177180	Fee-for-Service	1598941825	1598941825	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	811 E 11TH STREET	None	REEDLEY	CA	93654	2926	10	06019	36.60347345	-119.4404912	Fresno County
177199	Fee-for-Service	1679200976	1679200976	1	1	RIVERSIDE SAN BERNARDINO COU	1/11/2023	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	H CLINIC PHARMACY	66655 MARTINEZ RD	None	THERMAL	CA	92274	9007	33	06065	33.56398663	-116.1545603	Riverside County
177216	Fee-for-Service	1790857548	1790857548	1	1	REMSING, LISA MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72059	26	Psychiatry (child)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
177245	Fee-for-Service	1326071762	1326071762	1	1	RATNARATHORN, MONTHAKAN	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68760	40	Pediatrics	0	In state provider	MD	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
177259	Fee-for-Service	1922376037	1922376037	1	1	RODELO, LISA M MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119244	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
177305	Fee-for-Service	1467696963	1467696963	1	1	REED, LUCKEY C MD	1/14/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175206	None	None	0	In state provider	None	1617 N CALIFORNIA	STE 2E	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
177311	Fee-for-Service	1780659953	1780659953	1	1	RICHARDS, SONIA B MD	9/30/1993	174400000X	NA	Other	026	PHYSICIANS	46432	77	Infectious Disease	0	In state provider	None	18433 ROSCOE BLVD	STE 202	NORTHRIDGE	CA	91325	4130	19	06037	34.22076747	-118.534725	Los Angeles County
177318	Fee-for-Service	1275581852	1275581852	1	1	ROLLING PLAINS MEM HOSP	7/21/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	200 E ARIZONA AVE	None	SWEETWATER	TX	79556	7120	00	None	32.45399796	-100.397503	Nolan County
177325	Fee-for-Service	1952690398	1952690398	1	1	RALDOW, ANN C MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142963	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE B265	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
177364	Fee-for-Service	1043354111	1043354111	1	3	REDLANDS COMMUNITY HOSP	11/1/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	802 W COLTON AVE	STE E	REDLANDS	CA	92374	2905	36	06071	34.06290649	-117.1918845	San Bernardino County
177376	Fee-for-Service	1104367333	1104367333	1	1	RECHEL, MAGGIE	4/15/2025	208M00000X	NA	Other	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
177400	Fee-for-Service	1487987798	1487987798	1	1	RAD, ZSUZSANNA MD	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129451	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
177407	Fee-for-Service	1477808509	1477808509	1	1	ROJAS, ALAN N MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139535	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
177442	Fee-for-Service	1104947324	1104947324	1	2	ROESCHLEIN, AMELIA L MFT	10/12/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177446	Fee-for-Service	1376646869	1376646869	1	1	REGENTS OF THE UNIVERSITY OF	2/28/1988	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177451	Fee-for-Service	1104876143	1104876143	1	2	RITCHIE, HAVEN M MD	3/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
177460	Fee-for-Service	1679508790	1679508790	1	1	RU, XIUQING MD	11/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72528	78	Neoplastic Diseases/Oncology	0	In state provider	None	3440 W LOMITA BLVD	# 250	TORRANCE	CA	90505	4802	19	06037	33.81328127	-118.3452927	Los Angeles County
177468	Fee-for-Service	1124251723	1124251723	1	1	RAEN, HILA LCSW	10/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 BIRCH ST	WEST TOWER STE 3000	NEWPORT BEACH	CA	92660	2127	30	06059	33.66605605	-117.8586733	Orange County
177477	Fee-for-Service	1487982948	1487982948	1	1	ROSENER, SAMUEL J CCC-SLP	10/30/2009	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W SAN JOSE AVE	UNIT A	CLAREMONT	CA	91711	5204	19	06037	34.08314253	-117.7159185	Los Angeles County
177487	Fee-for-Service	1043798556	1043798556	1	1	RODRIGUEZ, ARTURO PT	3/26/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
177519	Fee-for-Service	1356478226	1356478226	1	1	RABOUBI, SHAHLA LMFT	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46891	-	NOT APPLICABLE	0	In state provider	None	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
177560	Fee-for-Service	1518150226	1518150226	1	1	RATTAN, BHARAT MD	10/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131571	41	Internal Medicine	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
177563	Fee-for-Service	1548520109	1548520109	1	1	RIO COLE D.O.	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 ULUKAHIKI ST	None	KAILUA	HI	96734	4454	00	None	21.38090913	-157.758388	Honolulu County
177604	Fee-for-Service	1275581852	1275581852	1	1	ROLLING PLAINS MEM HOSP	3/17/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	200 E ARIZONA AVE	None	SWEETWATER	TX	79556	7120	00	None	32.45399796	-100.397503	Nolan County
177606	Fee-for-Service	1649758624	1649758624	1	1	RIVERA, NOEL RCP	10/8/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
177613	Fee-for-Service	1952690398	1952690398	1	1	RALDOW, ANN C MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142963	30	Radiology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE B265	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
177625	Fee-for-Service	1114004066	1114004066	1	1	ROOKER, GRETCHEN H MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65166	01	General Practice	0	In state provider	None	690 GRAPE AVE	None	SUNNYVALE	CA	94087	1031	43	06085	37.37181767	-122.0532241	Santa Clara County
177644	Fee-for-Service	1134419526	1134419526	1	1	REYNOSO, MALI M	6/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
177646	Fee-for-Service	1770539702	1770539702	1	1	RETINA CONSULTANTS OF	5/26/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORANGE COUNTY, AMC	301 W BASTANCHURY RD	STE 285	FULLERTON	CA	92835	3432	30	06059	33.89397383	-117.9316737	Orange County
177675	Fee-for-Service	1295736676	1295736676	1	1	RUDO, BENJAMIN MD	6/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75136	40	Pediatrics	0	In state provider	None	11539 HAWTHORNE BLVD	FL 6	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
177689	Fee-for-Service	1659344356	1659344356	1	1	RENWICK, KENNETH K JR MD	5/15/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	50654	66	Emergency Medicine (Urgent Care)	0	In state provider	None	PO BOX 1245	None	PINECREST	CA	95364	0245	55	06109	38.18920386	-120.0060473	Tuolumne County
177728	Fee-for-Service	1104947324	1104947324	1	1	ROESCHLEIN, AMELIA L MFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47417	-	NOT APPLICABLE	0	In state provider	None	140 ARBOR DR	None	SAN DIEGO	CA	92103	2007	37	06073	32.75382424	-117.1635451	San Diego County
177731	Fee-for-Service	1720080195	1720080195	1	1	RUDERMAN, DAVID J MD	4/1/1983	207L00000X	NA	Other	026	PHYSICIANS	32739	05	Anesthesiology	0	In state provider	None	1820 TRIBUTE RD	STE J	SACRAMENTO	CA	95815	4307	34	06067	38.599578	-121.444326	Sacramento County
177736	Fee-for-Service	1376646869	1376646869	1	1	REGENTS OF THE UNIVERSITY OF	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177743	Fee-for-Service	1720017593	1720017593	1	1	REGALA, JAYVEE R MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75727	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
177748	Fee-for-Service	1679508790	1679508790	1	1	RU, XIUQING MD	11/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72528	68	Hematology	0	In state provider	None	3440 W LOMITA BLVD	# 250	TORRANCE	CA	90505	4802	19	06037	33.81328127	-118.3452927	Los Angeles County
177798	Fee-for-Service	1417306929	1417306929	1	1	RUIZ, ANGEL T LCSW	6/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
177804	Fee-for-Service	1881012995	1881012995	1	1	REED, DIANE V MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138625	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
177817	Fee-for-Service	1952764607	1952764607	1	1	ROBINSON, TYLER D MD	10/17/2023	208600000X	NA	General Surgery	026	PHYSICIANS	191423	None	None	0	In state provider	None	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
177832	Fee-for-Service	1083219075	1083219075	1	1	ROUNTREE, KATIE LMFT	9/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	None	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
177836	Fee-for-Service	1184858250	1184858250	1	1	REED, JENNIFER M PHD	8/23/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
177861	Fee-for-Service	1366784787	1366784787	1	1	ROHLWING, LUKE A MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132999	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
177892	Fee-for-Service	1831539337	1831539337	1	1	RUDD, CHRISTOPHER D PT	12/20/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177954	Fee-for-Service	1134150477	1134150477	1	1	REEVES-GARICA, JESSE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 SW 60TH CT	STE 204	MIAMI	FL	33155	4070	00	None	25.74153817	-80.29306992	Miami-Dade County
177963	Fee-for-Service	1295736676	1295736676	1	1	RUDO, BENJAMIN MD	6/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75136	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	FL 6	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
177978	Fee-for-Service	1659344356	1659344356	1	1	RENWICK, KENNETH K JR MD	5/15/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	50654	01	General Practice	0	In state provider	None	PO BOX 1245	None	PINECREST	CA	95364	0245	55	06109	38.18920386	-120.0060473	Tuolumne County
177988	Fee-for-Service	1790245322	1790245322	1	1	RASHED, GEDIA	10/17/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
178059	Fee-for-Service	1619332434	1619332434	1	1	REVIVE HOME HEALTH AGENCY	11/10/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	11484 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2301	19	06037	34.17212648	-118.3818195	Los Angeles County
178061	Fee-for-Service	1336190354	1336190354	1	1	REUSS, KAREN L MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74593	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
178082	Fee-for-Service	1982888202	1982888202	1	1	RAI CARE CTRS OAKLAND II LLC	1/1/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	RAI-EAST BAY-OAKLAND	2628 INTERNATIONAL BLVD	STE 100	OAKLAND	CA	94601	1512	01	06001	37.78105407	-122.2319285	Alameda County
178090	Fee-for-Service	1922789908	1922789908	1	1	RONAN, MOLLY CRNA	9/15/2023	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
178091	Fee-for-Service	1699885806	1699885806	1	1	ROUILLARD, KENNETH P MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	81455	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
178118	Fee-for-Service	1417206855	1417206855	1	1	RICHE, KIRSTEN F	5/23/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
178136	Fee-for-Service	1073678009	1073678009	1	1	RICAFORTE, ROMULO R MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39920	08	Family Practice	0	In state provider	None	11331 LONG BEACH BLVD	None	LYNWOOD	CA	90262	3300	19	06037	33.92832195	-118.2110194	Los Angeles County
178142	Fee-for-Service	1316107550	1316107550	1	1	RENAISSANCE RADIOLOGY	7/9/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2696	19	06037	34.07578277	-118.248587	Los Angeles County
178150	Fee-for-Service	1366784787	1366784787	1	1	ROHLWING, LUKE A MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132999	01	General Practice	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
178180	Fee-for-Service	1376590067	1376590067	1	1	RHONDA FLEMING M.D.	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 CURIE DR	STE 4700	EL PASO	TX	79902	2955	00	None	31.77871025	-106.4790919	El Paso County
178252	Fee-for-Service	1033699426	1033699426	1	1	REACHWELL HOME HEALTH INC	2/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANDFORD	STE 173	VALENCIA	CA	91355	4596	19	06037	34.43840443	-118.5730069	Los Angeles County
178293	Fee-for-Service	1295550192	1295550192	1	1	RAY OF HOPE MARRIAGE AND FAM	2/7/2025	193400000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ILY COUNSELING PROF. C	47395 MONROE ST	#175	INDIO	CA	92201	6796	33	06065	33.704685	-116.236575	Riverside County
178349	Fee-for-Service	1881721678	1881721678	1	1	RAMANATHAN, ANITA S MD	4/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	76096	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
178362	Fee-for-Service	1598755159	1598755159	1	1	RODGVELLER, BARRY N DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1360 W 6TH ST	STE 240	SAN PEDRO	CA	90732	3589	19	06037	33.73886546	-118.3075065	Los Angeles County
178378	Fee-for-Service	1699885806	1699885806	1	1	ROUILLARD, KENNETH P MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	81455	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
178404	Fee-for-Service	1104288729	1104288729	1	1	ROGERS, CHARLOTTE M MD	9/8/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	180371	None	None	0	In state provider	None	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
178424	Fee-for-Service	1275737850	1275737850	1	1	RAO, NIKHIL G MD	10/6/2020	2085R0001X	NA	Other	026	PHYSICIANS	140465	32	Radiation Therapy (D.O. only)	0	In state provider	None	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
178425	Fee-for-Service	1073678009	1073678009	1	1	RICAFORTE, ROMULO R MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39920	01	General Practice	0	In state provider	None	11331 LONG BEACH BLVD	None	LYNWOOD	CA	90262	3300	19	06037	33.92832195	-118.2110194	Los Angeles County
178438	Fee-for-Service	1326119249	1326119249	1	1	RADNER, GARY W MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84592	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
178450	Fee-for-Service	1881832251	1881832251	1	1	ROSENTHAL, JOHANNA MD INC	8/24/2010	193400000X	NA	Other	026	PHYSICIANS	40976	79	Neurology-Child	0	In state provider	None	17021 YORBA LINDA BLVD	STE 20	YORBA LINDA	CA	92886	3742	30	06059	33.88847378	-117.8372198	Orange County
178456	Fee-for-Service	1225109143	1225109143	1	1	RUBIN, SHARON E MD	2/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
178459	Fee-for-Service	1063405074	1063405074	1	2	REGENTS OF THE UNIV OF CA	5/1/1999	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
178494	Fee-for-Service	1407601875	1407601875	1	1	RIVERS MARRIAGE AND FAMILY T	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HERAPY, INC.	272 S LOS ROBLES AVE	None	PASADENA	CA	91101	2872	19	06037	34.141122	-118.141341	Los Angeles County
178568	Fee-for-Service	1730390337	1730390337	1	1	REN, JIE MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115905	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
178602	Fee-for-Service	1013245315	1013245315	1	1	ROYER, JONATHAN D LMFT	12/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1508 F ST	None	SACRAMENTO	CA	95814	1609	34	06067	38.582415	-121.4843265	Sacramento County
178667	Fee-for-Service	1699885806	1699885806	1	1	ROUILLARD, KENNETH P MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	81455	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
178695	Fee-for-Service	1477079317	1477079317	1	1	RICE, JENNIFER M NP	9/19/2022	363LP0222X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
178705	Fee-for-Service	1578316493	1578316493	1	1	ROOTWARD MARRIAGE AND FAMILY	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 BARRANCA ST	STE 729	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
178735	Fee-for-Service	1962872770	1962872770	1	1	REGENERATIVE ORTHOPEDICS INS	5/31/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	TITUTE, INC	842 CALIFORNIA BLVD	None	SAN LUIS OBISPO	CA	93401	2998	40	06079	35.28723916	-120.6555836	San Luis Obispo County
178737	Fee-for-Service	1881832251	1881832251	1	1	ROSENTHAL, JOHANNA MD INC	8/24/2010	193400000X	NA	Other	026	PHYSICIANS	40976	13	Neurology (M.D. only)	0	In state provider	None	17021 YORBA LINDA BLVD	STE 20	YORBA LINDA	CA	92886	3742	30	06059	33.88847378	-117.8372198	Orange County
178745	Fee-for-Service	1063405074	1063405074	1	2	REGENTS OF THE UNIV OF CA	6/6/2020	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
178755	Fee-for-Service	1790727097	1790727097	1	1	RUIZ, DIEGO E MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73489	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
178773	Fee-for-Service	1518194786	1518194786	1	1	RALLABANDI, SRUJANA MD	7/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151062	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
178782	Fee-for-Service	1043266802	1043266802	1	1	RIEKER, JEFFREY M MD	9/18/1988	207L00000X	NA	Other	026	PHYSICIANS	44862	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
178797	Fee-for-Service	1598927519	1598927519	1	1	RIEMER, CHRISTINA LMFT	2/17/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	13525 CIELO AZUL WAY	None	DESERT HOT SPRING	CA	92240	6235	33	06065	33.95048031	-116.4811265	Riverside County
178875	Fee-for-Service	1366427387	1366427387	1	1	RANKIN, GEORGE W JR MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92777	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
178924	Fee-for-Service	1538547237	1538547237	1	1	RAHIMI, FIROZA NP	8/18/2016	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
178982	Fee-for-Service	1821452335	1821452335	1	1	RAPS, CHRISTINE MD	8/21/2019	207P00000X	NA	Other	026	PHYSICIANS	162750	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
178989	Fee-for-Service	1043462633	1043462633	1	1	RANGWALA, ZAKIR T	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110754	05	Anesthesiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
179037	Fee-for-Service	1518937150	1518937150	1	1	REDMOND, BILLY G MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51611	08	Family Practice	0	In state provider	None	329 W 8TH ST	STE 101	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
179088	Fee-for-Service	1649832668	1649832668	1	1	RUSHTON, MICHAEL J DO	8/12/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
179096	Fee-for-Service	1942963491	1942963491	1	1	RUEDA, MARK JUSTIN	9/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
179140	Fee-for-Service	1821273376	1821273376	1	1	RUST, DANIEL W MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113080	22	Pathology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
179179	Fee-for-Service	1295263861	1295263861	1	1	RIVAS, RENEE N MD	7/30/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173043	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179218	Fee-for-Service	1659713725	1659713725	1	1	RECORD, NICOLE C DO	5/16/2023	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	16278	None	None	0	In state provider	None	16311 VENTURA BLVD	SUITE #1150	ENCINO	CA	91436	4386	19	06037	34.15706864	-118.4885978	Los Angeles County
179233	Fee-for-Service	1134169535	1134169535	2	13	REACH AIR MEDICAL SERVICES L	4/3/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	37610 SKY CANYON DR	HANGAR 51	MURRIETA	CA	92563	2693	33	06065	33.569739	-117.132867	Riverside County
179240	Fee-for-Service	1366699969	1366699969	1	1	RODRIGUEZ, ERIKA F MD	9/1/2021	207ZC0500X	NA	Other	026	PHYSICIANS	174457	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
179300	Fee-for-Service	1295797520	1295797520	1	1	REINGOLD, WARREN J MD	8/20/1998	174400000X	NA	Other	026	PHYSICIANS	50814	18	Ophthalmology	0	In state provider	None	12139 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3832	19	06037	34.15763747	-118.3980195	Los Angeles County
179301	Fee-for-Service	1538363114	1538363114	1	1	REDDY, VENKAT RAMANA P MD	9/20/2022	2085R0204X	NA	Other	026	PHYSICIANS	176259	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
179305	Fee-for-Service	1710211867	1710211867	1	1	ROBERTSON, LAUREN A MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109671	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9888 GENESSE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
179334	Fee-for-Service	1215487095	1215487095	1	1	ROBACK, RYAN G LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
179349	Fee-for-Service	1215209598	1215209598	1	1	RISHWAIN-TOZI, MEREDITH B DO	12/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11907	01	General Practice	0	In state provider	None	2575 E BIDWELL ST	SUITE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
179363	Fee-for-Service	1518183961	1518183961	1	1	REHMAN, NAIMA O MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133411	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
179378	Fee-for-Service	1487700084	1487700084	1	1	ROBINSON, MARK K MD	12/26/2014	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	43272	20	Orthopedic Surgery	0	In state provider	None	152 PIONEER LANE	STE A	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
179380	Fee-for-Service	1831408921	1831408921	1	1	RIVER, GERIN F MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116048	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
179416	Fee-for-Service	1679541528	1679541528	1	1	REMINGTON, BENJAMIN J MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76179	14	Neurological Surgery	0	In state provider	None	205 W GRANGER AVENUE	None	MODESTO	CA	95350	4402	50	06099	37.6673525	-120.9954534	Stanislaus County
179417	Fee-for-Service	1245620731	1245620731	1	1	ROMERO, JULIO C MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141588	41	Internal Medicine	0	In state provider	None	3610 ATLANTIC AVE	None	LONG BEACH	CA	90807	3418	19	06037	33.822621	-118.185002	Los Angeles County
179439	Fee-for-Service	1982079083	1982079083	1	1	RIVERA, CYNTHIA	2/2/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
179459	Fee-for-Service	1548876337	1548876337	1	1	RICHARDSON, JENAE A PSYD	9/21/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179460	Fee-for-Service	1922336064	1922336064	1	1	RX CONSULTANTS GROUP INC	1/14/2010	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MACY	11515 ARTESIA BLVD	STE 201	ARTESIA	CA	90701	3852	19	06037	33.87307453	-118.0885185	Los Angeles County
179484	Fee-for-Service	1417635095	1417635095	1	1	RICHARDSON, LEILANI LPCC	7/26/2023	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
179529	Fee-for-Service	1437113446	1437113446	1	1	ROBERTS, JOHN P MD	4/29/1999	208600000X	NA	General Surgery	026	PHYSICIANS	62500	41	Internal Medicine	0	In state provider	None	533 PARNASSUS AVE	# U370	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
179548	Fee-for-Service	1215099163	1215099163	1	1	ROGERS, KENNETH E PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
179549	Fee-for-Service	1124063508	1124063508	1	1	RAGAN, JANE MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73369	41	Internal Medicine	0	In state provider	None	123 MARGARET LN	STE A1	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
179562	Fee-for-Service	1821499526	1821499526	1	1	RODRIGUEZ VAZQUEZ, ADRIANA	5/10/2019	390200000X	NA	Other	026	PHYSICIANS	161746	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
179587	Fee-for-Service	1659308997	1659308997	1	1	RUSTIGAN, RYAN A DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	RUSTIGAN CHIROPRACTIC	1360 N FRESNO ST	None	FRESNO	CA	93703	3838	10	06019	36.76066058	-119.7814558	Fresno County
179594	Fee-for-Service	1629376082	1629376082	1	1	RADIANT SUN ACUPUNCTURE INC.	2/12/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3665 EUREKA WAY	None	REDDING	CA	96001	1026	45	06089	40.58394504	-122.4258671	Shasta County
179621	Fee-for-Service	1386960995	1386960995	1	1	ROSHAU, KEVIN J	5/26/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1723 27TH ST	None	BAKERSFIELD	CA	93301	2807	15	06029	35.38383629	-119.0218323	Kern County
179652	Fee-for-Service	1518183961	1518183961	1	1	REHMAN, NAIMA O MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133411	40	Pediatrics	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
179660	Fee-for-Service	1639137094	1639137094	1	1	ROWEN, ERIC M MD INC	4/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 320	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
179741	Fee-for-Service	1275608457	1275608457	1	1	RIDGEVIEW MEDICAL CENTER	1/12/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	500 S MAPLE ST	None	WACONIA	MN	55387	1714	00	None	44.843139	-93.79078701	Carver County
179775	Fee-for-Service	1619422391	1619422391	1	1	RACHEL BADOVICK	1/26/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
179789	Fee-for-Service	1376577882	1376577882	1	1	RICHEMONT, PHILLIP C MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
179799	Fee-for-Service	1992309041	1992309041	1	1	ROZMANIT, MEG A LMFT	5/18/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
179806	Fee-for-Service	1891139309	1891139309	1	1	RASHTI, PEDRAM MD INC A	11/20/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113049	None	None	0	In state provider	MEDICAL CORPORATION	314 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4305	42	06083	34.43103031	-119.7236859	Santa Barbara County
179851	Fee-for-Service	1184864449	1184864449	1	1	ROGERS, ELLIE E DO	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11261	01	General Practice	0	In state provider	None	200 S WELLS RD	STE 200	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
179908	Fee-for-Service	1023636529	1023636529	1	1	REFLECTIONS HOSPICE INC	3/24/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16438 VANOWEN ST	STE 207A	LAKE BALBOA	CA	91406	4733	19	06037	34.1938865	-118.491471	Los Angeles County
179913	Fee-for-Service	1538320874	1538320874	1	1	RASHEED, ZAKIYYAH J DO	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
179948	Fee-for-Service	1831195403	1831195403	1	1	RAGHAVAN, NARASIMHACHARI	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53734	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
179964	Fee-for-Service	1467880609	1467880609	1	1	RICKS-JAMES, ELISE	3/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3510 TORRANCE BLVD	SUITE 216	TORRANCE	CA	90503	4814	19	06037	33.83756756	-118.3469036	Los Angeles County
180007	Fee-for-Service	1831332295	1831332295	1	1	RIGHT HEAR PALM SPRINGS LLC	11/9/2010	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1073 W ROSS AVE	STE F	EL CENTRO	CA	92243	4371	13	06025	32.7814347	-115.5644787	Imperial County
180024	Fee-for-Service	1275608457	1275608457	1	1	RIDGEVIEW MEDICAL CENTER	1/12/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	500 S MAPLE ST	None	WACONIA	MN	55387	1714	00	None	44.843139	-93.79078701	Carver County
180078	Fee-for-Service	1407276363	1407276363	1	1	RUNGVIVATJARUS, TIRANUN MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141353	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
180088	Fee-for-Service	1952521544	1952521544	1	1	RUNIC, RADMILA MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
180102	Fee-for-Service	1033628144	1033628144	1	1	RENGIFO NEVAREZ, JOHANNA PH	4/8/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
180114	Fee-for-Service	1023761871	1023761871	1	1	RIGHTEOUS HOME HEALTH	2/13/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	816 N HOLLYWOOD WAY	UNIT 1	BURBANK	CA	91505	2831	19	06037	34.16503922	-118.3455811	Los Angeles County
180138	Fee-for-Service	1184864449	1184864449	1	1	ROGERS, ELLIE E DO	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11261	08	Family Practice	0	In state provider	None	200 S WELLS RD	STE 200	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
180160	Fee-for-Service	1134169535	1134169535	2	12	REACH AIR MEDICAL SERVICES L	3/3/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	770 AIRPORT ROAD	None	BISHOP	CA	93514	3623	14	06027	37.369854	-118.3641075	Inyo County
180199	Fee-for-Service	1023636529	1023636529	1	1	REFLECTIONS HOSPICE INC	3/24/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16438 VANOWEN ST	STE 207A	LAKE BALBOA	CA	91406	4733	19	06037	34.1938865	-118.491471	Los Angeles County
180235	Fee-for-Service	1457593535	1457593535	1	2	RONALD JOHN GARVIN	7/11/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2763 WISSEMANN DR	None	SACRAMENTO	CA	95826	3652	34	06067	38.554812	-121.3864695	Sacramento County
180237	Fee-for-Service	1831195403	1831195403	1	1	RAGHAVAN, NARASIMHACHARI	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53734	01	General Practice	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
180257	Fee-for-Service	1740464759	1740464759	1	1	REZA MALENKNIA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	4. C HOSPITALIST	515 NORTH MESA DR	None	MESA	AZ	85201	0000	00	None	33.424767	-111.8219445	Maricopa County
180264	Fee-for-Service	1699822262	1699822262	1	1	ROSEVOLD, ALYSSA L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
180283	Fee-for-Service	1922009752	1922009752	1	2	RASHID, SAQIB MD	10/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	96384	-	NOT APPLICABLE	0	In state provider	None	559 E BARDSLEY AVENUE	None	TULARE	CA	93274	5400	54	06107	36.1965538	-119.3415894	Tulare County
180305	Fee-for-Service	1154840767	1154840767	1	1	RUBY, RODGER E DO	11/20/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15987	08	Family Practice	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
180314	Fee-for-Service	1629310024	1629310024	1	1	RIVAS, NANCY NP	3/29/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
180325	Fee-for-Service	1972018950	1972018950	1	1	ROBINSON, CHRISTIANA J	3/26/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
180327	Fee-for-Service	1679100283	1679100283	1	1	RAMAN, SHREEYA MD	7/1/2023	390200000X	NA	Other	026	PHYSICIANS	183039	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
180361	Fee-for-Service	1033251814	1033251814	1	1	RAMMAHA, HAIFA A	2/16/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
180370	Fee-for-Service	1942746128	1942746128	1	1	RIOS, SIERRA	5/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
180373	Fee-for-Service	1972585180	1972585180	1	1	ROSE DOVE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1420 N CLAREMONT BLVD	SUITE 104A	CLAREMONT	CA	91711	3583	19	06037	34.10905443	-117.7028026	Los Angeles County
180379	Fee-for-Service	1952694887	1952694887	1	1	RUDY, MICHAEL D MD	10/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132162	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180409	Fee-for-Service	1871859546	1871859546	1	1	RIAZ, FAUZIA MD	9/5/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	164625	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180456	Fee-for-Service	1962587998	1962587998	1	1	RAULD, HUGO F MD	7/24/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49757	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1711 ORANGE ST	None	REDLANDS	CA	92374	2254	36	06071	34.0796409	-117.1824145	San Bernardino County
180528	Fee-for-Service	1215096888	1215096888	1	1	REECE, KIMBERLY C MD	10/11/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51400	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
180549	Fee-for-Service	1609073766	1609073766	1	1	RAUSCH, VALERIE D LCSW	3/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 ADAMS STREET	BLDG A 405	RIVERSIDE	CA	92504	8305	33	06065	33.9214315	-117.4148549	Riverside County
180608	Fee-for-Service	1942614805	1942614805	1	1	REDGATE, CHRISTOPHER MD	3/7/2018	207P00000X	NA	Other	026	PHYSICIANS	138215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
180660	Fee-for-Service	1972585180	1972585180	1	1	ROSE DOVE INC	11/8/2003	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1420 N CLAREMONT BLVD	SUITE 104A	CLAREMONT	CA	91711	3583	19	06037	34.10905443	-117.7028026	Los Angeles County
180687	Fee-for-Service	1124601422	1124601422	1	1	ROSS, MATTHEW NP	9/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
180700	Fee-for-Service	1265629919	1265629919	1	1	REYNOLDS, COLLIN D	8/1/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
180703	Fee-for-Service	1891950267	1891950267	1	1	RIVERSIDE EQUITIES LLC	8/1/2008	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8487 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92504	3222	33	06065	33.93106223	-117.4278913	Riverside County
180743	Fee-for-Service	1619992211	1619992211	1	1	RALPHS GROCERY COMPANY	6/18/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #611	425 S SUNRISE WAY	STE A	PALM SPRINGS	CA	92262	7664	33	06065	33.81631988	-116.5282432	Riverside County
180771	Fee-for-Service	1821067836	1821067836	1	1	ROY, ARJUN MD	11/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101641	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
180786	Fee-for-Service	1831200963	1831200963	1	1	RAJKUMAR, SUMITHA MD	2/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84719	41	Internal Medicine	0	In state provider	None	12276 HESPERIA RD	None	VICTORVILLE	CA	92395	5838	36	06071	34.47424926	-117.2915621	San Bernardino County
180793	Fee-for-Service	1619014974	1619014974	1	1	ROMEIRO, KATHLEEN M LCSW	9/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 EAST SHAW AVE.	STE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
180817	Fee-for-Service	1215096888	1215096888	1	1	REECE, KIMBERLY C MD	10/11/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51400	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
180859	Fee-for-Service	1245295088	1245295088	1	1	RUBEN, BETH S MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70065	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
180860	Fee-for-Service	1285176735	1285176735	1	1	RUBBA, LESLIE A CRNA	8/30/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
180918	Fee-for-Service	1689037533	1689037533	1	1	REEDLEY COMMUNITY HOSPITAL	9/30/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	406 JAMES STREET	None	SHAFTER	CA	93263	2035	15	06029	35.50258423	-119.2763447	Kern County
180936	Fee-for-Service	1215440656	1215440656	1	1	REYES, AUDREY N LCSW	2/6/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 TEXAS ST	STE D	FAIRFIELD	CA	94533	5700	48	06095	38.24926548	-122.046354	Solano County
180984	Fee-for-Service	1114921673	1114921673	1	1	RAHNEMUN, MARYAM MD	10/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53377	08	Family Practice	0	In state provider	None	14150 CULVER DR	105	IRVINE	CA	92604	0315	30	06059	33.70834263	-117.7839373	Orange County
181001	Fee-for-Service	1497101281	1497101281	1	1	RIUTZEL, KEVIN J DO	10/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16500	08	Family Practice	0	In state provider	None	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
181003	Fee-for-Service	1487186003	1487186003	1	1	RABI, SINA MD	3/22/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	157340	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
181011	Fee-for-Service	1841783842	1841783842	1	1	RANCHO ADOBE FIRE PROTECTION	5/23/2019	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	11000 MAIN ST	None	PENNGROVE	CA	94951	0000	49	06097	38.29539205	-122.6669436	Sonoma County
181058	Fee-for-Service	1083375448	1083375448	1	1	REED, DANIEL J PSYD	5/17/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
181064	Fee-for-Service	1669454823	1669454823	1	1	RAGLAND, KAREN D MD	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	66526	01	General Practice	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
181103	Fee-for-Service	1164859690	1164859690	1	1	REAMICO, RAMIR B CRNA	10/9/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
181107	Fee-for-Service	1407429426	1407429426	1	1	REMOTIGUE, RAFAEL	2/18/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1618 E CALDWELL AVE	None	VISALIA	CA	93292	9228	54	06107	36.298485	-119.2748445	Tulare County
181124	Fee-for-Service	1548429400	1548429400	1	1	RAPANUT, YVONNE R	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
181173	Fee-for-Service	1487130167	1487130167	1	1	ROCK HOLLOW CRITICAL CARE	8/27/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	1300 N VERMONT AVENUE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
181179	Fee-for-Service	1518480615	1518480615	1	1	RETINA INSTITUTE OF CALIFORN	8/24/2022	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	435 ARDEN AVE	430	GLENDALE	CA	91203	4049	19	06037	34.15848148	-118.2628845	Los Angeles County
181181	Fee-for-Service	1063886448	1063886448	1	1	RYANS REACH	11/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1321 LEAR LANE	None	TUSTIN	CA	92780	4546	30	06059	33.74030178	-117.8124474	Orange County
181197	Fee-for-Service	1326461708	1326461708	1	1	REDWOOD RADIOLOGY GROUP INC	4/1/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
181206	Fee-for-Service	1689037533	1689037533	1	1	REEDLEY COMMUNITY HOSPITAL	9/30/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	406 JAMES STREET	None	SHAFTER	CA	93263	2035	15	06029	35.50258423	-119.2763447	Kern County
181240	Fee-for-Service	1598738122	1598738122	1	1	RISHWAIN, GEORGE E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38366	10	Gastroenterology (M.D. only)	0	In state provider	None	1805 N CALIFORNIA ST	STE 309	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
181255	Fee-for-Service	1871848242	1871848242	1	2	RARDIN, ABBY M MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122183	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
181309	Fee-for-Service	1750374815	1750374815	1	1	REGENTS/UCDPBG/GYN ONCOL	5/1/1983	207VX0201X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
181353	Fee-for-Service	1669454823	1669454823	1	1	RAGLAND, KAREN D MD	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	66526	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
181385	Fee-for-Service	1255643474	1255643474	2	1	ROSARIO, GELEN R D MD	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113471	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	502 EUCLID AVE	SUITE 300	NATIONAL CITY	CA	91950	2950	37	06073	32.68505421	-117.0832793	San Diego County
181398	Fee-for-Service	1922363993	1922363993	1	1	ROLDAN, JUSTIN	4/2/2013	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
181435	Fee-for-Service	1689758138	1689758138	1	1	ROBERT C. GRIFFITH M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6311 KINGSTON PIKE	STE 22E	KNOXVILLE	TN	37919	4900	00	None	35.93228318	-84.00770091	Knox County
181440	Fee-for-Service	1346322559	1346322559	1	1	RISVOLD, MARY B MD	10/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
181448	Fee-for-Service	1205926821	1205926821	1	1	RIZA, AWAIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DEPT. OF NEUROLOGY OF	50 N. MEDICAL DRIVE	None	SALT LAKE CITY	UT	84132	0000	00	None	40.77197161	-111.8352608	Salt Lake County
181450	Fee-for-Service	1881700425	1881700425	1	1	ROSNER, BENJAMIN I MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89465	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
181453	Fee-for-Service	1144230830	1144230830	1	1	RX EXPRESS PHARMACY INC	10/1/2000	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6160 ARLINGTON AVE	STE C14	RIVERSIDE	CA	92504	1922	33	06065	33.9459066	-117.4360336	Riverside County
181466	Fee-for-Service	1518480615	1518480615	1	1	RETINA INSTITUTE OF CALIFORN	8/24/2022	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	435 ARDEN AVE	430	GLENDALE	CA	91203	4049	19	06037	34.15848148	-118.2628845	Los Angeles County
181472	Fee-for-Service	1689884074	1689884074	1	1	RAO, ARCHANA R MD	5/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130222	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1215 PLUMAS STREET	SUITE 1200	YUBA CITY	CA	95991	3490	51	06101	39.14709336	-121.6175316	Sutter County
181486	Fee-for-Service	1720183403	1720183403	1	1	RIVERSIDE MEDICAL CLINIC	2/1/1998	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7160 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94273905	-117.3941945	Riverside County
181494	Fee-for-Service	1689037533	1689037533	1	1	REEDLEY COMMUNITY HOSPITAL	1/22/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	406 JAMES STREET	None	SHAFTER	CA	93263	2035	15	06029	35.50258423	-119.2763447	Kern County
181500	Fee-for-Service	1801497284	1801497284	1	1	RACKHAM, KELLY CNP	3/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
181515	Fee-for-Service	1619300761	1619300761	1	1	REZAI, DAMOUN A MD	7/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138824	08	Family Practice	0	In state provider	None	11843 WHITTIER BLVD.	None	WHITTIER	CA	90601	3941	19	06037	33.98063769	-118.0503687	Los Angeles County
181527	Fee-for-Service	1689780629	1689780629	1	1	ROBERTS, LAURIE L NMW	11/30/1997	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16051 KASOTA RD	STE 700	APPLE VALLEY	CA	92307	2215	36	06071	34.543368	-117.2667825	San Bernardino County
181540	Fee-for-Service	1629394747	1629394747	1	1	RAVAL, RONAK N MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115471	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
181557	Fee-for-Service	1710996186	1710996186	1	1	RAKHMIN YUSUPOV	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
181573	Fee-for-Service	1417106972	1417106972	1	1	RIVERA, JESUS LCSW	7/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
181582	Fee-for-Service	1144213117	1144213117	1	1	REGIONAL MEDICAL CENTER	9/23/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SHELBY COUNTY HLTHCARE	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2897	00	None	35.14259562	-90.03187321	Shelby County
181622	Fee-for-Service	1700884228	1700884228	1	1	RAJA, KAVITHA MD	11/27/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	76421	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
181668	Fee-for-Service	1699229377	1699229377	1	1	REYNOSO, RUBEN	8/25/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	19367 VICTORY BLVD	SUITE 14	TARZANA	CA	91335	6302	19	06037	34.18658599	-118.5557169	Los Angeles County
181711	Fee-for-Service	1134255565	1134255565	1	1	ROBSON, DAYLE DEWITT MD	3/11/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50479	01	General Practice	0	In state provider	None	740 S INGLEWOOD AVE	None	INGLEWOOD	CA	90301	3238	19	06037	33.9537818	-118.3616075	Los Angeles County
181737	Fee-for-Service	1235407131	1235407131	1	1	RIPPY, KAREN E LMFT	6/11/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17775	-	NOT APPLICABLE	0	In state provider	None	20331 FLANAGAN ROAD	None	TRABUCO CANYON	CA	92679	0975	30	06059	33.66711239	-117.5844411	Orange County
181781	Fee-for-Service	1689037533	1689037533	1	1	REEDLEY COMMUNITY HOSPITAL	11/27/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	406 JAMES STREET	None	SHAFTER	CA	93263	2035	15	06029	35.50258423	-119.2763447	Kern County
181788	Fee-for-Service	1508354408	1508354408	1	1	RANGEL, CUAUHTLEHUANITZIN A	6/22/2022	207P00000X	NA	Other	026	PHYSICIANS	167054	None	None	0	In state provider	MD	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
181802	Fee-for-Service	1245647221	1245647221	1	1	RADZINSKY, ALIONA OD	8/18/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14006 RIVERSIDE DR	SUITE 274	SHERMAN OAKS	CA	91423	1963	19	06037	34.15757854	-118.437858	Los Angeles County
181813	Fee-for-Service	1881772382	1881772382	1	1	ROWEN, TERRIE M MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91724	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
181820	Fee-for-Service	1184630956	1184630956	1	1	ROBINSON, MING H INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74511	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23961 CALLE DE LA MAGDAL	STE 347	LAGUNA HILLS	CA	92653	3665	30	06059	33.60999658	-117.7126577	Orange County
181821	Fee-for-Service	1245307065	1245307065	1	1	ROSENQUIST, ROBERT C MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54692	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
181823	Fee-for-Service	1598971871	1598971871	1	1	RENDON, ABEL A PT	8/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11306 MOUNTAIN VIEW AVE	A-100	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
181835	Fee-for-Service	1730259029	1730259029	1	1	RUMSEY, EUGENE W JR MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40645	02	General Surgery	0	In state provider	None	4060 4TH AVE	STE 330	SAN DIEGO	CA	92103	2190	37	06073	32.75053673	-117.1616539	San Diego County
181838	Fee-for-Service	1275040495	1275040495	1	1	RUIZ, GABRIELA	5/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
181866	Fee-for-Service	1386092237	1386092237	1	1	REDELMAN, BARRETT LCSW	8/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
181871	Fee-for-Service	1144213117	1144213117	1	1	REGIONAL MEDICAL CENTER	1/30/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SHELBY COUNTY HLTHCARE	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2897	00	None	35.14259562	-90.03187321	Shelby County
181876	Fee-for-Service	1316340474	1316340474	1	1	RIVERA, CHRISTINE S PSYD	3/18/2023	225C00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 ASHTON AVE	None	MENLO PARK	CA	94025	6501	41	06081	37.43205327	-122.2036961	San Mateo County
181899	Fee-for-Service	1366070534	1366070534	1	1	RAMAKRISHNAN, NEERAJ MD	1/10/2024	390200000X	NA	Other	026	PHYSICIANS	189069	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
181928	Fee-for-Service	1063405074	1063405074	1	1	REGENTS OF THE UNIV OF CA	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
181973	Fee-for-Service	1932345550	1932345550	1	1	REYES GUATEMALA, CLAUDIA C L	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
181993	Fee-for-Service	1508486655	1508486655	1	1	REGO, ALICIA DO	9/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
182000	Fee-for-Service	1992997977	1992997977	1	1	RAO, LEKHA M MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103046	79	Neurology-Child	0	In state provider	None	10833 LE CONTE AVE	12-411 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
182003	Fee-for-Service	1598012635	1598012635	1	1	RAMIREZ, ANDREA D OT	5/19/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
182043	Fee-for-Service	1871022780	1871022780	1	1	ROTENSTEIN, LISA S MD	11/12/2023	207R00000X	NA	Other	026	PHYSICIANS	191609	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182124	Fee-for-Service	1730259029	1730259029	1	1	RUMSEY, EUGENE W JR MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40645	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 4TH AVE	STE 330	SAN DIEGO	CA	92103	2190	37	06073	32.75053673	-117.1616539	San Diego County
182140	Fee-for-Service	1033129952	1033129952	1	1	RIVERA, REBECCA MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53681	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4000 EMPIRE DR	STE 120	BAKERSFIELD	CA	93309	0400	15	06029	35.37480064	-119.0459033	Kern County
182148	Fee-for-Service	1518940428	1518940428	1	1	ROBERTS, CATHERINE C MD	10/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54794	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
182159	Fee-for-Service	1730263138	1730263138	1	1	ROLLINS, DAVID B MD	12/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50655	08	Family Practice	0	In state provider	None	1524 MCHENRY AVE	STE 135	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
182177	Fee-for-Service	1750317970	1750317970	1	1	RANCHO FACULTY MEDICAL	2/3/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES INC	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
182192	Fee-for-Service	1982040283	1982040283	1	2	ROMO, KIMBERLY A LMFT	7/8/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
182196	Fee-for-Service	1376625632	1376625632	1	1	ROBERT E CARTER MD INC	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	39364	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1004 FOWLER WAY	STE 1	PLACERVILLE	CA	95667	5746	09	06017	38.72683597	-120.7921028	El Dorado County
182232	Fee-for-Service	1073887972	1073887972	1	1	RAVI, ANITA MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123507	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
182253	Fee-for-Service	1013035716	1013035716	1	2	REGENTS OF THE UNIVERSITY OF	9/2/2015	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N DIEGO PEDIATRICS ASSOC	7910 FROST ST	STE 280	SAN DIEGO	CA	92123	2776	37	06073	32.80027449	-117.153846	San Diego County
182254	Fee-for-Service	1497874457	1497874457	1	1	RAJAMOHAN, ANANDH G MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112745	30	Radiology	0	In state provider	None	1520 SAN PABLO STREET	STE LL-1600	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
182260	Fee-for-Service	1225007149	1225007149	1	1	RAJGURU,AMIT S	10/1/2000	207R00000X	NA	Other	026	PHYSICIANS	67210	41	Internal Medicine	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
182264	Fee-for-Service	1679701767	1679701767	1	1	RIOS, NORMELENA D MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108277	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
182323	Fee-for-Service	1871679308	1871679308	1	1	RATNER, VICKI MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64563	20	Orthopedic Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
182327	Fee-for-Service	1760412050	1760412050	1	1	REGEV, RAN MD	5/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96685	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
182344	Fee-for-Service	1871868299	1871868299	1	1	RHEUMATOLOGY ASSOCIATES OF	6/1/2012	193400000X	NA	Other	026	PHYSICIANS	104056	41	Internal Medicine	0	In state provider	None	23206 LYONS AVE	SUITE 106	SANTA CLARITA	CA	91321	2671	19	06037	34.37981956	-118.5384385	Los Angeles County
182365	Fee-for-Service	1043693369	1043693369	1	1	RANDALL, TRISTAN H LCSW	12/10/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
182378	Fee-for-Service	1205071073	1205071073	1	1	RIZVI, MURTAZA MD	8/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95879	24	Plastic Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
182417	Fee-for-Service	1376350546	1376350546	1	1	ROSS, ESTELLE DOULA	2/7/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
182511	Fee-for-Service	1073544417	1073544417	1	1	RAVAN, SHAHRAM F MD	11/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40168	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	436 N BEDFORD DR	STE 214	BEVERLY HILLS	CA	90210	4312	19	06037	34.0685329	-118.4056227	Los Angeles County
182521	Fee-for-Service	1407050685	1407050685	1	1	RIES, JAMES T	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
182526	Fee-for-Service	1720085673	1720085673	1	1	ROSEN, NORMAN B MD	12/28/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34431	08	Family Practice	0	In state provider	None	1332 NATIVIDAD RD	#B	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
182563	Fee-for-Service	1669687745	1669687745	1	1	RYAN, LINDA K MFT	11/3/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
182566	Fee-for-Service	1437237237	1437237237	1	1	RADOSEVICH, PAUL M MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64820	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
182631	Fee-for-Service	1063878783	1063878783	1	1	RAUSCHER, GLENN DO	3/27/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	15774	30	Radiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
182633	Fee-for-Service	1871868299	1871868299	1	1	RHEUMATOLOGY ASSOCIATES OF	6/1/2012	193400000X	NA	Other	026	PHYSICIANS	104056	83	Rheumatology	0	In state provider	None	23206 LYONS AVE	SUITE 106	SANTA CLARITA	CA	91321	2671	19	06037	34.37981956	-118.5384385	Los Angeles County
182683	Fee-for-Service	1538537022	1538537022	1	1	ROSANIA, KIMBERLY	2/25/2020	2084P0804X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
182687	Fee-for-Service	1578880670	1578880670	1	1	RAGAB, OMAR M MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121003	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	SUITE B265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
182699	Fee-for-Service	1194859223	1194859223	1	1	ROCHAT, DERALD W MD INC	12/31/1995	193400000X	NA	Other	026	PHYSICIANS	25083	04	Otology, Laryngology, Rhinology	0	In state provider	None	1008 FOWLER WAY	STE C	PLACERVILLE	CA	95667	5701	09	06017	38.72648857	-120.791716	El Dorado County
182708	Fee-for-Service	1821033275	1821033275	1	1	RAYCHAUDHURI, SIBA P MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	52869	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
182777	Fee-for-Service	1629230099	1629230099	1	1	ROBLES, DENNIS M LMFT	5/10/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22446	-	NOT APPLICABLE	0	In state provider	None	30086 MISSION BLVD	None	HAYWARD	CA	94544	7233	01	06001	37.62668651	-122.0433367	Alameda County
182792	Fee-for-Service	1306001383	1306001383	1	1	ROY, RANDALL J MD	12/27/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	179750	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
182793	Fee-for-Service	1780941609	1780941609	1	1	ROSA, PAOLA A DO	6/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17685	15	Obstetrics (D.O. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
182809	Fee-for-Service	1710065586	1710065586	1	1	RAMACHANDRA, SRIVINAS MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38624	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
182857	Fee-for-Service	1427621820	1427621820	1	1	ROTHHAMMER-RUIZ, ANA M NP	8/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
182867	Fee-for-Service	1366814576	1366814576	1	1	ROUNDS, KACIE MD	9/28/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159372	None	None	0	In state provider	None	1423 MAGNOLIA	None	CHICO	CA	95926	3226	04	06007	39.74063551	-121.8499048	Butte County
182982	Fee-for-Service	1285952853	1285952853	1	1	RIKER, JEFFREY B MD A	10/29/2010	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	PROFESSIONAL CORPORATION	2840 LONG BEACH BLVD	STE 210	LONG BEACH	CA	90806	7509	19	06037	33.808743	-118.189341	Los Angeles County
182992	Fee-for-Service	1497754832	1497754832	1	1	ROOD, JACQUELINE S	11/2/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1687 ERRINGER ROAD	STE 109	SIMI VALLEY	CA	93065	3357	56	06111	34.268886	-118.761426	Ventura County
182998	Fee-for-Service	1275646069	1275646069	1	1	RICHMAN, MARK J MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	83458	41	Internal Medicine	0	In state provider	None	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1495	19	06037	34.32450186	-118.4456317	Los Angeles County
183003	Fee-for-Service	1154616951	1154616951	1	1	RAO, ANJALI S MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124792	01	General Practice	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
183038	Fee-for-Service	1932534021	1932534021	1	1	RENAL CONSULTANTS OF VENTURA	10/20/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2438 PONDEROSA DRIVE N	C-101	CAMARILLO	CA	93010	2369	56	06111	34.24219545	-119.0227012	Ventura County
183082	Fee-for-Service	1780941609	1780941609	1	1	ROSA, PAOLA A DO	6/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17685	09	Gynecology (D.O. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
183090	Fee-for-Service	1356538011	1356538011	1	1	RAMOS, JEFFREY A MD	5/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95018	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
183127	Fee-for-Service	1194131615	1194131615	1	1	RECINOS, FREYMAN M MD	11/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138410	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
183133	Fee-for-Service	1205024544	1205024544	1	1	RAO, SRIHARSHA MD	7/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115213	41	Internal Medicine	0	In state provider	None	3701 J STREET	STE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
183149	Fee-for-Service	1518228873	1518228873	1	1	RIVERA, DIANA LCSW	1/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
183221	Fee-for-Service	1972662401	1972662401	1	1	RUSSELL, SHILA	7/21/2009	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	312 W J ST	STE 202	LOS BANOS	CA	93635	4073	24	06047	37.06221105	-120.8570564	Merced County
183239	Fee-for-Service	1356434021	1356434021	1	1	REDDING HEARNG INSTITUTE	12/16/2004	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	499 HEMSTED DRIVE	SUITE A	REDDING	CA	96002	0165	45	06089	40.57373572	-122.3631628	Shasta County
183256	Fee-for-Service	1447243548	1447243548	1	2	REGENTS/UCDPBG/PED INF D	5/1/1999	2080P0208X	NA	HIV/AIDS/Infectious Disease	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
183272	Fee-for-Service	1285952853	1285952853	1	1	RIKER, JEFFREY B MD A	10/29/2010	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	PROFESSIONAL CORPORATION	2840 LONG BEACH BLVD	STE 210	LONG BEACH	CA	90806	7509	19	06037	33.808743	-118.189341	Los Angeles County
183278	Fee-for-Service	1336798842	1336798842	1	1	RAMOS, ARIANA LCSW	1/31/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
183288	Fee-for-Service	1275646069	1275646069	1	1	RICHMAN, MARK J MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	83458	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1495	19	06037	34.32450186	-118.4456317	Los Angeles County
183299	Fee-for-Service	1093799264	1093799264	1	1	ROSE, JOHN S MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75451	70	Clinic (mixed specialty)	0	In state provider	None	4150 V ST	FL 2	SACRAMENTO	CA	95817	1460	34	06067	38.556081	-121.4570475	Sacramento County
183418	Fee-for-Service	1720088354	1720088354	1	5	RIDEOUT MEMORIAL HOSPITAL	9/15/2000	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	970 PLUMAS STREET	None	YUBA CITY	CA	95991	4019	51	06101	39.14322052	-121.6176856	Sutter County
183421	Fee-for-Service	1205024544	1205024544	1	1	RAO, SRIHARSHA MD	7/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115213	77	Infectious Disease	0	In state provider	None	3701 J STREET	STE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
183428	Fee-for-Service	1558756080	1558756080	1	1	REID, JENNIFER E MD	7/20/2021	208600000X	NA	General Surgery	026	PHYSICIANS	167857	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
183468	Fee-for-Service	1225639875	1225639875	1	1	RHOE, ALEXANDRA D PT	9/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	957 FAULKNERROAD	105	SANTA PAULA	CA	93060	9129	56	06111	34.33481551	-119.0867489	Ventura County
183469	Fee-for-Service	1285767079	1285767079	1	1	READ JAMIE N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LEGACY EMANUEL HOSPITAL	2801 N. GANTENBIEN AVE.	None	PORTLAND	OR	97227	0000	00	None	45.54387841	-122.6696022	Multnomah County
183483	Fee-for-Service	1508187170	1508187170	1	1	RAZO, HUGO M MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125202	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
183494	Fee-for-Service	1780231639	1780231639	1	1	ROSS, JENNY PT	9/22/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
183511	Fee-for-Service	1396732855	1396732855	1	1	RATHOD, RAMESH MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	33160	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 E VALENCIA MESA DR	STE 200	FULLERTON	CA	92835	3817	30	06059	33.89343304	-117.9279349	Orange County
183512	Fee-for-Service	1386832442	1386832442	1	1	ROSSI, JENNIFER K MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105598	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
183515	Fee-for-Service	1134242100	1134242100	1	1	RYLAND, ANTHONY D LMFT	3/19/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38997	-	NOT APPLICABLE	0	In state provider	None	40 WEST G STREET	SUITES A-E	LOS BANOS	CA	93635	3657	24	06047	37.06661683	-120.8545413	Merced County
183531	Fee-for-Service	1073776720	1073776720	1	1	ROBERT L ALUNDAY MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
183538	Fee-for-Service	1134169535	1134169535	2	1	REACH AIR MEDICAL SERVICES L	11/30/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6030 OLD OREGON	None	REDDING	CA	96002	9330	45	06089	40.52040065	-122.2907625	Shasta County
183558	Fee-for-Service	1285952853	1285952853	1	1	RIKER, JEFFREY B MD A	10/29/2010	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	2840 LONG BEACH BLVD	STE 210	LONG BEACH	CA	90806	7509	19	06037	33.808743	-118.189341	Los Angeles County
183562	Fee-for-Service	1801974571	1801974571	1	1	RYDER, STEVEN H MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85914	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
183566	Fee-for-Service	1184801482	1184801482	1	1	REDDY, DEEPA R MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107799	78	Neoplastic Diseases/Oncology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
183573	Fee-for-Service	1992098701	1992098701	1	1	RAJA, SABIYA B MD	8/16/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	137496	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
183585	Fee-for-Service	1093799264	1093799264	1	1	ROSE, JOHN S MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75451	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4150 V ST	FL 2	SACRAMENTO	CA	95817	1460	34	06067	38.556081	-121.4570475	Sacramento County
183612	Fee-for-Service	1326747270	1326747270	1	1	ROYAL RIDE TRANSPORT LLC	5/8/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3550 WATT AVE	STE 140 OFFICE 213	SACRAMENTO	CA	95821	2667	34	06067	38.630115	-121.3819245	Sacramento County
183627	Fee-for-Service	1023671062	1023671062	1	1	RAAE-NIELSEN, JENNIFER E MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176525	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
183639	Fee-for-Service	1043320708	1043320708	1	1	RALEYS	10/6/1975	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13384 LINCOLN WAY	None	AUBURN	CA	95603	3239	31	06061	38.92402983	-121.0558304	Placer County
183672	Fee-for-Service	1710097613	1710097613	2	1	RENDON, RAYMOND R	9/1/2012	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	2039 FOREST AVE	SUITE 206	SAN JOSE	CA	95128	4815	43	06085	37.32711929	-121.934266	Santa Clara County
183677	Fee-for-Service	1407923352	1407923352	1	1	REDDY, SUDHA M MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61732	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
183694	Fee-for-Service	1699820688	1699820688	1	1	ROEFS, JOHN A MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73508	30	Radiology	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
183696	Fee-for-Service	1770521452	1770521452	1	1	ROYTMAN, MARINA M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148700	41	Internal Medicine	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
183699	Fee-for-Service	1780180711	1780180711	1	1	RALPH, STEPHEN R MD	5/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183074	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
183709	Fee-for-Service	1205024544	1205024544	1	1	RAO, SRIHARSHA MD	7/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3701 J STREET	STE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
183716	Fee-for-Service	1649808312	1649808312	1	1	RICHARDSON, SAMUEL	5/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
183726	Fee-for-Service	1558654921	1558654921	1	1	RIPP, GAVIN P	10/3/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
183732	Fee-for-Service	1538658638	1538658638	1	1	ROI, MATTHEW MD	9/27/2023	207L00000X	NA	Other	026	PHYSICIANS	177868	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
183750	Fee-for-Service	1851864581	1851864581	1	1	ROCKENSTEIN, MEREDITH L LMFT	8/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
183772	Fee-for-Service	1881794428	1881794428	1	1	RAITT, NELSON W MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	52154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3043	31	06061	38.76507948	-121.2477476	Placer County
183821	Fee-for-Service	1689668691	1689668691	1	1	ROE, STANLEY J MD	11/23/1993	207L00000X	NA	Other	026	PHYSICIANS	22832	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
183827	Fee-for-Service	1194025403	1194025403	1	1	RENTZ, JESSICA M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
183840	Fee-for-Service	1699712307	1699712307	1	1	RAMOS, ARTHUR MD	1/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68080	08	Family Practice	0	In state provider	None	11525 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
183871	Fee-for-Service	1932534021	1932534021	1	2	RENAL CONSULTANTS OF VENTURA	2/29/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	1900 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.22014556	-119.1484924	Ventura County
183897	Fee-for-Service	1710459995	1710459995	1	1	REYES, JOANNE B NP	2/4/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	555 TACHEVAH DR	STE 2W-103	PALM SPRINGS	CA	92262	5764	33	06065	33.83753681	-116.5424435	Riverside County
183909	Fee-for-Service	1821576885	1821576885	1	1	ROBLES, KAREN J RCP	11/5/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
183942	Fee-for-Service	1356729032	1356729032	1	1	RYAN, KATHERINE J DO	9/6/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	21833	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
183989	Fee-for-Service	1346851508	1346851508	1	1	RESNICK, DANIEL CRNA	5/22/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
184051	Fee-for-Service	1841376779	1841376779	1	1	ROBIE, BETH E MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	59309	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PERMANENTE MEDICAL GROUP	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
184060	Fee-for-Service	1881794428	1881794428	1	1	RAITT, NELSON W MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	52154	41	Internal Medicine	0	In state provider	None	2 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3043	31	06061	38.76507948	-121.2477476	Placer County
184086	Fee-for-Service	1629396213	1629396213	1	1	RUSSELL, ANIKA A MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116850	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184090	Fee-for-Service	1013553064	1013553064	1	1	RAMIREZ, NATASHA M NP	2/1/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
184108	Fee-for-Service	1275038127	1275038127	1	1	RANDHAWA, SUKHBIR DO	1/10/2025	207R00000X	NA	Other	026	PHYSICIANS	23518	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
184110	Fee-for-Service	1760600399	1760600399	1	1	RHODEN, KEITH A CRNA	3/14/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
184127	Fee-for-Service	1699712307	1699712307	1	1	RAMOS, ARTHUR MD	1/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68080	01	General Practice	0	In state provider	None	11525 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
184138	Fee-for-Service	1982231445	1982231445	1	1	ROSENTHAL, AMANDA MD	7/15/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	188970	07	Dermatology	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
184165	Fee-for-Service	1881181071	1881181071	1	1	RONEN, JOSHUA A MD	7/29/2021	208M00000X	NA	Other	026	PHYSICIANS	173560	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184207	Fee-for-Service	1255582540	1255582540	1	1	RIZVI, ABID A MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105314	None	None	0	In state provider	None	1335 CYPRESS STREET	205	SAN DIMAS	CA	91773	3538	19	06037	34.09583252	-117.834134	Los Angeles County
184208	Fee-for-Service	1881071033	1881071033	1	1	REGUIEG, AMEL MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157893	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91346	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
184214	Fee-for-Service	1972074789	1972074789	1	1	RIZVI, SAMAD PSYD	3/25/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
184216	Fee-for-Service	1326449273	1326449273	1	1	RAMOS, GLENDA P PSYD	1/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
184231	Fee-for-Service	1457410029	1457410029	1	1	RUBENS, GEORGE H MD	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	44106	20	Orthopedic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
184254	Fee-for-Service	1952784852	1952784852	1	1	REHMAN, HAROON MD	2/18/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	168291	None	None	0	In state provider	None	310 HARTNELL AVE	None	REDDING	CA	96002	1800	45	06089	40.56670901	-122.3688887	Shasta County
184262	Fee-for-Service	1831509306	1831509306	1	1	ROME, AARON M DO	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14733	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
184264	Fee-for-Service	1730193996	1730193996	1	1	RESNIKOFF, JOSEPH R MD	3/1/1999	207RC0200X	NA	Other	026	PHYSICIANS	81283	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	501 WASHINGTON ST	STE 508	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
184268	Fee-for-Service	1285667741	1285667741	1	1	RENN, HOPE A CNMW	3/1/2000	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
184270	Fee-for-Service	1396024337	1396024337	1	1	RAMOS-GARCIA, RAQUEL V MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137845	41	Internal Medicine	0	In state provider	None	1101 N CHERRY STREET	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
184278	Fee-for-Service	1134169535	1134169535	2	19	REACH AIR MEDICAL SERVICES L	3/15/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LC.	6120 LINDBERG ST	None	STOCKTON	CA	95206	3921	39	06077	37.8942614	-121.2498858	San Joaquin County
184279	Fee-for-Service	1639103260	1639103260	1	1	RUDOLF, JAMES D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50751	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25455 BARTON RD	STE 212A	LOMA LINDA	CA	92354	3177	36	06071	34.04805253	-117.249534	San Bernardino County
184280	Fee-for-Service	1942582168	1942582168	1	1	ROBEL, ROSE CAMILLE V OT	12/23/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
184286	Fee-for-Service	1346475928	1346475928	1	1	REN, ANDREW H MD	11/10/2009	207R00000X	NA	Other	026	PHYSICIANS	106267	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184356	Fee-for-Service	1407994288	1407994288	1	1	RAO, SANJAY S MD	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92683	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
184434	Fee-for-Service	1033643267	1033643267	1	1	REITER, NICHOLAS E MD	1/25/2022	207P00000X	NA	Other	026	PHYSICIANS	175633	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
184462	Fee-for-Service	1083241178	1083241178	1	1	RAI, DIPTI R MD	7/1/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
184463	Fee-for-Service	1134169535	1134169535	2	17	REACH AIR MEDICAL SERVICES L	3/6/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
184471	Fee-for-Service	1073661963	1073661963	1	1	ROTH, PATRICK D MD	9/30/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74529	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
184479	Fee-for-Service	1871053462	1871053462	1	1	REYES, AMANDA C MD	12/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178548	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
184500	Fee-for-Service	1891952180	1891952180	1	1	REISIN, BENJAMIN LMFT	7/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1590 SOUTH IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77950118	-115.5697279	Imperial County
184518	Fee-for-Service	1003249475	1003249475	1	1	RELIANCE HOSPICE SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	601 S BRAND BLVD	STE 311	SAN FERNANDO	CA	91340	4040	19	06037	34.27854612	-118.4441844	Los Angeles County
184533	Fee-for-Service	1700380607	1700380607	1	1	ROUSSOS, ALEXANDER DO	8/18/2023	207LP2900X	NA	Other	026	PHYSICIANS	19536	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
184552	Fee-for-Service	1730193996	1730193996	1	1	RESNIKOFF, JOSEPH R MD	3/1/1999	207RC0200X	NA	Other	026	PHYSICIANS	81283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 WASHINGTON ST	STE 508	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
184561	Fee-for-Service	1609593680	1609593680	1	1	ROSS-NASH, ZOE PSYD	11/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
184608	Fee-for-Service	1093755183	1093755183	1	1	REASH, SHEILA R CRNA	6/17/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	5200 FAIRVIEW BLVD	None	WYOMING	MN	55092	8013	00	None	45.32172586	-92.99989785	Chisago County
184619	Fee-for-Service	1962598938	1962598938	1	1	ROLAND, MICHELE M MD	4/28/1999	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	53583	01	General Practice	0	In state provider	None	4661 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6020	19	06037	34.0981775	-118.290996	Los Angeles County
184620	Fee-for-Service	1275526295	1275526295	1	1	REGENTS/UCDPBG/ORTHO SUR	5/1/1983	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
184655	Fee-for-Service	1255577904	1255577904	1	1	RAINOW, ALEX MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154306	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
184679	Fee-for-Service	1013993468	1013993468	1	1	RIGGS, KIMBERLY A PT	12/6/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	685 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
184736	Fee-for-Service	1356012777	1356012777	1	1	REZAGHOLIPOUR SARABI, ARASH	12/9/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
184782	Fee-for-Service	1255494910	1255494910	1	1	RHODES, KRISTEN CRNA	3/21/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
184804	Fee-for-Service	1003249475	1003249475	1	1	RELIANCE HOSPICE SERVICES	6/1/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	601 S BRAND BLVD	STE 311	SAN FERNANDO	CA	91340	4040	19	06037	34.27854612	-118.4441844	Los Angeles County
184807	Fee-for-Service	1689177255	1689177255	1	1	REYNOLDS, SHAWNA LCSW	2/6/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
184833	Fee-for-Service	1851954424	1851954424	1	1	RANDALL, SHELBY J DO	7/20/2022	207P00000X	NA	Other	026	PHYSICIANS	20015	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
184848	Fee-for-Service	1225612468	1225612468	1	1	RILEY, MARCUS W NP	1/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 6100,6300,7200,7300	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
184872	Fee-for-Service	1063882579	1063882579	1	1	RICKERTS, MATTHEW M PT	7/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
184884	Fee-for-Service	1467933085	1467933085	1	1	ROSEN-HANSON, FELECYTIE S LM	9/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2151 CALIFORNIA STREET	UNIT B	CONCORD	CA	94520	2324	07	06013	37.97739893	-122.0402219	Contra Costa County
184914	Fee-for-Service	1346581923	1346581923	1	1	RAFF, EVAN A MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137235	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
184916	Fee-for-Service	1164818985	1164818985	1	1	ROSENTHAL, AYELET MD	6/15/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155501	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
184929	Fee-for-Service	1700216694	1700216694	1	1	REVIVE HOSPICE CARE GROUP	8/19/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	3430 OCEAN VIEW BLVD	None	GLENDALE	CA	91208	1566	19	06037	34.20135989	-118.2282592	Los Angeles County
184938	Fee-for-Service	1053347138	1053347138	1	1	RICE, BRUCE J MD	1/25/1977	208600000X	NA	General Surgery	026	PHYSICIANS	30304	04	Otology, Laryngology, Rhinology	0	In state provider	None	2316 DWIGHT WAY	None	BERKELEY	CA	94704	2281	01	06001	37.86460853	-122.2621987	Alameda County
184949	Fee-for-Service	1154301745	1154301745	1	1	REGENTS OF THE UNIV CA	5/29/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	251 TURNPIKE	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
184951	Fee-for-Service	1811538010	1811538010	1	1	REST ASSURED HOSPICE INC	4/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	#217	RESEDA	CA	91335	6184	19	06037	34.2011975	-118.5419835	Los Angeles County
184968	Fee-for-Service	1356427058	1356427058	1	1	ROCKWELL, JOHN C MD	7/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103318	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
184976	Fee-for-Service	1134169535	1134169535	2	36	REACH AIR MEDICAL SERVICES L	4/19/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LC.	79880 AVENUE 42	# B	BERMUDA DUNES	CA	92203	1453	33	06065	33.74383059	-116.2702744	Riverside County
184981	Fee-for-Service	1619150935	1619150935	1	1	REIDER, SHANNON J DO	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9810	41	Internal Medicine	0	In state provider	None	19601 MARINER AVENUE	None	TORRANCE	CA	90503	1647	19	06037	33.85295217	-118.3506987	Los Angeles County
185008	Fee-for-Service	1316051733	1316051733	1	1	RUBINSTEIN, PAUL C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49968	10	Gastroenterology (M.D. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
185067	Fee-for-Service	1417009879	1417009879	1	1	REYNOSO, MARIA E MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80949	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
185114	Fee-for-Service	1518277433	1518277433	1	1	REVILLA, MARIA E PHD	2/2/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
185126	Fee-for-Service	1063565174	1063565174	1	1	ROBERTSON, CHRISTINE LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
185142	Fee-for-Service	1215179163	1215179163	1	1	RUDIKOFF, ANDREW G MD	6/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105724	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
185170	Fee-for-Service	1558094839	1558094839	1	1	RACHELL, MICHELLE M NP	1/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
185174	Fee-for-Service	1366435380	1366435380	1	2	REGENTS/UCDPBG/ICU PAIN	5/28/2020	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
185186	Fee-for-Service	1861832750	1861832750	1	1	ROW, VIJAY K MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140463	01	General Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
185214	Fee-for-Service	1275910283	1275910283	1	1	RALPH, MARILYN MD	11/19/2018	207R00000X	NA	Other	026	PHYSICIANS	146365	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
185216	Fee-for-Service	1700216694	1700216694	1	1	REVIVE HOSPICE CARE GROUP	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	3430 OCEAN VIEW BLVD	None	GLENDALE	CA	91208	1566	19	06037	34.20135989	-118.2282592	Los Angeles County
185219	Fee-for-Service	1497017339	1497017339	1	2	ROBINSON, ERIC MD	9/16/2024	207P00000X	NA	Other	026	PHYSICIANS	140384	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
185225	Fee-for-Service	1508122656	1508122656	1	1	RIYAT, NAYNA D MD	9/27/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	181957	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185227	Fee-for-Service	1053347138	1053347138	1	1	RICE, BRUCE J MD	1/25/1977	208600000X	NA	General Surgery	026	PHYSICIANS	30304	49	Unknown	0	In state provider	None	2316 DWIGHT WAY	None	BERKELEY	CA	94704	2281	01	06001	37.86460853	-122.2621987	Alameda County
185234	Fee-for-Service	1013095827	1013095827	1	1	REARDON, KAREN ANNE MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	74304	83	Rheumatology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
185237	Fee-for-Service	1154301745	1154301745	1	1	REGENTS OF THE UNIV CA	9/2/2021	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	251 TURNPIKE	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
185238	Fee-for-Service	1811538010	1811538010	1	1	REST ASSURED HOSPICE INC	4/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	#217	RESEDA	CA	91335	6184	19	06037	34.2011975	-118.5419835	Los Angeles County
185257	Fee-for-Service	1124280896	1124280896	1	1	ROSENBERG, JOSHUA D MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107148	78	Neoplastic Diseases/Oncology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
185294	Fee-for-Service	1316051733	1316051733	1	1	RUBINSTEIN, PAUL C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49968	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
185306	Fee-for-Service	1063502839	1063502839	1	1	ROSEN, FREDERICK S MD	3/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84955	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
185363	Fee-for-Service	1750544516	1750544516	1	1	RIES, MAUREEN C MD	9/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127234	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
185375	Fee-for-Service	1710932231	1710932231	1	1	RAO, SUCHITRA MD	11/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93521	08	Family Practice	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95340	0000	24	06047	37.28825369	-120.4963159	Merced County
185399	Fee-for-Service	1396324885	1396324885	1	1	RAO, SHALINI S MD	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
185461	Fee-for-Service	1366435380	1366435380	1	2	REGENTS/UCDPBG/ICU PAIN	5/1/1999	207LP2900X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
185465	Fee-for-Service	1801921952	1801921952	1	2	ROY MEDICAL GROUP INC	1/1/1996	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	16063 VANOWEN ST	None	VAN NUYS	CA	91406	4810	19	06037	34.1939643	-118.4831734	Los Angeles County
185467	Fee-for-Service	1477789063	1477789063	1	1	RICE, TOREY J LMFT	3/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
185517	Fee-for-Service	1295926319	1295926319	1	1	RIBONI, KATRINA F MD	11/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137846	05	Anesthesiology	0	In state provider	None	3700 E SOUTH STREET	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
185524	Fee-for-Service	1154301745	1154301745	1	1	REGENTS OF THE UNIV CA	2/3/2021	261QM1300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	251 TURNPIKE	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
185543	Fee-for-Service	1124280896	1124280896	1	1	ROSENBERG, JOSHUA D MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107148	68	Hematology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
185557	Fee-for-Service	1396872792	1396872792	1	1	RSCR INLAND INC	9/18/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3980 CARRICK ST	None	RIVERSIDE	CA	92505	3004	33	06065	33.90880715	-117.4747574	Riverside County
185567	Fee-for-Service	1144631243	1144631243	1	2	R'ID, SABAH ASHURA MD	10/1/2021	390200000X	NA	Other	026	PHYSICIANS	142192	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185586	Fee-for-Service	1952357709	1952357709	1	1	RIES, MARIANNE C MD	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	68550	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
185605	Fee-for-Service	1114002128	1114002128	1	1	ROGUE VALLEY MEM HOSP	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
185620	Fee-for-Service	1346327368	1346327368	1	2	RIGHT HEALTHCARE INC	9/20/2018	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5640 DISTRICT BLVD	STE 111	BAKERSFIELD	CA	93313	2184	15	06029	35.31308529	-119.0652842	Kern County
185641	Fee-for-Service	1740252725	1740252725	2	1	RUVO, VERONICA Y DO MD	6/15/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
185736	Fee-for-Service	1164596763	1164596763	1	1	RAU, JYOTI MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87540	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
185740	Fee-for-Service	1235239740	1235239740	1	1	RUBENSTONE, SALLY J MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	53652	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
185753	Fee-for-Service	1801921952	1801921952	1	2	ROY MEDICAL GROUP INC	1/1/1996	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	16063 VANOWEN ST	None	VAN NUYS	CA	91406	4810	19	06037	34.1939643	-118.4831734	Los Angeles County
185812	Fee-for-Service	1154301745	1154301745	1	1	REGENTS OF THE UNIV CA	5/1/1996	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	UC DAVIS MEDICAL GROUP	251 TURNPIKE	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
185833	Fee-for-Service	1588764047	1588764047	1	1	RASHID, AHSAN MD	2/1/1996	207R00000X	NA	Other	026	PHYSICIANS	48233	01	General Practice	0	In state provider	None	113 WATERWORKS WAY	STE 250	IRVINE	CA	92618	3169	30	06059	33.66497942	-117.7635578	Orange County
185838	Fee-for-Service	1306209523	1306209523	1	1	ROMANS, DUSTI D LCSW	4/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
185870	Fee-for-Service	1003964834	1003964834	1	1	RAWI, BASHIR A MD	12/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48140	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
185879	Fee-for-Service	1831434778	1831434778	1	1	REISLER, ELIZABETH G LCSW	6/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
185946	Fee-for-Service	1609261379	1609261379	1	1	RAGHAVAN, KESAV MD	3/23/2020	390200000X	NA	Other	026	PHYSICIANS	148430	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
185965	Fee-for-Service	1609983485	1609983485	1	1	REZVANI, ANDREW R MD	2/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128390	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185987	Fee-for-Service	1427052463	1427052463	1	1	RUBENSTEIN, JOEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
185999	Fee-for-Service	1700158680	1700158680	1	1	RYAN, WYATT E LMFT	3/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	197 NORTH 10TH STREET	SUITE 101	GROVER BEACH	CA	93433	0000	40	06079	35.1206659	-120.6190364	San Luis Obispo County
186027	Fee-for-Service	1013462860	1013462860	1	1	RUDOLPH, LENA B	10/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
186067	Fee-for-Service	1689739484	1689739484	1	1	RAWLES, ANDREW T PT	8/29/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
186068	Fee-for-Service	1306588199	1306588199	1	1	ROQUE, RONALD MD	2/19/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4770 W HERNDON AVE	STE 107	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
186105	Fee-for-Service	1518378124	1518378124	1	1	RUSSO, FRANCO A MD	1/30/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	140491	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
186142	Fee-for-Service	1649569633	1649569633	1	1	RUPLE, LARRY	11/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
186173	Fee-for-Service	1255765251	1255765251	1	1	ROJAS, CHIKA M LCSW	3/14/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
186225	Fee-for-Service	1083054571	1083054571	1	1	REX, CHRISTOPHER U MD	12/16/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	148673	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
186227	Fee-for-Service	1457320921	1457320921	1	1	RARDIN, KARIN W OD	5/5/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39355 CALIFORNIA ST	STE 103	FREMONT	CA	94538	1447	01	06001	37.54733091	-121.9819574	Alameda County
186254	Fee-for-Service	1609983485	1609983485	1	1	REZVANI, ANDREW R MD	2/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128390	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186342	Fee-for-Service	1497833073	1497833073	1	1	RADHAKRISHNAN, SINDHU MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92624	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
186343	Fee-for-Service	1508164211	1508164211	1	1	REDDY, SUDHIR K MD INC	9/19/2011	193400000X	NA	Other	026	PHYSICIANS	48880	41	Internal Medicine	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
186361	Fee-for-Service	1659329233	1659329233	1	1	ROBERTSON, GREGORY J MD	12/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76912	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
186369	Fee-for-Service	1730507054	1730507054	1	1	RANE, AJINKYA MD	12/11/2020	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	170022	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
186394	Fee-for-Service	1790111086	1790111086	1	2	ROBERTS, DAIRIAN M OT	7/13/2024	225X00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
186405	Fee-for-Service	1194381632	1194381632	1	1	RIOJA, PRISCILLA LMFT	7/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
186406	Fee-for-Service	1235398942	1235398942	2	1	ROY, ANJALI MD	4/1/2019	2085B0100X	NA	MRI Provider	026	PHYSICIANS	154060	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
186456	Fee-for-Service	1447310263	1447310263	1	1	ROSENBERG, DORIE N LMFT	10/21/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 C ST	7C	SAN RAFAEL	CA	94901	3891	21	06041	37.97082935	-122.5311011	Marin County
186468	Fee-for-Service	1780017434	1780017434	1	1	RAND, WILLIAM C MD PC	10/8/2013	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	33446	20	Orthopedic Surgery	0	In state provider	None	935 N GEM ST	None	TULARE	CA	93274	2127	54	06107	36.22107814	-119.3398789	Tulare County
186516	Fee-for-Service	1134360258	1134360258	1	1	RIDDELL, FRANCESCA A LMFT	9/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186520	Fee-for-Service	1356851760	1356851760	1	1	RUSSELL, MARGARET LMFT	5/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
186537	Fee-for-Service	1790001287	1790001287	1	1	REICHEL, MICHAEL MD	4/4/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176833	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
186538	Fee-for-Service	1477799419	1477799419	1	1	REDONDO BEACH UNIFIED	10/14/2007	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1401 INGLEWOOD AVE	None	REDONDO BEACH	CA	90278	3999	19	06037	33.8673363	-118.3612695	Los Angeles County
186603	Fee-for-Service	1245446855	1245446855	1	1	RAINVILLE, JANET L LCSW	7/13/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	705 PINE ST	None	MOUNT SHASTA	CA	96067	2133	47	06093	41.31597283	-122.3193007	Siskiyou County
186628	Fee-for-Service	1508164211	1508164211	1	1	REDDY, SUDHIR K MD INC	9/19/2011	193400000X	NA	Other	026	PHYSICIANS	48880	10	Gastroenterology (M.D. only)	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
186656	Fee-for-Service	1356429104	1356429104	1	1	RODRIGUEZ, BRUCE D MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55460	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
186729	Fee-for-Service	1992898993	1992898993	1	1	RICHMAN, KATHERINE M MD	5/1/1998	2085R0203X	NA	Other	026	PHYSICIANS	80333	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
186734	Fee-for-Service	1902832702	1902832702	2	1	ROMERO, KENNETH A MD	8/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66351	05	Anesthesiology	0	In state provider	None	752 MEDICAL CENTER CT	STE 206	CHULA VISTA	CA	91911	6658	37	06073	32.61800405	-117.0232585	San Diego County
186746	Fee-for-Service	1497745772	1497745772	1	1	ROBERTO, ROLANDO F MD	5/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86870	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
186822	Fee-for-Service	1316483720	1316483720	1	1	RADIOLOGIC ASSOCIATES OF NOR	7/26/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	1	Border provider	THWEST ARIZONA PLC	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
186837	Fee-for-Service	1083858823	1083858823	1	1	ROOTS COMMUNITY HEALTH	2/11/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	9925 INTERNATIONAL BLVD	STE 5	OAKLAND	CA	94603	2558	01	06001	37.74332565	-122.1698542	Alameda County
186889	Fee-for-Service	1508845579	1508845579	1	1	ROBERTS, JASON D MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95372	42	Nuclear Medicine	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
186909	Fee-for-Service	1386906428	1386906428	1	1	RUFFNER, NICHOLE MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122442	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
186934	Fee-for-Service	1285699660	1285699660	1	1	RUDNICK, DAVID M MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85214	34	Urology and Urological Surgery	0	In state provider	None	1496 PROFESSIONAL DR	STE 603	PETALUMA	CA	94954	6698	49	06097	38.25575122	-122.6329158	Sonoma County
187004	Fee-for-Service	1013386432	1013386432	1	1	REDDY, SILPA R DO	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14160	41	Internal Medicine	0	In state provider	None	6719 ALVARADO ROAD	STE 108	SAN DIEGO	CA	92120	5254	37	06073	32.77684978	-117.055137	San Diego County
187042	Fee-for-Service	1003867276	1003867276	1	1	RATTNER, ZACHARY MD	6/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86843	30	Radiology	0	In state provider	None	7301 GIRARD AVE	STE B	LA JOLLA	CA	92037	5150	37	06073	32.83764565	-117.2715586	San Diego County
187146	Fee-for-Service	1598801474	1598801474	1	1	ROSENBLATT, ERIN M PHD	12/8/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4000 BROADWAY	STE 4	OAKLAND	CA	94611	5670	01	06001	37.82771857	-122.2565587	Alameda County
187161	Fee-for-Service	1285683482	1285683482	1	1	REISS, JAMES A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CASCADE HEART	200 NE MOTHER JOSEPH PL,	SUITE 400	VANCOUVER	WA	98664	0000	00	None	45.624096	-122.580144	Clark County
187165	Fee-for-Service	1013620038	1013620038	1	1	RAMOS, DAVID V NP	5/26/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
187178	Fee-for-Service	1508845579	1508845579	1	1	ROBERTS, JASON D MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95372	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
187185	Fee-for-Service	1144387408	1144387408	1	1	RAPHAEL, ROBERT I MD	10/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81318	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
187233	Fee-for-Service	1407885031	1407885031	1	1	RINGS, SUDHAKAR MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
187236	Fee-for-Service	1528241809	1528241809	1	1	RHEE, MARY MD	4/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94296	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
187254	Fee-for-Service	1932429065	1932429065	1	1	ROMO, CHRISTIE A MD	3/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118216	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	STE 101	DAVIS	CA	95616	6217	57	06113	38.56287659	-121.7715536	Yolo County
187272	Fee-for-Service	1609869627	1609869627	1	2	REGENTS/UCDPBG/SUR CARDI	8/11/2022	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
187290	Fee-for-Service	1023294931	1023294931	1	1	ROBERTS, TAYA L DO	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
187323	Fee-for-Service	1881687309	1881687309	1	1	RAHIMI, MOSTAFA S MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89780	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
187371	Fee-for-Service	1023105343	1023105343	1	1	RAND, TIMOTHY C MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41179	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3801 KATELLA AVE	SUITE 430	LOS ALAMITOS	CA	90720	6902	30	06059	33.80318951	-118.066068	Orange County
187397	Fee-for-Service	1730281593	1730281593	1	1	REYBLAT, POLINA MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88234	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
187511	Fee-for-Service	1972660207	1972660207	1	1	ROA, DORCAS L PHD	1/12/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
187561	Fee-for-Service	1609869627	1609869627	1	2	REGENTS/UCDPBG/SUR CARDI	5/1/1999	2086S0129X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
187572	Fee-for-Service	1972772945	1972772945	1	1	ROBERTS, MICAH J DO	8/9/2019	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	13291	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3838 SAN DIMAS STREET	STE A200	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
187653	Fee-for-Service	1295494961	1295494961	1	2	ROBERT A CLARK MD MEDICAL CO	5/26/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4401 ATLANTIC AVE STE 41	None	LONG BEACH	CA	90807	2263	19	06037	33.836976	-118.185096	Los Angeles County
187689	Fee-for-Service	1942370531	1942370531	1	1	RABANERA, ROGELIO MD INC	11/1/1983	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	25752	10	Gastroenterology (M.D. only)	0	In state provider	None	3650 E SOUTH STREET	SUITE 110B	LAKEWOOD	CA	90712	1534	19	06037	33.8601747	-118.1494013	Los Angeles County
187703	Fee-for-Service	1497920847	1497920847	1	1	RUBALCAVA, DANIEL M MD	12/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
187730	Fee-for-Service	1598769002	1598769002	1	1	RATANAWONGSA, NEDA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76954	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187735	Fee-for-Service	1881029148	1881029148	1	1	REYES, MONICA OD	4/20/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10092 CHAPMAN AVE	STE 1	GARDEN GROVE	CA	92840	2833	30	06059	33.7885755	-117.9566235	Orange County
187738	Fee-for-Service	1528171352	1528171352	1	1	ROSAASEN, JONATHAN A MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85781	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
187746	Fee-for-Service	1760405328	1760405328	1	1	RASMUSSEN, LAYNE J MD	12/16/1989	207L00000X	NA	Other	026	PHYSICIANS	46128	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
187754	Fee-for-Service	1780048850	1780048850	1	1	REUTHER, KRISTA M LCSW	10/20/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187792	Fee-for-Service	1174713911	1174713911	1	1	RUBAL, JORGE MD	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99592	08	Family Practice	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
187832	Fee-for-Service	1255917019	1255917019	1	1	RASHID, UMER MD	10/18/2024	207R00000X	NA	Other	026	PHYSICIANS	187611	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
187877	Fee-for-Service	1982625190	1982625190	1	1	RAMONAS, KRISTA M MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86798	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187881	Fee-for-Service	1477025971	1477025971	1	1	RODEN, FRANCES	3/14/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
187901	Fee-for-Service	1487617270	1487617270	1	1	ROSENTHAL, RAUL J MD	4/11/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
187958	Fee-for-Service	1477597037	1477597037	1	1	RYAN SNYDER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2521 GLENN HENDREN DR	STE 204	LIBERTY	MO	64068	3388	00	None	39.27613607	-94.42532385	Clay County
187968	Fee-for-Service	1043638125	1043638125	1	1	RENDUCHINTALA, KAVITA MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140137	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
188006	Fee-for-Service	1982047635	1982047635	1	1	RUSSELL, TARA A MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136212	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
188008	Fee-for-Service	1821436684	1821436684	1	1	RAGESH PANIKKATH, DEEPA MD	8/13/2021	207RR0500X	NA	Other	026	PHYSICIANS	161120	None	None	0	In state provider	None	29798 HAUN RD	SUITE 301	MENIFEE	CA	92586	6542	33	06065	33.68787713	-117.1748638	Riverside County
188026	Fee-for-Service	1861926305	1861926305	1	1	RONCO, ANTHONY MD	9/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159826	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
188041	Fee-for-Service	1346376886	1346376886	1	3	RSCR INLAND INC	7/23/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	VERBENA HOUSE	8368 VERBENA DR	None	RIVERSIDE	CA	92504	2444	33	06065	33.94256031	-117.4339532	Riverside County
188042	Fee-for-Service	1952443335	1952443335	1	1	ROGOWAY, WILLIAM M MD	2/1/1984	207RH0003X	NA	Oncology	026	PHYSICIANS	9170	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
188057	Fee-for-Service	1366435380	1366435380	1	1	REGENTS/UCDPBG/ICU PAIN	5/7/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
188062	Fee-for-Service	1306879937	1306879937	1	1	ROBERT J. MARTIN, JR., M.D.,	6/3/2020	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	INC.	1600 NORTH ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
188082	Fee-for-Service	1164483061	1164483061	1	1	RASKIN, DAMON B MD INC	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81334	41	Internal Medicine	0	In state provider	None	881 ALMA REAL DR	None	PACIFIC PALISADES	CA	90272	3731	19	06037	34.04487687	-118.5250831	Los Angeles County
188086	Fee-for-Service	1942226030	1942226030	1	1	RIOS-ARAICO, WILLY J MD	5/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34295	40	Pediatrics	0	In state provider	None	855 3RD AVE	STE 2200	CHULA VISTA	CA	91911	1353	37	06073	32.62197574	-117.0723222	San Diego County
188105	Fee-for-Service	1922233055	1922233055	1	1	ROBINSON, JOSEPH L MD	7/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94439	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	STE M335	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
188126	Fee-for-Service	1962516203	1962516203	1	1	RUTTI, PETER J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36364	18	Ophthalmology	0	In state provider	None	2016 FOREST AVE	STE 1	SAN JOSE	CA	95128	4804	43	06085	37.327006	-121.933009	Santa Clara County
188172	Fee-for-Service	1417045956	1417045956	1	1	RAMIN, DAVID S MD APMC	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64295	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVE	STE 707	CULVER CITY	CA	90232	6841	19	06037	34.02243278	-118.3981492	Los Angeles County
188180	Fee-for-Service	1619997806	1619997806	1	1	ROSEN, SONJA L MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82821	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
188181	Fee-for-Service	1568484863	1568484863	1	1	RODRIGUEZ, ROMAN MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	38805	26	Psychiatry (child)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
188258	Fee-for-Service	1356492201	1356492201	1	1	ROESSLER, STEPHANIE K LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
188268	Fee-for-Service	1205396678	1205396678	1	1	RIVERA RIVERA, XAVIER MD	7/1/2024	207ZP0102X	NA	Other	026	PHYSICIANS	181232	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
188276	Fee-for-Service	1639105430	1639105430	1	1	ROSS, BART	6/7/2013	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	#202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
188309	Fee-for-Service	1972552784	1972552784	1	1	RUBENSTEIN, JAMES MD	5/1/1998	207R00000X	NA	Other	026	PHYSICIANS	78262	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
188318	Fee-for-Service	1235189663	1235189663	1	1	ROBERT JOSEPH PARKES, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 NOTT ST	None	SCHENECTADY	NY	12308	2425	00	None	42.819975	-73.9165185	Schenectady County
188322	Fee-for-Service	1285646760	1285646760	1	1	RAMIREZ, JOSE M MD	10/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46281	08	Family Practice	0	In state provider	None	7600 HOSPITAL DR	STE H	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
188330	Fee-for-Service	1881098200	1881098200	1	1	RODRIGUEZ, TONY LCSW	5/9/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18185	-	NOT APPLICABLE	0	In state provider	None	113 E F ST	None	TEHACHAPI	CA	93561	1710	15	06029	35.13095398	-118.4470847	Kern County
188335	Fee-for-Service	1619420239	1619420239	1	1	ROSE, CAROLYN	8/29/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	224 OTIS STREET	None	SANTA CRUZ	CA	95060	3552	44	06087	36.97170634	-122.0370025	Santa Cruz County
188340	Fee-for-Service	1336540327	1336540327	1	1	ROMAN, ZENELIA NP	1/23/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
188343	Fee-for-Service	1366435380	1366435380	1	1	REGENTS/UCDPBG/ICU PAIN	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
188375	Fee-for-Service	1487172516	1487172516	1	1	ROACH, JESSICA LCSW	2/5/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
188403	Fee-for-Service	1306127154	1306127154	1	1	RAND, AIMEE M NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90037	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
188428	Fee-for-Service	1598968844	1598968844	1	1	RAMRATTAN, SHAMSUNDER DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6991	None	None	0	In state provider	None	43839 N 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
188461	Fee-for-Service	1417928557	1417928557	1	1	REARDON, JACQUELINE M DO	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10015	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
188471	Fee-for-Service	1619997806	1619997806	1	1	ROSEN, SONJA L MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82821	38	Geriatrics	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
188477	Fee-for-Service	1659378313	1659378313	1	1	RAJACICH, GEORGE M MD	1/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SURGICAL MEDICAL GROUP	14914 SHERMAN WAY	None	VAN NUYS	CA	91405	2113	19	06037	34.20110364	-118.458051	Los Angeles County
188535	Fee-for-Service	1437689502	1437689502	1	1	RIVERA GONZALEZ, ANA LMFT	2/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
188595	Fee-for-Service	1972552784	1972552784	1	1	RUBENSTEIN, JAMES MD	5/1/1998	207R00000X	NA	Other	026	PHYSICIANS	78262	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
188607	Fee-for-Service	1174296222	1174296222	1	1	RED ROSE HOME HEALTH	2/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3721 W BURBANK BLVD	SUITE C2	BURBANK	CA	91505	2240	19	06037	34.17444805	-118.3510762	Los Angeles County
188622	Fee-for-Service	1619420239	1619420239	1	1	ROSE, CAROLYN	8/29/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	224 OTIS STREET	None	SANTA CRUZ	CA	95060	3552	44	06087	36.97170634	-122.0370025	Santa Cruz County
188635	Fee-for-Service	1295728780	1295728780	1	1	ROBERT E HELGANS M.D.	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1100 BALSAM AVE	None	BOULDER	CO	80304	3404	00	None	40.02670649	-105.2833275	Boulder County
188656	Fee-for-Service	1740433705	1740433705	1	1	RAFII, FARHAD MD	1/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105505	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
188669	Fee-for-Service	1982856324	1982856324	1	1	ROMANO, BEVERLY J LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
188713	Fee-for-Service	1881607653	1881607653	1	1	RAY, SAYAN DEB MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66934	41	Internal Medicine	0	In state provider	None	1201 W LA VETA AVE	STE 208	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
188740	Fee-for-Service	1508089897	1508089897	1	1	RONAY, MARIANNE E NP	7/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
188743	Fee-for-Service	1053488486	1053488486	1	1	RUSHEEN, JEFFREY M MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	42908	05	Anesthesiology	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
188767	Fee-for-Service	1942658752	1942658752	1	1	RUIZ, MARCO A MD	7/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158850	08	Family Practice	0	In state provider	None	17762 BEACH BLVD.	220	HUNTINGTON BEACH	CA	92647	6860	30	06059	33.70404013	-117.9890603	Orange County
188786	Fee-for-Service	1699061515	1699061515	1	1	RATHBUN, LUCINDA A LMFT	12/28/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 COLUSA AVE	STE A	YUBA CITY	CA	95991	4148	51	06101	39.14074601	-121.6172196	Sutter County
188809	Fee-for-Service	1447483474	1447483474	1	1	REYNOLDS, DWIGHT C MD	2/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
188823	Fee-for-Service	1578675344	1578675344	2	1	RAYMOND M. WRIGHT	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	320 ALPENGLOW LN	None	LIVINGSTON	MT	59047	8506	00	None	45.675135	-110.5268085	Park County
188856	Fee-for-Service	1336267137	1336267137	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92013	9001	37	06073	32.7537975	-117.1658298	San Diego County
188895	Fee-for-Service	1154644813	1154644813	1	1	RODRIGUEZ, KAREN A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
188936	Fee-for-Service	1376659508	1376659508	1	1	ROLLINS, CHRISTON M	6/16/1988	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	C AND J OPTICAL FASHIONS	731 E YOSEMITE AVE	STE F	MERCED	CA	95340	8039	24	06047	37.33216946	-120.461247	Merced County
188944	Fee-for-Service	1063589208	1063589208	1	1	RICE, SCOTT C MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55043	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
188952	Fee-for-Service	1780022863	1780022863	1	1	RUBIO, MARIA D MD	9/8/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150419	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
188989	Fee-for-Service	1235297318	1235297318	1	1	RUIZ, RUBEN JR MD	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	33512	-	NOT APPLICABLE	0	In state provider	None	154 A CAPP STREET	None	SAN FRANCISCO	CA	94110	1210	38	06075	37.76405528	-122.4186219	San Francisco County
189037	Fee-for-Service	1659370260	1659370260	1	1	RANFORD V. MILLER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	427 GUY PARK AVE	None	AMSTERDAM	NY	12010	1054	00	None	42.954579	-74.2164255	Montgomery County
189063	Fee-for-Service	1194969394	1194969394	1	1	RAJABALI, MURTAZA MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115364	08	Family Practice	0	In state provider	None	1010 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	5929	19	06037	33.886314	-118.395912	Los Angeles County
189076	Fee-for-Service	1861742389	1861742389	1	1	ROBERTS, RACHEL PT	10/26/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
189077	Fee-for-Service	1538346291	1538346291	1	1	RICHLIN, STEVEN B OD INC	9/11/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8907 WILSHIRE BLVD	3RD FL	BEVERLY HILLS	CA	90211	1937	19	06037	34.06709946	-118.385955	Los Angeles County
189087	Fee-for-Service	1114396371	1114396371	1	1	RAHAVARD, BEHNOOSH B MD	12/2/2020	207LP2900X	NA	Other	026	PHYSICIANS	167634	None	None	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
189089	Fee-for-Service	1700830304	1700830304	1	1	RAWSON, LEONARD G MD	1/1/1985	207R00000X	NA	Other	026	PHYSICIANS	28300	41	Internal Medicine	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
189140	Fee-for-Service	1336267137	1336267137	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92013	9001	37	06073	32.7537975	-117.1658298	San Diego County
189159	Fee-for-Service	1437770468	1437770468	1	2	RIIID MEDICAL GROUP IRVINE I	2/1/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16100 SAND CANYON AVE	STE 240	IRVINE	CA	92618	3724	30	06059	33.6632187	-117.7721984	Orange County
189166	Fee-for-Service	1679758544	1679758544	1	1	RAMIREZ, ADRIANA M MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110329	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
189183	Fee-for-Service	1932165206	1932165206	1	2	RIVERA, MARTHA M MD	6/22/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88457	15	Obstetrics (D.O. only)	0	In state provider	None	1101 CHERRY	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
189185	Fee-for-Service	1700095866	1700095866	1	1	RIALTO UNIF SCHOOL DIST	1/3/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	182 E WALNUT AVE	None	RIALTO	CA	92376	3530	36	06071	34.12866149	-117.3689595	San Bernardino County
189232	Fee-for-Service	1063589208	1063589208	1	1	RICE, SCOTT C MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55043	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
189278	Fee-for-Service	1629356951	1629356951	1	1	REYHAN, IRIS MD	10/17/2017	2080P0216X	NA	Other	026	PHYSICIANS	128118	83	Rheumatology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189302	Fee-for-Service	1073777041	1073777041	1	1	RYDEN, ARMAND M MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106925	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
189317	Fee-for-Service	1558578831	1558578831	1	1	ROHANY, MEHDI MD	4/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	123885	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
189320	Fee-for-Service	1437163441	1437163441	1	1	REDDY, VIVEK V MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82747	30	Radiology	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
189323	Fee-for-Service	1316014129	1316014129	1	1	RENSLO, MYUNGHI J MD	12/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67246	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
189334	Fee-for-Service	1477734754	1477734754	1	1	RIVERA, VERONICA R MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93252	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
189365	Fee-for-Service	1033137724	1033137724	1	1	RENEW BEHAVIORAL HEALTH INC	3/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66124	None	None	0	In state provider	None	4000 LONG BEACH BLVD	SUITE 228	LONG BEACH	CA	90807	2617	19	06037	33.830928	-118.189321	Los Angeles County
189433	Fee-for-Service	1326278334	1326278334	1	1	RAJASHEKARA, SHEILA M MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131408	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
189468	Fee-for-Service	1023157864	1023157864	1	1	RICE, ABRAHAM C MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72863	40	Pediatrics	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
189474	Fee-for-Service	1700095866	1700095866	1	1	RIALTO UNIF SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	182 E WALNUT AVE	None	RIALTO	CA	92376	3530	36	06071	34.12866149	-117.3689595	San Bernardino County
189515	Fee-for-Service	1619029832	1619029832	1	1	RAMANI, JAY MD	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85475	05	Anesthesiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
189540	Fee-for-Service	1457963886	1457963886	1	1	RAND-GIOVANNETTI, DEVIN PHD	11/30/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
189632	Fee-for-Service	1598483257	1598483257	1	1	RAGASA, JULI ANNE NP	10/20/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
189641	Fee-for-Service	1902821507	1902821507	1	1	RALPHS GROCERY COMPANY	5/23/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #132	1770 W CARSON ST	None	TORRANCE	CA	90501	2821	19	06037	33.83145651	-118.3109805	Los Angeles County
189642	Fee-for-Service	1568699668	1568699668	1	1	RUSSELL, CHRISTOPHER J MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108279	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189676	Fee-for-Service	1265467435	1265467435	1	2	RAO, MOHAN P MD	7/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62446	41	Internal Medicine	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
189779	Fee-for-Service	1841375870	1841375870	1	1	RAI, MEETINDER & RAI,	5/23/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	NIRMAL MDS	1930 E HATCH RD	STE A	MODESTO	CA	95351	5141	50	06099	37.60918353	-120.9607965	Stanislaus County
189802	Fee-for-Service	1457433237	1457433237	1	1	ROPER, PAMELA L MD	8/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155653	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189818	Fee-for-Service	1922016815	1922016815	1	1	RAD MED GRP SN CRUZ CO I	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SPLIT RADIOLOGY	231 GREEN VALLEY RD	None	FREEDOM	CA	95019	3140	44	06087	36.93832783	-121.7708828	Santa Cruz County
189824	Fee-for-Service	1093830770	1093830770	1	1	RIOS, MARTHA PSYD	10/23/2024	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
189841	Fee-for-Service	1053300251	1053300251	1	1	REDDY, SUMANA MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	52581	03	Allergy	0	In state provider	None	9456 CUYAMACA ST	STE 102	SANTEE	CA	92071	5919	37	06073	32.84894464	-116.9834985	San Diego County
189900	Fee-for-Service	1427402288	1427402288	1	1	ROBINSON, MATTHEW R DO	5/2/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	16072	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
189909	Fee-for-Service	1639108798	1639108798	2	1	RON ANDREWS MEDICAL CO	3/15/2017	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	117 CARLOS DR	None	SAN RAFAEL	CA	94903	2005	21	06041	38.01685578	-122.5353057	Marin County
189919	Fee-for-Service	1629038021	1629038021	1	1	RUBIN, ANDREW M MD	7/27/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	79554	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
189932	Fee-for-Service	1861400483	1861400483	1	1	RAMAN, PUSHPA K MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64249	40	Pediatrics	0	In state provider	None	431 DEL NORTE AVE	None	YUBA CITY	CA	95991	4113	51	06101	39.14404587	-121.6186913	Sutter County
189962	Fee-for-Service	1164006540	1164006540	1	1	RASHIDI, PEGAH LMFT	9/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
189963	Fee-for-Service	1730144064	1730144064	1	1	RUSSO, ROBERT MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62682	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
189966	Fee-for-Service	1932530714	1932530714	1	1	RAMZAN, AMIN A MD	10/3/2019	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	127936	15	Obstetrics (D.O. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
189968	Fee-for-Service	1265467435	1265467435	1	2	RAO, MOHAN P MD	7/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62446	45	Nephrology (Renal-Kidney)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
190028	Fee-for-Service	1508824715	1508824715	1	1	RAPER, PAUL L MD	1/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43318	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
190068	Fee-for-Service	1841375870	1841375870	1	1	RAI, MEETINDER & RAI,	5/23/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	NIRMAL MDS	1930 E HATCH RD	STE A	MODESTO	CA	95351	5141	50	06099	37.60918353	-120.9607965	Stanislaus County
190077	Fee-for-Service	1982804670	1982804670	1	1	ROOF, JASON G MD	11/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99404	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
190179	Fee-for-Service	1265483192	1265483192	1	1	RODRIGUEZ, RAFAEL A MD	9/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85779	None	None	0	In state provider	None	632 WEST GIBSON ROAD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
190186	Fee-for-Service	1467613166	1467613166	1	1	ROTNOFSKY, JAMIE PHD	9/10/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
190213	Fee-for-Service	1356303143	1356303143	1	1	RUTWIJ K JOTANI M.D.	8/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7067 VETERANS PKWY	STE 200	PELL CITY	AL	35125	5128	00	None	33.60532661	-86.30207608	St. Clair County
190220	Fee-for-Service	1437439577	1437439577	1	1	ROARK, HEIDI R	11/21/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
190224	Fee-for-Service	1568533321	1568533321	1	1	RYU, JULIE MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94343	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
190246	Fee-for-Service	1417370032	1417370032	1	1	RITTER CENTER	11/1/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97151013	-122.5251246	Marin County
190293	Fee-for-Service	1568995868	1568995868	1	1	RAZA, MEHER F DO	8/23/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
190301	Fee-for-Service	1477748952	1477748952	1	1	REYES, RONALD L PT	3/18/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
190316	Fee-for-Service	1902253560	1902253560	1	1	RECOVERY HOMES OF AMERICA	2/4/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1950 E 17TH ST	#150	SANTA ANA	CA	92705	6852	30	06059	33.75981549	-117.839349	Orange County
190358	Fee-for-Service	1841375870	1841375870	1	1	RAI, MEETINDER & RAI,	5/23/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	11	Aviation (M.D. only)	0	In state provider	NIRMAL MDS	1930 E HATCH RD	STE A	MODESTO	CA	95351	5141	50	06099	37.60918353	-120.9607965	Stanislaus County
190383	Fee-for-Service	1083647036	1083647036	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1433 N ACACIA AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60898603	-119.4510614	Fresno County
190405	Fee-for-Service	1831369222	1831369222	1	1	RADER, COLLIN DO	10/9/2023	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	20118	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
190425	Fee-for-Service	1801091939	1801091939	1	1	ROBERT ROSE	7/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
190435	Fee-for-Service	1740293661	1740293661	1	1	RUSSO, ROBERT A MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61822	41	Internal Medicine	0	In state provider	None	805 VETERANS BLVD	None	REDWOOD CITY	CA	94063	1734	41	06081	37.49076853	-122.2291439	San Mateo County
190444	Fee-for-Service	1821062340	1821062340	1	1	ROLFSON, BRIAN MD	12/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
190513	Fee-for-Service	1568533321	1568533321	1	1	RYU, JULIE MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94343	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
190532	Fee-for-Service	1417370032	1417370032	1	1	RITTER CENTER	11/1/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97151013	-122.5251246	Marin County
190539	Fee-for-Service	1255345922	1255345922	1	1	ROSENSTEIN, WENDY S MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	48995	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
190546	Fee-for-Service	1346224466	1346224466	1	1	ROSEN, SUZANNE R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71819	08	Family Practice	0	In state provider	None	909 BLANCO CIR	None	SALINAS	CA	93901	4401	27	06053	36.65354107	-121.6381985	Monterey County
190619	Fee-for-Service	1841775392	1841775392	2	1	ROSE PHARMACY RM LLC	7/31/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	35400 BOB HOPE DR	207	RANCHO MIRAGE	CA	92270	1774	33	06065	33.7914	-116.4058625	Riverside County
190670	Fee-for-Service	1083647036	1083647036	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1433 N ACACIA AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60898603	-119.4510614	Fresno County
190737	Fee-for-Service	1992376123	1992376123	1	1	RAVAGO, THERESA PATRICE L AU	3/25/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
190761	Fee-for-Service	1609850080	1609850080	1	1	RICKARDS, ENASS N MD	4/1/1995	174400000X	NA	Other	026	PHYSICIANS	79785	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
190804	Fee-for-Service	1134169535	1134169535	2	23	REACH AIR MEDICAL SERVICES L	11/27/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10676 SHERMAN WAY	None	BURBANK	CA	91505	1051	19	06037	34.20114346	-118.3629894	Los Angeles County
190816	Fee-for-Service	1255360517	1255360517	1	1	ROCHESTER GENERAL HOSPITAL	2/3/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1426 PORTLAND AVE	None	ROCHESTER	NY	14621	3016	00	None	43.19262486	-77.5843484	Monroe County
190898	Fee-for-Service	1801363973	1801363973	1	1	REISINGER, ERIC S LMFT	10/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
190943	Fee-for-Service	1265803126	1265803126	1	1	ROUNDS, ALEXANDRA	3/29/2024	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	205 W CLAY ST	SUITE 5	UKIAH	CA	95482	5452	23	06045	39.14781024	-123.2087207	Mendocino County
190968	Fee-for-Service	1891187688	1891187688	1	1	RAMOS, IRENE NP	4/19/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191026	Fee-for-Service	1730273681	1730273681	1	1	RUTH, ROBERT M MD	5/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81288	20	Orthopedic Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
191094	Fee-for-Service	1134169535	1134169535	2	8	REACH AIR MEDICAL SERVICES L	11/30/2009	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1111 AIRPORT RD	None	IMPERIAL	CA	92251	1828	13	06025	32.83456409	-115.5722102	Imperial County
191118	Fee-for-Service	1710047436	1710047436	1	1	RAINES, MICHELLE F LMFT	7/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
191132	Fee-for-Service	1912085986	1912085986	1	1	RITT, DONALD J MD INC	3/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	10	Gastroenterology (M.D. only)	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
191155	Fee-for-Service	1225289176	1225289176	1	1	RUSSELL, BRENDA S LMFT	1/29/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9700 EL CAMINO REAL	303	ATASCADERO	CA	93422	5568	40	06079	35.46523281	-120.647999	San Luis Obispo County
191198	Fee-for-Service	1154409225	1154409225	1	1	RAPP, SUSAN L MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61074	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
191209	Fee-for-Service	1942395041	1942395041	1	1	ROGERS, PATRICIA L MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	43446	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
191222	Fee-for-Service	1659329746	1659329746	1	1	REGENTS OF THE UNIVERSITY OF	2/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IRVINE	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
191225	Fee-for-Service	1437271905	1437271905	1	1	ROBINSON, MELODY A LCSW	7/10/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74220	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
191239	Fee-for-Service	1669402095	1669402095	1	1	RIDDLE, SARAH W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
191311	Fee-for-Service	1730273681	1730273681	1	1	RUTH, ROBERT M MD	5/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81288	46	Hand Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
191324	Fee-for-Service	1730544313	1730544313	1	1	RIDGECREST REGIONAL HOSPITAL	1/9/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1011 N CHINA LAKE BLVD	SUITE A	RIDGECREST	CA	93555	3130	15	06029	35.640108	-117.6698465	Kern County
191337	Fee-for-Service	1891138343	1891138343	1	1	RYAN, KELSEY U MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134954	01	General Practice	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91910	5736	37	06073	32.62870793	-117.0750108	San Diego County
191351	Fee-for-Service	1205218641	1205218641	1	1	ROSE DESERT CONGREGATE CARE	6/6/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3032 W MILLING ST	None	LANCASTER	CA	93536	8390	19	06037	34.69463549	-118.185018	Los Angeles County
191364	Fee-for-Service	1003294455	1003294455	1	1	RAYMUNDO, STEPHANIE-GRACE A	6/11/2018	390200000X	NA	Other	026	PHYSICIANS	146261	40	Pediatrics	0	In state provider	MD	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
191367	Fee-for-Service	1659912327	1659912327	1	1	ROBERTSON, RACHAEL A NP	12/7/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191377	Fee-for-Service	1083478432	1083478432	1	1	RINALDI, JESSIE AU	8/2/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
191419	Fee-for-Service	1912085986	1912085986	1	1	RITT, DONALD J MD INC	3/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
191454	Fee-for-Service	1114075918	1114075918	1	1	RAHAL, MUNIF MD	5/1/1999	207R00000X	NA	Other	026	PHYSICIANS	63911	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
191462	Fee-for-Service	1124184395	1124184395	1	1	RIVERA, ADRIAN M LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
191470	Fee-for-Service	1962554766	1962554766	1	1	REDDY, ANUPAMA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56173	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
191478	Fee-for-Service	1629548169	1629548169	1	1	ROACH, KRISTINA L NP	7/19/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
191484	Fee-for-Service	1174742951	1174742951	1	1	RAJESH, VINUTHA MD	3/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120258	01	General Practice	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
191500	Fee-for-Service	1659449379	1659449379	2	1	ROCA, PETER MD	10/18/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42841	None	None	0	In state provider	None	220 S PALISADE DR	STE 203B	SANTA MARIA	CA	93454	8904	42	06083	34.95143521	-120.412098	Santa Barbara County
191507	Fee-for-Service	1952307522	1952307522	1	1	ROBNETT, THEODORE J MD	6/25/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75314	78	Neoplastic Diseases/Oncology	0	In state provider	None	3320 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94190958	-121.1061362	Placer County
191512	Fee-for-Service	1588045223	1588045223	1	1	RAVOTTI, KENDELL L T	8/7/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
191569	Fee-for-Service	1528195690	1528195690	1	1	RSCR CALIFORNIA, INC	10/6/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1757 BRIGHTON AVE	None	GROVER BEACH	CA	93433	1813	40	06079	35.12341138	-120.6096306	San Luis Obispo County
191571	Fee-for-Service	1144213455	1144213455	1	1	RUSSO ANTHONY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D ALENE	ID	83814	2611	00	None	47.69465937	-116.7917936	Kootenai County
191595	Fee-for-Service	1790065167	1790065167	1	1	RASOR, TERESA LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
191598	Fee-for-Service	1821201013	1821201013	1	1	RABOUBI, ALIREZA MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110594	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
191611	Fee-for-Service	1730544313	1730544313	1	1	RIDGECREST REGIONAL HOSPITAL	3/9/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 N CHINA LAKE BLVD	SUITE A	RIDGECREST	CA	93555	3130	15	06029	35.640108	-117.6698465	Kern County
191638	Fee-for-Service	1326401993	1326401993	1	1	REDDY, ABHITA MD	11/22/2022	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	179771	None	None	0	In state provider	None	8635 W 3RD ST	STE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
191674	Fee-for-Service	1053450767	1053450767	1	1	RAJ, KAVITHA P MD	6/9/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	93219	41	Internal Medicine	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
191683	Fee-for-Service	1295912657	1295912657	1	1	ROMA, ANDRES A MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141700	22	Pathology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191702	Fee-for-Service	1689990947	1689990947	1	1	REZAIMEHR, YALDA MD	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115274	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
191704	Fee-for-Service	1376082974	1376082974	1	1	RADFORD, KEMISHA	10/24/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127682	-	NOT APPLICABLE	0	In state provider	None	1319 FRUITVALE AVE	None	OAKLAND	CA	94601	2927	01	06001	37.77708782	-122.2261804	Alameda County
191706	Fee-for-Service	1912085986	1912085986	1	1	RITT, DONALD J MD INC	3/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	30223	41	Internal Medicine	0	In state provider	None	9850 GENESEE AVE	STE 930	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
191746	Fee-for-Service	1417976366	1417976366	1	1	ROGET, VANCE R MD	9/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41460	25	Physical Medicine and Rehabilitation	0	In state provider	None	803 COFFEE RD	STE 6	MODESTO	CA	95355	4228	50	06099	37.65474897	-120.9756157	Stanislaus County
191767	Fee-for-Service	1588077721	1588077721	1	1	RAJAGOPALAN, PRIYA MD	6/2/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162519	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191794	Fee-for-Service	1225386220	1225386220	1	1	RAYA, DAVID S LCSW	11/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
191803	Fee-for-Service	1407497076	1407497076	1	1	ROCHA, GUADALUPE OD	10/15/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2619 E COLORADO BLVD	SUITE 150	PASADENA	CA	91107	3747	19	06037	34.14616014	-118.0964013	Los Angeles County
191815	Fee-for-Service	1861421489	1861421489	1	1	RAZIANO, RANDALL M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 S 3RD ST	None	MONTROSE	CO	81401	4212	00	None	38.480076	-107.868969	Montrose County
191819	Fee-for-Service	1144372244	1144372244	1	1	RACELA, RAYMUNDO C MD	7/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136954	02	General Surgery	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
191854	Fee-for-Service	1770042699	1770042699	1	1	RAPHELSON, JANNA R	11/2/2023	208M00000X	NA	Other	026	PHYSICIANS	177298	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191886	Fee-for-Service	1508882655	1508882655	1	1	RICE, VALERIE A PHD	1/1/1999	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191900	Fee-for-Service	1730544313	1730544313	1	1	RIDGECREST REGIONAL HOSPITAL	1/9/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1011 N CHINA LAKE BLVD	SUITE A	RIDGECREST	CA	93555	3130	15	06029	35.640108	-117.6698465	Kern County
191934	Fee-for-Service	1679558373	1679558373	1	1	RAJAGOPALAN, SUJATHA MD	2/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87907	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
191962	Fee-for-Service	1053450767	1053450767	1	1	RAJ, KAVITHA P MD	6/9/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	93219	68	Hematology	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
191974	Fee-for-Service	1407995038	1407995038	1	1	REDDY MEDICAL GROUP INC	10/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7045 N MAPLE AVE	STE 108	FRESNO	CA	93720	8008	10	06019	36.83898291	-119.7453487	Fresno County
192000	Fee-for-Service	1134662976	1134662976	1	1	RICHTER, MICHELE LPCC	1/4/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
192007	Fee-for-Service	1194885129	1194885129	1	1	RENNER, THOMAS J	5/10/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	362 MAIN STREET	None	FERNDALE	CA	95536	0577	12	06023	40.57618925	-124.2642163	Humboldt County
192025	Fee-for-Service	1457795221	1457795221	1	1	RAWLINGS, KRISTEN D LMFT	10/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
192032	Fee-for-Service	1528084225	1528084225	1	1	REYNOLDS, JULIE	7/2/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2138 MARGUERITE ST	None	DOS PALOS	CA	93620	2351	24	06047	36.986775	-120.6301889	Merced County
192052	Fee-for-Service	1508925173	1508925173	1	1	ROGERS, TOMIE LEE MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77261	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
192053	Fee-for-Service	1871671511	1871671511	1	1	ROTAS, CAROL H MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42040	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
192059	Fee-for-Service	1013999499	1013999499	1	1	ROMANS, MATTHEW L MD	12/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82297	24	Plastic Surgery	0	In state provider	None	242 E ROMIE LN	None	SALINAS	CA	93901	3128	27	06053	36.66108115	-121.6511171	Monterey County
192072	Fee-for-Service	1760910020	1760910020	1	1	RHEA, CRYSTAL A DO	8/6/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16703	08	Family Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
192083	Fee-for-Service	1497062616	1497062616	1	1	ROUSSO, KRISTINA C	11/4/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
192086	Fee-for-Service	1720269418	1720269418	1	1	REYES, CANDICE M MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122233	None	None	0	In state provider	None	2335 E KASHIAN LANE	301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
192118	Fee-for-Service	1649720566	1649720566	1	1	REBELO, MARCIA A LCSW	9/4/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	187 CALLE MAGDALENA	SUITE 114	ENCINITAS	CA	92024	3709	37	06073	33.0458382	-117.2838317	San Diego County
192119	Fee-for-Service	1215911730	1215911730	1	1	RAMNATH, VENKTESH R MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107714	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
192143	Fee-for-Service	1477218121	1477218121	1	1	REGEV, SHANEE NP	1/17/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
192199	Fee-for-Service	1528428950	1528428950	1	1	RX POINT PHARMACY INC	5/23/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2718 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	3936	56	06111	34.27163451	-118.742976	Ventura County
192210	Fee-for-Service	1770967333	1770967333	1	1	RAMOS ORTEGA, IVETTE MD	10/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148333	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
192237	Fee-for-Service	1760989362	1760989362	1	1	RUHI-WILLIAMS, PERISA MD	6/28/2021	208600000X	NA	General Surgery	026	PHYSICIANS	165142	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
192244	Fee-for-Service	1508022781	1508022781	1	2	REZVAN, AZADEH MD	1/7/2021	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	110360	None	None	0	In state provider	None	1325 ANAHEIM	None	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
192250	Fee-for-Service	1053450767	1053450767	1	1	RAJ, KAVITHA P MD	6/9/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	93219	78	Neoplastic Diseases/Oncology	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
192262	Fee-for-Service	1407995038	1407995038	1	1	REDDY MEDICAL GROUP INC	10/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	7045 N MAPLE AVE	STE 108	FRESNO	CA	93720	8008	10	06019	36.83898291	-119.7453487	Fresno County
192316	Fee-for-Service	1497949275	1497949275	1	1	RALPHS GROCERY COMPANY	10/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #096	160 N LAKE AVE	None	PASADENA	CA	91101	1836	19	06037	34.148979	-118.1323525	Los Angeles County
192410	Fee-for-Service	1215911730	1215911730	1	1	RAMNATH, VENKTESH R MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107714	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
192437	Fee-for-Service	1750374872	1750374872	1	2	REGENTS/UCDPBG/OTOLARYNG	6/25/2020	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
192477	Fee-for-Service	1659015949	1659015949	1	1	ROHATGI, KARTHIK W MD	5/7/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
192499	Fee-for-Service	1821446626	1821446626	1	1	ROMERO, ELIANA LMFT	7/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
192511	Fee-for-Service	1578613451	1578613451	1	1	RIPPNER, THOMAS F OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2511 MAIN ST	None	CAMBRIA	CA	93428	3407	40	06079	35.56586831	-121.0796086	San Luis Obispo County
192514	Fee-for-Service	1083489389	1083489389	1	1	ROSALES, ANDREA	1/31/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
192522	Fee-for-Service	1255337713	1255337713	1	1	RICHMOND, RONALD D MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	74763	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
192549	Fee-for-Service	1093077703	1093077703	1	1	ROTTA, STACEY A MD	7/18/2019	2086S0102X	NA	General Surgery	026	PHYSICIANS	156409	02	General Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
192553	Fee-for-Service	1902216864	1902216864	1	1	RIPLEY, STEPHANIE S OD	10/28/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
192569	Fee-for-Service	1821461377	1821461377	1	1	RELIANCE HOSPICE CARE INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	39675 CEDAR BLVD	SUITE 235	NEWARK	CA	94560	5940	01	06001	37.52050519	-121.9962032	Alameda County
192602	Fee-for-Service	1255324323	1255324323	1	2	REGENTS/UCDPBG/IM HOSP	5/21/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
192627	Fee-for-Service	1780872168	1780872168	1	1	ROBINSON, ANGELIKA H	4/1/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	2225 N PERRIS BLVD	None	PERRIS	CA	92571	2580	33	06065	33.81251709	-117.2260543	Riverside County
192650	Fee-for-Service	1508098153	1508098153	1	1	RIMLER, JONATHAN C MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116186	24	Plastic Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
192653	Fee-for-Service	1124465745	1124465745	1	1	RAJAGOPAL, AMUTHA V MD	7/11/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	135167	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
192659	Fee-for-Service	1073535704	1073535704	1	1	ROBERT S PERRET MD	12/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1990 INDUSTRIAL BLVD	None	HOUMA	LA	70363	7055	00	None	29.57007888	-90.68782355	Terrebonne Parish
192674	Fee-for-Service	1003804071	1003804071	1	1	R AND J PROSTHETIC APPLIANCE	9/13/2000	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	CO INC	2407 E MAIN ST	None	VENTURA	CA	93003	2603	56	06111	34.27595138	-119.2640648	Ventura County
192681	Fee-for-Service	1093473332	1093473332	1	1	REYES, ATHENA CRNA	5/31/2024	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
192693	Fee-for-Service	1376573253	1376573253	1	1	ROKHSHADFAR, SAGHI MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76664	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
192698	Fee-for-Service	1215911730	1215911730	1	1	RAMNATH, VENKTESH R MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107714	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
192725	Fee-for-Service	1750374872	1750374872	1	2	REGENTS/UCDPBG/OTOLARYNG	5/1/1999	207Y00000X	NA	ENT/Otolaryngology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
192781	Fee-for-Service	1033403647	1033403647	1	1	RONGEY, CHRISTINE L MD	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136255	22	Pathology (M.D. only)	0	In state provider	None	2615 EYE STREET	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
192817	Fee-for-Service	1336487685	1336487685	1	1	REGENTS OF THE UNIVERSITY OF	7/25/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ACY	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
192846	Fee-for-Service	1093379794	1093379794	1	1	ROEVER, JOHN A MD	2/3/2023	207P00000X	NA	Other	026	PHYSICIANS	181554	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
192847	Fee-for-Service	1013136035	1013136035	1	1	RUBIN MANAVI, MD INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CENTRAL MEDICAL CENTER	214 N CENTRAL AVE	None	GLENDALE	CA	91203	3556	19	06037	34.148628	-118.2579135	Los Angeles County
192857	Fee-for-Service	1821461377	1821461377	1	1	RELIANCE HOSPICE CARE INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	39675 CEDAR BLVD	SUITE 235	NEWARK	CA	94560	5940	01	06001	37.52050519	-121.9962032	Alameda County
192862	Fee-for-Service	1780743344	1780743344	1	1	ROSEN, RONALD M MD	7/31/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48384	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
192865	Fee-for-Service	1235522319	1235522319	1	2	RETINA SAN DIEGO	6/29/2022	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	477 N EL CAMINO REAL	STE C302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
192889	Fee-for-Service	1255324323	1255324323	1	2	REGENTS/UCDPBG/IM HOSP	5/1/1999	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
193012	Fee-for-Service	1750374872	1750374872	1	2	REGENTS/UCDPBG/OTOLARYNG	5/22/2020	207Y00000X	NA	ENT/Otolaryngology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
193067	Fee-for-Service	1164467791	1164467791	1	1	RAYA-MORONES,RUBY A MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51286	40	Pediatrics	0	In state provider	None	11525 BROOKSHIRE AVE	#301	LOS ANGELES	CA	90030	4909	19	06037	33.93544635	-118.1318321	Los Angeles
193081	Fee-for-Service	1396937868	1396937868	1	1	READER, BEVERLY MD	3/10/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	112747	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
193094	Fee-for-Service	1053349670	1053349670	1	1	RAPOPORT, BASIL MD	12/1/1997	174400000X	NA	Other	026	PHYSICIANS	25179	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193112	Fee-for-Service	1073507968	1073507968	1	1	ROOHIAN, ARSHIA DPM	4/23/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 370	LAGUNA WOODS	CA	92637	2752	30	06059	33.60928782	-117.7295058	Orange County
193137	Fee-for-Service	1013136035	1013136035	1	1	RUBIN MANAVI, MD INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTRAL MEDICAL CENTER	214 N CENTRAL AVE	None	GLENDALE	CA	91203	3556	19	06037	34.148628	-118.2579135	Los Angeles County
193139	Fee-for-Service	1992816136	1992816136	1	1	RAHMANI, SHERVIN MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	67716	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
193150	Fee-for-Service	1962531137	1962531137	1	1	RYDEL, TRACY A MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93563	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
193171	Fee-for-Service	1003807124	1003807124	1	1	RAUCH, STEVEN D MD	10/1/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	84	Surgery-Head and Neck	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
193178	Fee-for-Service	1407122328	1407122328	1	1	ROGERS, JOSEPH A MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140292	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
193197	Fee-for-Service	1538522768	1538522768	1	1	ROME, CAMBIA MD	1/8/2025	208600000X	NA	General Surgery	026	PHYSICIANS	156869	02	General Surgery	0	In state provider	None	2335 KASHIAN	220	FRESNO	CA	93701	2230	10	06019	36.74333844	-119.7831874	Fresno County
193310	Fee-for-Service	1780107235	1780107235	1	1	RODRIGUEZ KAWAS, ANDREA MD	11/8/2021	207R00000X	NA	Other	026	PHYSICIANS	174999	None	None	0	In state provider	None	341 E MAIN ST	STE 100	SAN JACINTO	CA	92583	4205	33	06065	33.78391437	-116.9562698	Riverside County
193325	Fee-for-Service	1780111070	1780111070	1	1	RUSSELL, CHRISTOPHER G CRNA	4/22/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
193385	Fee-for-Service	1053349670	1053349670	1	1	RAPOPORT, BASIL MD	12/1/1997	174400000X	NA	Other	026	PHYSICIANS	25179	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193434	Fee-for-Service	1912994005	1912994005	1	2	ROBERT BROWN MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	27800 NORTHWEST FWY	None	CYPRESS	TX	77433	5302	00	None	29.98639218	-95.73439441	Harris County
193448	Fee-for-Service	1821487430	1821487430	1	1	RUDOLF, FRANCES E MD	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	143832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
193452	Fee-for-Service	1437207214	1437207214	1	1	ROY, RAJIV B MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75318	67	Endocrinology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
193461	Fee-for-Service	1003807124	1003807124	1	1	RAUCH, STEVEN D MD	10/1/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
193476	Fee-for-Service	1255733150	1255733150	1	1	RUIZ, LLANI M LCSW	9/28/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13173 OSBORNE ST	None	ARLETA	CA	91331	4019	19	06037	34.24659608	-118.4199492	Los Angeles County
193492	Fee-for-Service	1376586529	1376586529	1	2	RICHERT, EDWARD P MD	3/2/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	35911	-	NOT APPLICABLE	0	In state provider	None	441 N MAIN ST	None	ALTURAS	CA	96101	3457	25	06049	41.48803571	-120.542554	Modoc County
193497	Fee-for-Service	1134112295	1134112295	1	1	REGENTS/UCDPBG/NEUROSURG	5/1/1983	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
193501	Fee-for-Service	1477633626	1477633626	1	1	ROUM, JAMES H MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	62370	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
193522	Fee-for-Service	1235719139	1235719139	1	1	RANA, HARIS A MD	5/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188465	08	Family Practice	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
193562	Fee-for-Service	1831342849	1831342849	1	1	RASHKIS, JULIE W PHD	9/6/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
193567	Fee-for-Service	1881629343	1881629343	1	1	ROTTMAN, STEVEN J MD	4/1/1995	207PE0004X	NA	Other	026	PHYSICIANS	32094	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
193585	Fee-for-Service	1891968145	1891968145	1	1	REYNOSO, JUAN MD JR	7/7/2008	207P00000X	NA	Other	026	PHYSICIANS	103440	None	None	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3899	40	06079	35.113419	-120.5915945	San Luis Obispo County
193610	Fee-for-Service	1700288347	1700288347	1	1	ROBINSON, RHONDA	8/29/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
193679	Fee-for-Service	1427176221	1427176221	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193709	Fee-for-Service	1912090465	1912090465	1	1	RADVILLE, SANA A MD	1/1/1995	2080P0203X	NA	Other	026	PHYSICIANS	46391	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193742	Fee-for-Service	1437207214	1437207214	1	1	ROY, RAJIV B MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75318	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
193777	Fee-for-Service	1306875067	1306875067	1	1	ROLEN, PAUL B MD	6/24/2021	2085D0003X	NA	MRI Provider	026	PHYSICIANS	139428	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
193825	Fee-for-Service	1508977414	1508977414	1	1	REPRODUCTIVE HLTH CARE	9/24/1990	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SIERRA HEALTH CENTER	501 S BROOKHURST RD	None	FULLERTON	CA	92833	3207	30	06059	33.865002	-117.959396	Orange County
193829	Fee-for-Service	1770693434	1770693434	1	1	RALEY'S	3/22/1985	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8391 FOLSOM BLVD	None	SACRAMENTO	CA	95826	3598	34	06067	38.548197	-121.394079	Sacramento County
193855	Fee-for-Service	1396701629	1396701629	1	1	ROTHMAN, BARRY J MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	19383	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
193865	Fee-for-Service	1013035716	1013035716	1	1	REGENTS OF THE UNIVERSITY OF	7/2/2007	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	UCSD PEDIATRICS ASSOC	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
193911	Fee-for-Service	1134169535	1134169535	2	9	REACH AIR MEDICAL SERVICES L	11/30/2009	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6151 FREEPORT BLVD	STE 180	SACRAMENTO	CA	95822	3530	34	06067	38.513664	-121.498398	Sacramento County
193927	Fee-for-Service	1194032714	1194032714	1	1	RAV KHATRI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRYHINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
193937	Fee-for-Service	1740398585	1740398585	2	1	ROSHANRAVAN, BABACK MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156197	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
193951	Fee-for-Service	1861770737	1861770737	1	1	RACHERLA, HARINI MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133840	40	Pediatrics	0	In state provider	None	4617 FREEPORT BLVD	SUITE B	SACRAMENTO	CA	95822	2015	34	06067	38.533311	-121.4939295	Sacramento County
193955	Fee-for-Service	1639534316	1639534316	1	1	RODRIGUEZ, JOSE ALBERTO CRN	6/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
193970	Fee-for-Service	1427176221	1427176221	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193997	Fee-for-Service	1831459361	1831459361	1	1	RANDALL TYLER HANSEN	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 N 2260 W	None	HURRICANE	UT	84737	2034	00	None	37.17774517	-113.3295348	Washington County
193998	Fee-for-Service	1912090465	1912090465	1	1	RADVILLE, SANA A MD	1/1/1995	2080P0203X	NA	Other	026	PHYSICIANS	46391	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194011	Fee-for-Service	1972734119	1972734119	1	1	ROYTER, VLADIMIR MD	5/31/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	109062	13	Neurology (M.D. only)	0	In state provider	None	125 MALL DR	STE 209B	HANFORD	CA	93230	5786	16	06031	36.3246477	-119.6685218	Kings County
194069	Fee-for-Service	1487086799	1487086799	1	1	RIOS-MASSIN, EVELYN L LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
194073	Fee-for-Service	1225533706	1225533706	1	1	RUMMAN, GEORGIANA LMFT	3/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
194079	Fee-for-Service	1447556063	1447556063	1	1	ROSS, KATERI LMFT	12/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
194085	Fee-for-Service	1770010027	1770010027	1	1	ROSE, SAMUEL D MD	1/13/2025	208M00000X	NA	Other	026	PHYSICIANS	178687	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
194088	Fee-for-Service	1003539776	1003539776	1	1	REDWOOD RECOVERY CENTER LLC	1/4/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4 7TH ST	B	EUREKA	CA	95501	0226	12	06023	40.79955969	-124.1707557	Humboldt County
194100	Fee-for-Service	1639448400	1639448400	1	2	RIDGECREST REGIONAL HOSPITAL	9/13/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1041 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.63953945	-117.669891	Kern County
194112	Fee-for-Service	1750313151	1750313151	1	1	REICHEL, RONALD R MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86094	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
194164	Fee-for-Service	1710956776	1710956776	1	1	RADLAUER, GERALD M MD	12/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87597	41	Internal Medicine	0	In state provider	None	18031 HIGHWAY 18	STE C	APPLE VALLEY	CA	92345	0000	36	06071	34.54008717	-117.2706344	San Bernardino County
194215	Fee-for-Service	1134169535	1134169535	2	18	REACH AIR MEDICAL SERVICES L	3/15/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1310 POPPY DR	None	WILLITS	CA	94590	9533	23	06045	39.45230521	-123.3741556	Mendocino County
194224	Fee-for-Service	1740398585	1740398585	2	1	ROSHANRAVAN, BABACK MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156197	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
194226	Fee-for-Service	1245377415	1245377415	1	1	RANDHAWA, RUVDEEP S MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79420	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
194286	Fee-for-Service	1184808438	1184808438	1	1	RAY, EDWARD C MD	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	91870	24	Plastic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194288	Fee-for-Service	1518130533	1518130533	1	1	RIGGS, DAVID L JR MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134917	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
194291	Fee-for-Service	1437788411	1437788411	1	1	RANDHAWA, SIMRANJIT	9/18/2024	207R00000X	NA	Other	026	PHYSICIANS	191258	41	Internal Medicine	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
194299	Fee-for-Service	1972734119	1972734119	1	1	ROYTER, VLADIMIR MD	5/31/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	109062	36	Psychiatry	0	In state provider	None	125 MALL DR	STE 209B	HANFORD	CA	93230	5786	16	06031	36.3246477	-119.6685218	Kings County
194304	Fee-for-Service	1518565779	1518565779	1	1	RITKES, JOSEPH A LCSW	4/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4664 34TH ST	APT 8	SAN DIEGO	CA	92116	3474	37	06073	32.76250874	-117.1206901	San Diego County
194321	Fee-for-Service	1295290724	1295290724	1	1	RHODES, MADISON M PT	5/30/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
194325	Fee-for-Service	1639465206	1639465206	1	1	REDWOOD PODIATRY GROUP INC	6/12/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3258 TIMBER FALL CT	None	EUREKA	CA	95503	4888	12	06023	40.77919128	-124.1360589	Humboldt County
194358	Fee-for-Service	1184686768	1184686768	1	1	ROLLINS,VAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5475 S 500 E	None	OGDEN	UT	84405	6905	00	None	41.16449014	-111.9686412	Weber County
194367	Fee-for-Service	1376928408	1376928408	1	1	RAMOS, JENNIFER D NP	3/22/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
194387	Fee-for-Service	1821017302	1821017302	1	1	REDDICK, LAURA T LMFT	7/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2830 G ST	STE C3	EUREKA	CA	95501	4447	12	06023	40.78218776	-124.1624709	Humboldt County
194389	Fee-for-Service	1639448400	1639448400	1	2	RIDGECREST REGIONAL HOSPITAL	9/13/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1041 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.63953945	-117.669891	Kern County
194421	Fee-for-Service	1366590317	1366590317	1	1	ROSEN, LOUIS DO	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	5340	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
194422	Fee-for-Service	1124143797	1124143797	1	1	ROMANO, JAMES J MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63080	24	Plastic Surgery	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
194449	Fee-for-Service	1619172400	1619172400	1	1	RUOCCO, MARTIN J MD	11/6/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89298	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
194493	Fee-for-Service	1225507940	1225507940	1	1	RANI, ASHA LCSW	12/9/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
194502	Fee-for-Service	1588851034	1588851034	1	1	ROCHA, AMARANTA LCSW	11/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
194515	Fee-for-Service	1245377415	1245377415	1	1	RANDHAWA, RUVDEEP S MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79420	67	Endocrinology	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
194619	Fee-for-Service	1437129889	1437129889	1	1	REICHMANN, SUSAN LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5662 W 63RD STREET	None	LOS ANGELES	CA	90056	2013	19	06037	33.98217271	-118.3809807	Los Angeles County
194631	Fee-for-Service	1689871154	1689871154	1	1	RAO, AMOL R MD	1/31/2011	390200000X	NA	Other	026	PHYSICIANS	112418	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
194642	Fee-for-Service	1831206192	1831206192	1	1	RAO, SANJAY C MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75736	14	Neurological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194694	Fee-for-Service	1518250869	1518250869	1	1	ROSE, BRENT S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142735	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
194714	Fee-for-Service	1679717573	1679717573	1	1	ROSENBERG, CLAUDIA LCSW	6/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
194718	Fee-for-Service	1558390880	1558390880	1	1	RAO, ADUPA P MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62170	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
194770	Fee-for-Service	1134373160	1134373160	1	1	RIETSCH, RENEE J. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
194798	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
194812	Fee-for-Service	1659304517	1659304517	1	1	ROBERT A AST, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2520 CHERRY AVE	None	BREMERTON	WA	98310	4229	00	None	47.58282763	-122.6259856	Kitsap County
194814	Fee-for-Service	1700801453	1700801453	1	1	REESE,MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2127 E HARMONY RD	STE 125	FORT COLLINS	CO	80527	0000	00	None	40.52313048	-105.036552	Larimer County
194834	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	3/22/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
194836	Fee-for-Service	1841347077	1841347077	1	1	REID, KEITH E MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134785	05	Anesthesiology	0	In state provider	None	2185 WEST CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
194846	Fee-for-Service	1992930986	1992930986	1	1	REGENTS OF THE UNIVERSITY OF	8/10/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4860 Y ST	STE 200	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
194854	Fee-for-Service	1730110784	1730110784	1	1	RAMASWAMY, VYJAYANTI MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56139	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
194875	Fee-for-Service	1316372519	1316372519	1	1	REYNAGA, NATALIE J LCSW	11/4/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194901	Fee-for-Service	1982248811	1982248811	1	1	RIVERA-PALACIOS, JESENIA LP	10/16/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CC	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
194943	Fee-for-Service	1861916959	1861916959	1	1	RABBANI, TIFFANY LCSW	11/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
194956	Fee-for-Service	1730158825	1730158825	1	1	RILEY, GEOFFREY M MD	5/31/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78948	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
194960	Fee-for-Service	1124859822	1124859822	1	1	ROBINSON, KAITLYN	9/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	585 SATURN	STE A	SAN DIEGO	CA	92154	4721	37	06073	32.586336	-117.088506	San Diego County
194963	Fee-for-Service	1093893794	1093893794	2	1	RABINDER S. SIDHU, M.D., INC	1/21/2025	207K00000X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	A MEDICAL CENTER	7151 N CEDAR AVE	SUITE 103	FRESNO	CA	93720	3389	10	06019	36.84032402	-119.7564071	Fresno County
194980	Fee-for-Service	1518250869	1518250869	1	1	ROSE, BRENT S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142735	30	Radiology	0	In state provider	None	200 ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
194991	Fee-for-Service	1134416282	1134416282	1	1	REED, ERIC J MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118169	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
195006	Fee-for-Service	1588610794	1588610794	1	1	ROY, LISA P MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104715	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
195007	Fee-for-Service	1629101217	1629101217	1	1	ROSS, ROBIN L MD	1/11/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	171173	-	NOT APPLICABLE	0	In state provider	None	9015 MURRAY AVE	100	GILROY	CA	95020	3675	43	06085	37.03080985	-121.5741639	Santa Clara County
195025	Fee-for-Service	1952118036	1952118036	1	1	RICHMOND EQUITY AND EMPOWERM	4/10/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	ENT INITIATIVE, INC.	3511 CUTTING BLVD	None	RICHMOND	CA	94804	3241	07	06013	37.92532377	-122.3357333	Contra Costa County
195087	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
195108	Fee-for-Service	1477661247	1477661247	1	1	REISCH, ROBERT B MD	8/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69436	20	Orthopedic Surgery	0	In state provider	None	2300 S FLOWER ST	STE 200	LOS ANGELES	CA	90007	2676	19	06037	34.0294397	-118.2734132	Los Angeles County
195121	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
195130	Fee-for-Service	1417370032	1417370032	1	2	RITTER CENTER	2/20/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	12 & 16 RITTER STREET	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97151013	-122.5251246	Marin County
195218	Fee-for-Service	1811078173	1811078173	1	1	RICHARD P SHUGERMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3954	00	None	47.662389	-122.281857	King County
195229	Fee-for-Service	1447007141	1447007141	1	1	RIVERSIDE RETIREMENT VILLA	3/26/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	4609 ARLINGTON AVE	None	RIVERSIDE	CA	92504	2705	33	06065	33.94641848	-117.4035608	Riverside County
195250	Fee-for-Service	1093893794	1093893794	2	1	RABINDER S. SIDHU, M.D., INC	1/21/2025	207K00000X	NA	Other	026	PHYSICIANS	None	43	Pediatric Allergy	0	In state provider	A MEDICAL CENTER	7151 N CEDAR AVE	SUITE 103	FRESNO	CA	93720	3389	10	06019	36.84032402	-119.7564071	Fresno County
195273	Fee-for-Service	1003820358	1003820358	1	1	REMULLA, JUANCHO F MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52247	18	Ophthalmology	0	In state provider	None	18112 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2211	36	06071	34.54077367	-117.2688167	San Bernardino County
195308	Fee-for-Service	1295150365	1295150365	1	1	RUBY, KIM M MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126050	20	Orthopedic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
195311	Fee-for-Service	1245468933	1245468933	1	1	ROBBINS, AYAKA K LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
195324	Fee-for-Service	1689176901	1689176901	1	1	ROMBERG, RANDALL A	4/5/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1807 XIMENO AVENUE	None	LONG BEACH	CA	90815	2850	19	06037	33.7907401	-118.1389039	Los Angeles County
195338	Fee-for-Service	1376641969	1376641969	1	1	REGENTS OF THE UNVERSITY	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
195346	Fee-for-Service	1871543785	1871543785	1	1	ROSENBAUM, ABRAHAM MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95276	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195371	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
195386	Fee-for-Service	1881685956	1881685956	1	1	ROE, JAMES T MD	10/31/1991	174400000X	NA	Other	026	PHYSICIANS	45044	45	Nephrology (Renal-Kidney)	0	In state provider	None	1513 W TEMPLE ST	# 100	LOS ANGELES	CA	90026	5024	19	06037	34.06787233	-118.2594381	Los Angeles County
195399	Fee-for-Service	1477661247	1477661247	1	1	REISCH, ROBERT B MD	8/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69436	01	General Practice	0	In state provider	None	2300 S FLOWER ST	STE 200	LOS ANGELES	CA	90007	2676	19	06037	34.0294397	-118.2734132	Los Angeles County
195401	Fee-for-Service	1215205927	1215205927	1	1	ROBERTS, CHELSEA A	1/4/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
195410	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	4/14/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
195527	Fee-for-Service	1215114251	1215114251	1	1	REZNIK, GARY MD INC	3/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67314	41	Internal Medicine	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
195561	Fee-for-Service	1972676468	1972676468	1	1	RIVERSIDE COUNTY CCS	3/19/2001	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	HEMET MTU	3401 MUSTANG WAY	BLDG D	HEMET	CA	92545	9257	33	06065	33.72075249	-117.008865	Riverside County
195584	Fee-for-Service	1942284518	1942284518	1	1	ROBBINS, JOHN A MD	7/26/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	34724	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
195598	Fee-for-Service	1700964475	1700964475	1	1	RAMOS, CYNTHIA B MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50743	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 HOSPITAL DR	STE 220	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
195617	Fee-for-Service	1275131658	1275131658	1	1	RADIANTLY MINDFUL LICENSED C	3/24/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	145 EAST LIVE OAK	UNIT # F	ARCADIA	CA	91001	5246	19	06037	34.10813818	-118.0259008	Los Angeles County
195646	Fee-for-Service	1396092466	1396092466	1	1	ROMANO, JULIE LCSW	2/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
195660	Fee-for-Service	1285384974	1285384974	1	1	RAUSER, THOMAS MD	10/29/2024	390200000X	NA	Other	026	PHYSICIANS	189154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
195663	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	8/1/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
195674	Fee-for-Service	1528136843	1528136843	1	1	RAJAN, PRIYA V MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83777	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195675	Fee-for-Service	1881685956	1881685956	1	1	ROE, JAMES T MD	10/31/1991	174400000X	NA	Other	026	PHYSICIANS	45044	41	Internal Medicine	0	In state provider	None	1513 W TEMPLE ST	# 100	LOS ANGELES	CA	90026	5024	19	06037	34.06787233	-118.2594381	Los Angeles County
195681	Fee-for-Service	1174630016	1174630016	1	1	RETAMOZO, MILTON R MD	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79166	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
195684	Fee-for-Service	1043250863	1043250863	1	1	RAKESH SHRIVASTAVA	11/21/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2308 W HIGHWAY 66	None	STROUD	OK	74079	6729	00	None	35.76962135	-96.61505084	Creek County
195689	Fee-for-Service	1144675034	1144675034	1	1	RENOSTO, VALERIE T MD	6/5/2020	208M00000X	NA	Other	026	PHYSICIANS	161626	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
195690	Fee-for-Service	1619539392	1619539392	1	1	RESENDEZ, ALEENA DPM	11/28/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
195697	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
195710	Fee-for-Service	1346635083	1346635083	1	1	RUSTAGI, ARJUN MD	11/30/2021	207R00000X	NA	Other	026	PHYSICIANS	145156	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195712	Fee-for-Service	1003837675	1003837675	1	1	ROSE, JACK CHANDLER MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88152	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	# 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
195744	Fee-for-Service	1609015882	1609015882	1	1	RODRIGUEZ, YVETTE M LCSW	1/18/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
195814	Fee-for-Service	1215114251	1215114251	1	1	REZNIK, GARY MD INC	3/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67314	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
195829	Fee-for-Service	1194969030	1194969030	1	1	RIFF, BRIAN P MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143535	10	Gastroenterology (M.D. only)	0	In state provider	None	1211 W LA PALMA AVE	STE 306	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
195865	Fee-for-Service	1528696325	1528696325	1	1	RIAHI, IRENE R MD	4/26/2024	207ZP0102X	NA	Other	026	PHYSICIANS	181954	22	Pathology (M.D. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
195946	Fee-for-Service	1861673857	1861673857	1	1	RUZER MEDICAL SVCS, INC	10/28/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	RUZER MEDICAL SVCS, INC	16300 CRENSHAW BLVD	SUITE 204	TORRANCE	CA	90504	1441	19	06037	33.88242243	-118.3264875	Los Angeles County
195948	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
195955	Fee-for-Service	1235455882	1235455882	1	1	ROY, ABHIK MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141139	10	Gastroenterology (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
195969	Fee-for-Service	1174630016	1174630016	1	1	RETAMOZO, MILTON R MD	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79166	02	General Surgery	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
195986	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
196023	Fee-for-Service	1235152000	1235152000	1	1	ROUSLIN, DAVID E PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
196086	Fee-for-Service	1710351085	1710351085	1	1	ROBKIN, DALIA S	3/27/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4419 VAN NUYS BLVD	411	SHERMAN OAKS	CA	91403	2910	19	06037	34.151697	-118.448716	Los Angeles County
196102	Fee-for-Service	1104013895	1104013895	1	1	RUIZ, JOSE A MD	12/31/2007	207R00000X	NA	Other	026	PHYSICIANS	95453	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
196108	Fee-for-Service	1154361020	1154361020	1	1	RONALD P BARLOW MD	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 W 800 N	None	OREM	UT	84341	6000	00	None	40.31373134	-111.7150045	Utah County
196109	Fee-for-Service	1639146533	1639146533	2	1	RIVERA, ERNESTO MALFRED A MD	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	1901 PORT LANE	None	AMARILLO	TX	79106	2430	00	None	35.19394499	-101.9134555	Potter County
196125	Fee-for-Service	1841235611	1841235611	1	1	RAGINS, MELINDA L MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77392	40	Pediatrics	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
196156	Fee-for-Service	1528696325	1528696325	1	1	RIAHI, IRENE R MD	4/26/2024	207ZP0102X	NA	Other	026	PHYSICIANS	181954	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
196163	Fee-for-Service	1063886448	1063886448	1	2	RYANS REACH	1/28/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2009 CATALINA AVE	None	SANTA ANA	CA	92705	7804	30	06059	33.76463587	-117.8386825	Orange County
196173	Fee-for-Service	1477531614	1477531614	1	1	ROSSEN, RONALD M MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	22902	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
196220	Fee-for-Service	1760484430	1760484430	1	1	RAGLAND, DORIS E MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65355	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	FL 6	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
196239	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
196242	Fee-for-Service	1235455882	1235455882	1	1	ROY, ABHIK MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141139	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
196272	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	4/14/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
196310	Fee-for-Service	1659720555	1659720555	1	1	RAMIREZ SANCHEZ, CLAUDIA C M	9/15/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	160493	None	None	0	In state provider	D	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
196322	Fee-for-Service	1295062214	1295062214	1	1	RAWAL, RACHNA MD INC	7/28/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	82575	40	Pediatrics	0	In state provider	None	14930 IMPERIAL HWY	UNIT A	LA MIRADA	CA	90638	2100	19	06037	33.91709152	-118.012653	Los Angeles County
196346	Fee-for-Service	1962918359	1962918359	1	1	ROMERO GREEN, SAMANTHA LCSW	7/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
196368	Fee-for-Service	1922033430	1922033430	1	1	RIZKALLA INC	2/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
196455	Fee-for-Service	1881891737	1881891737	1	1	RUBIDA, RANDALL T LMFT	12/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
196484	Fee-for-Service	1457748543	1457748543	1	1	RODRIGUEZ, BRENDA LCSW	11/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
196490	Fee-for-Service	1457837023	1457837023	1	1	ROSE, SANTELIA MD	3/7/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166638	None	None	0	In state provider	None	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	19	06037	33.98364904	-118.4449069	Los Angeles County
196513	Fee-for-Service	1467423525	1467423525	1	1	RODRIGUEZ, JUAN C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76332	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
196521	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
196543	Fee-for-Service	1962746339	1962746339	1	1	RADIOLOGY PARTNERS LLC	9/3/2020	261QR0208X	NA	Mammography Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3160 CASTRO VALLEY BLVD.	SUITE 235	CASTRO VALLEY	CA	94546	5564	01	06001	37.69558946	-122.0802885	Alameda County
196545	Fee-for-Service	1295142529	1295142529	1	2	RIESER, ALEXANDER P AU	6/21/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
196560	Fee-for-Service	1710287297	1710287297	1	50	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
196590	Fee-for-Service	1619457991	1619457991	1	1	ROBINSON, NICOLE L CNP	3/31/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
196596	Fee-for-Service	1083963821	1083963821	1	1	REEVES, LISA M	2/3/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	935 MINNEWAWA AVE	APT. F	CLOVIS	CA	93612	5511	10	06019	36.8186886	-119.7089403	Fresno County
196608	Fee-for-Service	1952525123	1952525123	1	1	REGWAN, STEVEN DO	6/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14198	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	230 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65837657	-121.6469645	Monterey County
196611	Fee-for-Service	1811255060	1811255060	1	1	REGENTS OF THE UNIVERSITY OF	11/26/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
196630	Fee-for-Service	1942644315	1942644315	1	1	RAZDAN, ANUPRIYA MD	9/10/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	147382	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
196641	Fee-for-Service	1710287297	1710287297	1	125	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
196642	Fee-for-Service	1184651234	1184651234	1	1	RAO, KALPANA S MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82932	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
196668	Fee-for-Service	1336289230	1336289230	1	1	RAROQUE, SOLEDAD S U MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50607	40	Pediatrics	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
196671	Fee-for-Service	1073782637	1073782637	1	1	RYAN T MURPHY MD	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2845 GREENBRIER RD	None	GREEN BAY	WI	54311	6519	00	None	44.47337651	-87.940791	Brown County
196679	Fee-for-Service	1942337464	1942337464	1	1	READE-SAN JOSE, MONICA A LMF	9/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3851 KATELLA AVE	380	LOS ALAMITOS	CA	90720	3309	30	06059	33.80319053	-118.0657305	Orange County
196746	Fee-for-Service	1366837148	1366837148	1	1	RIDER, ASHLEY MD	9/1/2018	207P00000X	NA	Other	026	PHYSICIANS	147834	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
196802	Fee-for-Service	1154102770	1154102770	1	1	RUFF, KRISTA NP	11/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
196811	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
196825	Fee-for-Service	1013370865	1013370865	1	1	RUSOJA, EVAN A MD	4/29/2020	207P00000X	NA	Other	026	PHYSICIANS	155678	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
196869	Fee-for-Service	1326115924	1326115924	1	1	ROURA, STACEY A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
196878	Fee-for-Service	1447253125	1447253125	1	4	RIDGECREST REGIONAL HOSPITAL	3/17/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	409 DRUMMOND AVE	None	RIDGECREST	CA	93555	3120	15	06029	35.63699547	-117.6771015	Kern County
196887	Fee-for-Service	1083963821	1083963821	1	1	REEVES, LISA M	2/3/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	935 MINNEWAWA AVE	APT. F	CLOVIS	CA	93612	5511	10	06019	36.8186886	-119.7089403	Fresno County
196901	Fee-for-Service	1811255060	1811255060	1	1	REGENTS OF THE UNIVERSITY OF	9/30/2019	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
196914	Fee-for-Service	1104909258	1104909258	2	1	RANCHO DRUGS INC	12/27/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17798 WIKA RD	None	APPLE VALLEY	CA	92307	1219	36	06071	34.53997463	-117.2753327	San Bernardino County
196931	Fee-for-Service	1710287297	1710287297	1	125	REGENTS UNIVERSITY OF CALIFO	12/5/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
196937	Fee-for-Service	1669687562	1669687562	1	1	REID, DARYL A MD	12/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145506	None	None	0	In state provider	None	316 S STRATFORD AVENUE	SUITE C	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
196943	Fee-for-Service	1790140309	1790140309	1	1	RIVERSIDE COUNTY MEDICAL	9/11/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	SERVICES AMC	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
196956	Fee-for-Service	1336289230	1336289230	1	1	RAROQUE, SOLEDAD S U MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50607	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
197079	Fee-for-Service	1528035417	1528035417	1	1	RATTO, DAVID R MD	2/2/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44900	01	General Practice	0	In state provider	None	7365 CARNELIAN ST	STE 137	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
197099	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	4/22/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
197101	Fee-for-Service	1407110182	1407110182	1	1	RHEE, KATHERINE E MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131028	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
197128	Fee-for-Service	1780132514	1780132514	1	1	REESER, CORINE E	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
197187	Fee-for-Service	1811255060	1811255060	1	1	REGENTS OF THE UNIVERSITY OF	7/16/2024	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
197216	Fee-for-Service	1194795583	1194795583	1	1	RHODEN, DIANE H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
197217	Fee-for-Service	1710287297	1710287297	1	125	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
197265	Fee-for-Service	1174365613	1174365613	1	1	ROBLES CORTES, JORGE MD	3/13/2025	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
197387	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
197417	Fee-for-Service	1144781733	1144781733	1	1	ROACH, MONIQUE N LCSW	10/15/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	325	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
197423	Fee-for-Service	1003836602	1003836602	1	1	RASTOGI, ANJAY MD	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82681	13	Neurology (M.D. only)	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
197429	Fee-for-Service	1639432453	1639432453	1	1	RAI, RABINA MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134408	01	General Practice	0	In state provider	None	11600 INDIAN HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
197440	Fee-for-Service	1518940741	1518940741	1	1	RAFF, GARY W MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86790	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
197478	Fee-for-Service	1811255060	1811255060	1	1	REGENTS OF THE UNIVERSITY OF	9/10/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
197483	Fee-for-Service	1013929173	1013929173	1	1	RESS, RICHARD M MD INC	4/28/1999	174400000X	NA	Other	026	PHYSICIANS	19122	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	STE 516	BEVERLY HILLS	CA	90211	1789	19	06037	34.0696407	-118.3836988	Los Angeles County
197504	Fee-for-Service	1710287297	1710287297	1	125	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
197546	Fee-for-Service	1801000245	1801000245	1	1	RAMPART MULTI-SPEC MED	6/30/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	2534 W 3RD ST	None	LOS ANGELES	CA	90057	1916	19	06037	34.06535038	-118.2775802	Los Angeles County
197588	Fee-for-Service	1134289267	1134289267	1	1	REVOLLO, HUGO A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26394	41	Internal Medicine	0	In state provider	None	10948 RAMONA BLVD	None	EL MONTE	CA	91731	2633	19	06037	34.07200171	-118.0367115	Los Angeles County
197594	Fee-for-Service	1043065394	1043065394	1	1	ROCHA, ROSIO LCSW	5/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
197605	Fee-for-Service	1871939082	1871939082	1	1	RAYMOND RENAISSANCE SURGERY	8/30/2016	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER, LLC	125 NORTH RAYMOND AVENUE	SUITE 212	PASADENA	CA	91103	4535	19	06037	34.14800227	-118.1489424	Los Angeles County
197619	Fee-for-Service	1356559678	1356559678	1	1	RINCON VALLEY UNION SCHOOL	8/16/2001	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1000 YULUPA AVE	None	SANTA ROSA	CA	95405	7020	49	06097	38.444121	-122.6741175	Sonoma County
197675	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
197737	Fee-for-Service	1134169535	1134169535	2	32	REACH AIR MEDICAL SERVICES L	5/2/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	960 A AVENUE C	STE A	ELY	NV	89301	3307	00	None	39.25707624	-114.8707942	White Pine County
197766	Fee-for-Service	1811255060	1811255060	1	1	REGENTS OF THE UNIVERSITY OF	8/8/2024	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
197768	Fee-for-Service	1245691450	1245691450	1	1	ROLDAN, MARIO DO	9/24/2021	208600000X	NA	General Surgery	026	PHYSICIANS	19064	None	None	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
197769	Fee-for-Service	1013929173	1013929173	1	1	RESS, RICHARD M MD INC	4/28/1999	174400000X	NA	Other	026	PHYSICIANS	19122	83	Rheumatology	0	In state provider	None	250 N ROBERTSON BLVD	STE 516	BEVERLY HILLS	CA	90211	1789	19	06037	34.0696407	-118.3836988	Los Angeles County
197788	Fee-for-Service	1144619925	1144619925	1	1	RASP, ANDRIYANA LMFT	12/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HERAPY	400 MOBIL AVE	SUITE D-22	CAMARILLO	CA	93010	6338	56	06111	34.22111093	-119.0429505	Ventura County
197791	Fee-for-Service	1710287297	1710287297	1	125	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	13160 MINDANAO WAY	301, 303, 315	MARINA DEL REY	CA	90292	6358	19	06037	33.98450811	-118.4376278	Los Angeles County
197819	Fee-for-Service	1013063163	1013063163	1	1	RODGERS, MARGARET L MD	5/24/2008	174400000X	NA	Other	026	PHYSICIANS	84357	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
197825	Fee-for-Service	1457432122	1457432122	1	1	RECTOR, ERNEST R MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84062	34	Urology and Urological Surgery	0	In state provider	None	1 SHRADER ST	STE 560	SAN FRANCISCO	CA	94117	1077	38	06075	37.77467326	-122.4529451	San Francisco County
197838	Fee-for-Service	1134861123	1134861123	1	1	REYES, MARLON R NP	9/28/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
197841	Fee-for-Service	1134189822	1134189822	1	1	ROONEY, RICHARD C	6/18/2020	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	76424	20	Orthopedic Surgery	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
197847	Fee-for-Service	1427244557	1427244557	1	1	RAJPAL, RANJIT SINGH MD	1/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35339	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	860 E ALMOND AVE	None	MADERA	CA	93637	5603	20	06039	36.9454636	-120.0479548	Madera County
197947	Fee-for-Service	1245443688	1245443688	1	1	ROLAND, CHRISTINE M MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72060	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
197949	Fee-for-Service	1013155019	1013155019	1	1	RAOOF, MUSTAFA MD	8/3/2017	208600000X	NA	General Surgery	026	PHYSICIANS	135371	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
197950	Fee-for-Service	1386684629	1386684629	1	1	ROH, MICHAEL L MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94706	18	Ophthalmology	0	In state provider	None	4300 LONG BEACH BLVD	STE 300	LONG BEACH	CA	90807	2008	19	06037	33.83662572	-118.1900605	Los Angeles County
197961	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	8/12/2024	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
197998	Fee-for-Service	1184811549	1184811549	1	1	RYAN, WILLIAM R MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97821	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
198021	Fee-for-Service	1104892454	1104892454	1	1	RUSSELL, WILLIAM M MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37912	30	Radiology	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
198059	Fee-for-Service	1487086195	1487086195	1	1	REYNOLDS, IAN A CPO	5/11/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	463 BREWSTER AVE	SUITE 6	REDWOOD CITY	CA	94063	1783	41	06081	37.4919571	-122.2297604	San Mateo County
198062	Fee-for-Service	1639241706	1639241706	1	1	ROMINES, PETER DPM	2/8/2015	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9121 FOLSOM BLVD	# 4	SACRAMENTO	CA	95826	2473	34	06067	38.559906	-121.3624125	Sacramento County
198074	Fee-for-Service	1295003085	1295003085	1	1	REY-MONROY, MA MILDRED MD	3/17/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	16415 COLORADO AVE	STE 308	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
198087	Fee-for-Service	1063729580	1063729580	1	1	RAINA, SAMEER MD	12/6/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139638	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
198136	Fee-for-Service	1427244557	1427244557	1	1	RAJPAL, RANJIT SINGH MD	1/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35339	41	Internal Medicine	0	In state provider	None	860 E ALMOND AVE	None	MADERA	CA	93637	5603	20	06039	36.9454636	-120.0479548	Madera County
198168	Fee-for-Service	1750458527	1750458527	1	1	RUIDERA, NG IRENE H NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
198183	Fee-for-Service	1568626430	1568626430	1	1	RICHARDS, JACLYN P MD	9/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104017	40	Pediatrics	0	In state provider	None	9041 MAGNOLIA AVE	STE 305	RIVERSIDE	CA	92503	3957	33	06065	33.92541585	-117.4378266	Riverside County
198193	Fee-for-Service	1114927449	1114927449	1	1	RIEDERS, DANIEL E MD	3/31/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45077	None	None	0	In state provider	None	150 CATHERINE LANE	STE F	GRASS VALLEY	CA	95945	5719	29	06057	39.22894557	-121.0489578	Nevada County
198196	Fee-for-Service	1366520181	1366520181	1	1	RAMIREZ, VICTOR MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37793	02	General Surgery	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
198216	Fee-for-Service	1851478796	1851478796	1	1	RUSSO, CAROLYN L MD	12/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	55159	68	Hematology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
198246	Fee-for-Service	1285735571	1285735571	1	1	RADIOLOGY CONSULTANTS	2/1/2000	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	1	Border provider	LTD	235 W 6TH ST	None	RENO	NV	89503	4505	00	None	39.53165987	-119.8181899	Washoe County
198249	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	11/25/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
198271	Fee-for-Service	1164420840	1164420840	1	1	RODRIGUEZ, CARLOS A MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138158	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
198279	Fee-for-Service	1487947206	1487947206	1	1	RIVER CITY RECOVERY CENTER,	9/4/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2218 E ST	None	SACRAMENTO	CA	95816	3511	34	06067	38.581047	-121.4742285	Sacramento County
198283	Fee-for-Service	1568655264	1568655264	1	1	RIGGINS, NINA Y MD	5/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114482	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
198298	Fee-for-Service	1548534092	1548534092	1	1	RAKIS-GARABEDIAN, VANESSA A	3/11/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
198317	Fee-for-Service	1700876539	1700876539	1	1	ROSA, ROBERT C	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11495 CARMEL MOUNTAIN RD	STE 102	SAN DIEGO	CA	92128	4618	37	06073	32.97867398	-117.0836249	San Diego County
198344	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
198355	Fee-for-Service	1285656793	1285656793	1	1	REINER, ROBERT S OD INC	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	21739 S AVALON BLVD	None	CARSON	CA	90745	3302	19	06037	33.830361	-118.263757	Los Angeles County
198382	Fee-for-Service	1134133879	1134133879	1	1	RESNICK, WILLIAM J MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	66239	36	Psychiatry	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06473399	-118.445865	Los Angeles County
198411	Fee-for-Service	1376107565	1376107565	1	1	ROUSSEAU, JENNA MD	9/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185990	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
198416	Fee-for-Service	1730387176	1730387176	1	1	ROWLES, SHAWN A MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	#315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
198428	Fee-for-Service	1447265913	1447265913	1	1	RAPPAPORT, VALERIE J MD	6/19/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56264	47	Miscellaneous	0	In state provider	None	1524 MCHENRY AVE	STE 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
198430	Fee-for-Service	1700015427	1700015427	1	1	RICHA, GOYAL MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140232	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
198471	Fee-for-Service	1700217619	1700217619	1	1	RANCHO COUNSELING CENTER, LI	2/2/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C.	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
198472	Fee-for-Service	1326458845	1326458845	1	2	RAMISCAL, JUDI ANNE B MD	9/16/2021	390200000X	NA	Other	026	PHYSICIANS	160447	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
198482	Fee-for-Service	1174731970	1174731970	1	1	RABESSLER MD PC	7/29/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
198500	Fee-for-Service	1730208059	1730208059	1	1	REINHART, ROLAND D MD	8/12/2020	207LP2900X	NA	Other	026	PHYSICIANS	49097	05	Anesthesiology	0	In state provider	None	39800 PORTOLA	None	PALM DESERT	CA	92260	0620	33	06065	33.76148288	-116.3735976	Riverside County
198504	Fee-for-Service	1851478796	1851478796	1	1	RUSSO, CAROLYN L MD	12/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	55159	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
198508	Fee-for-Service	1043382682	1043382682	1	1	REXINGER, THOMAS K CRNA	7/18/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
198531	Fee-for-Service	1922699412	1922699412	1	1	RYAN, SEAN J	1/30/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	480 PLUMAS BOULEVARD	SUITE 204	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
198540	Fee-for-Service	1295816064	1295816064	1	1	REINISCH, JOHN F MD	8/18/1997	2086S0122X	NA	General Surgery	026	PHYSICIANS	49544	24	Plastic Surgery	0	In state provider	None	390 N SEPULVEDA BLVD	None	EL SEGUNDO	CA	90245	4475	19	06037	33.92077214	-118.3960953	Los Angeles County
198544	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
198555	Fee-for-Service	1124137559	1124137559	1	1	RITE AID #6255	8/26/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1038 E COLORADO BLVD	None	PASADENA	CA	91106	2323	19	06037	34.14589744	-118.129106	Los Angeles County
198610	Fee-for-Service	1134475874	1134475874	1	1	ROSSETTO, HARRIET LCSW	1/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	12057	-	NOT APPLICABLE	0	In state provider	None	8831 VENICE BLVD	None	LOS ANGELES	CA	90034	3223	19	06037	34.03056062	-118.3863512	Los Angeles County
198634	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
198717	Fee-for-Service	1467649996	1467649996	1	1	REYES, MICHELE M	10/7/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
198728	Fee-for-Service	1598530693	1598530693	1	1	RAY, BLAIR CD	3/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	45	06089	0	0	None
198734	Fee-for-Service	1932534021	1932534021	1	3	RENAL CONSULTANTS OF VENTURA	2/29/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2705 LOMA VISTA ROAD	101	VENTURA	CA	93003	1596	56	06111	34.27504051	-119.2600018	Ventura County
198760	Fee-for-Service	1700217619	1700217619	1	1	RANCHO COUNSELING CENTER, LI	1/19/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C.	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
198774	Fee-for-Service	1356607352	1356607352	1	1	ROBINSON, CAROLINA D MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145294	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 SOUTH MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
198792	Fee-for-Service	1851478796	1851478796	1	1	RUSSO, CAROLYN L MD	12/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	55159	78	Neoplastic Diseases/Oncology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
198825	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
198828	Fee-for-Service	1336505874	1336505874	1	1	RIBERA, DEBORAH LMFT	1/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
198835	Fee-for-Service	1497768311	1497768311	1	1	RAMOS, MILDRED A MD	1/31/1988	207ZP0102X	NA	Other	026	PHYSICIANS	52193	01	General Practice	0	In state provider	None	15375 BARRANCA PARKWAY	SUITE H-105	IRVINE	CA	92618	2209	30	06059	33.66174175	-117.7431116	Orange County
198850	Fee-for-Service	1043972870	1043972870	1	1	RUIZ, TIFFANIE C NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10200 SEPULVEDA BLVD	STE 200	MISSION HILLS	CA	91345	2657	19	06037	34.25572562	-118.4673156	Los Angeles County
198859	Fee-for-Service	1356193817	1356193817	1	1	RODRIGUEZ, DAVID	5/19/2024	342000000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6758 LINVILLE DR	None	WEED	CA	96094	9087	47	06093	41.38286238	-122.3798969	Siskiyou County
198925	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
198958	Fee-for-Service	1386743177	1386743177	1	1	ROBERTS NGAN SUGERMAN	10/11/2000	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	201 S ALVARADO ST	STE 717	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
198976	Fee-for-Service	1245712918	1245712918	1	1	RASTEIRO, JORDAN LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
198985	Fee-for-Service	1710484704	1710484704	1	1	REYES, NICOLAS MD	6/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166783	None	None	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
198993	Fee-for-Service	1760844310	1760844310	1	1	ROESSNER, JEDD LYN T MD	6/23/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159778	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
199015	Fee-for-Service	1154550788	1154550788	1	1	RENTMEESTER, LANDEN L MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
199043	Fee-for-Service	1023679065	1023679065	1	1	RAHMAN, SYED MD	10/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179286	None	None	0	In state provider	None	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	50	06099	37.66975543	-120.9724048	Stanislaus County
199057	Fee-for-Service	1689755084	1689755084	1	1	RICHMOND, TANISHA DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1323 W 3RD ST	None	DAYTON	OH	45402	6714	00	None	39.75539679	-84.21717053	Montgomery County
199089	Fee-for-Service	1073623740	1073623740	1	1	RALEY'S	9/14/1989	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 LAKE BLVD	UNIT B	REDDING	CA	96003	2506	45	06089	40.61074891	-122.3806643	Shasta County
199121	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
199124	Fee-for-Service	1497768311	1497768311	1	1	RAMOS, MILDRED A MD	1/31/1988	207ZP0102X	NA	Other	026	PHYSICIANS	52193	22	Pathology (M.D. only)	0	In state provider	None	15375 BARRANCA PARKWAY	SUITE H-105	IRVINE	CA	92618	2209	30	06059	33.66174175	-117.7431116	Orange County
199131	Fee-for-Service	1700550365	1700550365	1	2	R&C TRANSPORTATION LLC	7/6/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12576 CIPRIANO LN	None	EASTVALE	CA	91752	7307	33	06065	33.97208451	-117.557865	Riverside County
199146	Fee-for-Service	1053686865	1053686865	1	1	ROJAS, RODOLFO R A MD	1/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130587	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
199167	Fee-for-Service	1417474826	1417474826	1	1	RENNO, PATRICIA A PHD	10/31/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
199183	Fee-for-Service	1508993874	1508993874	1	1	ROCKCREEK, INC	11/22/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	26219 EDGEMONT DR	None	HIGHLAND	CA	92346	1652	36	06071	34.14986554	-117.2323404	San Bernardino County
199211	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	5/27/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
199255	Fee-for-Service	1720102544	1720102544	1	1	ROBINSON-OSDER, GINA G NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
199298	Fee-for-Service	1316301914	1316301914	1	1	ROSS, NICOLE E MD	9/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141736	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
199307	Fee-for-Service	1770625345	1770625345	1	1	RODRIGUEZ, MELISSA F	6/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
199312	Fee-for-Service	1306107271	1306107271	1	1	ROMBERG, FREDERICK W MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152496	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
199333	Fee-for-Service	1801149299	1801149299	1	1	ROBERTS, MARY D LMFT	11/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
199352	Fee-for-Service	1376704650	1376704650	1	1	RESTORICK, SAOZINHA LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
199365	Fee-for-Service	1942629258	1942629258	1	1	RINONOS, SERENDIPITY Z MD	7/23/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167969	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 MEDICAL PLAZA # B200	None	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
199383	Fee-for-Service	1447520101	1447520101	1	1	RAMOS, ARMANDO G OT	3/19/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
199396	Fee-for-Service	1871594259	1871594259	1	1	RALPH A. D'SILVA, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4530 E MUIRWOOD DR	STE 105	PHOENIX	AZ	85048	7693	00	None	33.303006	-111.9855375	Maricopa County
199399	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
199443	Fee-for-Service	1497829790	1497829790	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF I LLC	490 CHADBOURNE RD	None	FAIRFIELD	CA	94534	9613	48	06095	38.234772	-122.081549	Solano County
199467	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
199491	Fee-for-Service	1265467435	1265467435	1	1	RAO, MOHAN P MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62446	45	Nephrology (Renal-Kidney)	0	In state provider	None	25 S RAYMOND AVE	STE 201	ALHAMBRA	CA	91801	7146	19	06037	34.09042452	-118.1450725	Los Angeles County
199498	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	5/27/2020	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
199523	Fee-for-Service	1578649224	1578649224	1	1	ROSE-INNES, ANDREW PETER MD	2/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
199525	Fee-for-Service	1154646495	1154646495	1	1	RUMERY, MATHEW D MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129321	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
199535	Fee-for-Service	1184672024	1184672024	1	1	RONALD DIVINE	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 E HIGHLAND	STE 120	PHOENIX	AZ	85016	0000	00	None	33.506415	-112.0334085	Maricopa County
199561	Fee-for-Service	1881915346	1881915346	1	1	RANDAZZO, WILLIAM T MD	12/6/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	136905	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
199565	Fee-for-Service	1609018340	1609018340	1	1	RAHN, DOUGLAS A III MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115869	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199613	Fee-for-Service	1144423849	1144423849	1	1	RAO, NEAL M MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108744	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
199680	Fee-for-Service	1649290248	1649290248	1	1	RECKAMP, KAREN L MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75041	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA STE 12	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
199689	Fee-for-Service	1942334024	1942334024	1	1	ROMO, WENDY LMFT	7/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
199691	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	12/9/2020	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
199702	Fee-for-Service	1659933398	1659933398	1	1	ROWLAND, KATHLEEN M MD	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	186543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
199723	Fee-for-Service	1205831922	1205831922	1	1	ROY, TAPAN MD	7/8/2022	2085R0001X	NA	Other	026	PHYSICIANS	51244	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
199750	Fee-for-Service	1801161591	1801161591	1	1	ROBINSON, ANGELA NP	11/25/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
199757	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
199767	Fee-for-Service	1629218185	1629218185	1	1	ROUTT DIALYSIS, LLC	1/27/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	4860 VISTA BLVD	STE 100	SPARKS	NV	89436	2817	00	None	39.58012118	-119.7180559	Washoe County
199774	Fee-for-Service	1396738530	1396738530	1	1	ROBERTS, MICHAEL A MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77138	18	Ophthalmology	0	In state provider	None	201 S ALVARADO ST	STE 406	LOS ANGELES	CA	90057	2353	19	06037	34.06417777	-118.2719543	Los Angeles County
199777	Fee-for-Service	1265467435	1265467435	1	1	RAO, MOHAN P MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62446	41	Internal Medicine	0	In state provider	None	25 S RAYMOND AVE	STE 201	ALHAMBRA	CA	91801	7146	19	06037	34.09042452	-118.1450725	Los Angeles County
199782	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
199825	Fee-for-Service	1548362973	1548362973	1	1	RIVERSIDE MEDICAL CLINIC	4/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	830 MAGNOLIA AVE	None	CORONA	CA	92882	3813	33	06065	33.86017131	-117.5520534	Riverside County
199848	Fee-for-Service	1053875294	1053875294	1	1	ROSE, CAROL A RCP	2/5/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
199857	Fee-for-Service	1609018340	1609018340	1	1	RAHN, DOUGLAS A III MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115869	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199877	Fee-for-Service	1104105626	1104105626	1	1	RACHAKONDA, LEELANAND P MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
199881	Fee-for-Service	1356499578	1356499578	1	2	REEN, GURCHARAN SINGH MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	41841	41	Internal Medicine	0	In state provider	None	1900 MOWRY AVE	202	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
199934	Fee-for-Service	1285620658	1285620658	1	1	RUCKMAN, DAVID A MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67884	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
199935	Fee-for-Service	1922288802	1922288802	1	1	RODRIGUEZ, REBECCAH R DO	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10913	08	Family Practice	0	In state provider	None	6699 ALVARADO ROAD	STE 2100	SAN DIEGO	CA	92120	5238	37	06073	32.77665383	-117.0540279	San Diego County
199938	Fee-for-Service	1548586936	1548586936	1	1	ROOD, COREY J MD	7/22/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162920	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
199943	Fee-for-Service	1033592712	1033592712	1	1	REDDY, SANHITA MD	10/28/2019	207L00000X	NA	Other	026	PHYSICIANS	147799	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
199963	Fee-for-Service	1043238041	1043238041	1	1	RUBIN, RUTH MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55162	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
199976	Fee-for-Service	1730386681	1730386681	1	1	RAHMANI, SHIRIN MD	1/24/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96438	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
199978	Fee-for-Service	1306194543	1306194543	1	1	RICHARDSON, KIMBERLY	5/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
199986	Fee-for-Service	1710287297	1710287297	1	30	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
199989	Fee-for-Service	1386013019	1386013019	1	1	RAY MUN LOO MD MEDICAL CORPO	4/9/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	101118	40	Pediatrics	0	In state provider	None	2421 MARSHALL AVE	None	IMPERIAL	CA	92251	9599	13	06025	32.82911866	-115.5688241	Imperial County
200042	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
200048	Fee-for-Service	1255561403	1255561403	1	1	ROJAS, DEBRA D LMFT	12/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2875 MIDDLEFIELD RD	SUITE 8	PALO ALTO	CA	94306	2548	43	06085	37.43220267	-122.1273597	Santa Clara County
200049	Fee-for-Service	1912284621	1912284621	1	1	REEN, SANDEEP MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116455	08	Family Practice	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
200073	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	5/27/2020	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
200114	Fee-for-Service	1548362973	1548362973	1	1	RIVERSIDE MEDICAL CLINIC	4/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	830 MAGNOLIA AVE	None	CORONA	CA	92882	3813	33	06065	33.86017131	-117.5520534	Riverside County
200168	Fee-for-Service	1356499578	1356499578	1	2	REEN, GURCHARAN SINGH MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	41841	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1900 MOWRY AVE	202	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
200170	Fee-for-Service	1003968223	1003968223	1	1	RAO, RAMINENI R MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	38851	26	Psychiatry (child)	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
200187	Fee-for-Service	1790934883	1790934883	1	1	RAMOS, ARLEEN S LCSW	1/21/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
200267	Fee-for-Service	1710287297	1710287297	1	28	REGENTS UNIVERSITY OF CALIFO	12/18/2020	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
200298	Fee-for-Service	1841425642	1841425642	1	1	ROULEAU, SUSAN E	5/29/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
200312	Fee-for-Service	1023165453	1023165453	1	1	RAPID RESPONSE LLC	6/30/2006	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1445 DREAMY WAY	None	SACRAMENTO	CA	95835	1761	34	06067	38.673279	-121.494168	Sacramento County
200333	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
200338	Fee-for-Service	1912469032	1912469032	1	1	RAMOS, JENNIFER	4/17/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181645	08	Family Practice	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
200360	Fee-for-Service	1710287297	1710287297	1	82	REGENTS UNIVERSITY OF CALIFO	5/27/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2100 WEST 3RD STREET	100	LOS ANGELES	CA	90057	1971	19	06037	34.06308947	-118.2733326	Los Angeles County
200364	Fee-for-Service	1487772380	1487772380	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
200402	Fee-for-Service	1548362973	1548362973	1	1	RIVERSIDE MEDICAL CLINIC	4/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	830 MAGNOLIA AVE	None	CORONA	CA	92882	3813	33	06065	33.86017131	-117.5520534	Riverside County
200409	Fee-for-Service	1093840753	1093840753	1	1	REYES, ZOEISE B LMFT	4/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
200459	Fee-for-Service	1003968223	1003968223	1	1	RAO, RAMINENI R MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	38851	36	Psychiatry	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
200480	Fee-for-Service	1427086560	1427086560	1	1	RUDDY, RICHARD M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
200527	Fee-for-Service	1548345580	1548345580	1	1	ROW, PAUL K MD AMC	12/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74103	18	Ophthalmology	0	In state provider	None	2225 PORT CHICAGO HWY	None	CONCORD	CA	94520	2051	07	06013	37.98176172	-122.0311946	Contra Costa County
200544	Fee-for-Service	1952637050	1952637050	1	1	REGENTS OF THE UNIVERSITY OF	3/4/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	8676	37	06073	32.7537975	-117.1658298	San Diego County
200570	Fee-for-Service	1528099439	1528099439	1	1	ROLFES, RICHARD A DPM	8/18/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	595 BUCKINGHAM WAY	SUITE 330	SAN FRANCISCO	CA	94132	1911	38	06075	37.73012679	-122.4767395	San Francisco County
200580	Fee-for-Service	1891094207	1891094207	1	1	ROSENTHAL, MARTIN G MD	2/1/2021	2086S0127X	NA	General Surgery	026	PHYSICIANS	171075	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
200590	Fee-for-Service	1407047749	1407047749	1	1	RONQUILLO, RINA R MD	4/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99286	01	General Practice	0	In state provider	None	6942 UNIVERSITY AVE	#A	LA MESA	CA	91941	5963	37	06073	32.75532823	-117.0487443	San Diego County
200612	Fee-for-Service	1982709432	1982709432	1	1	REIS, MARK T MD	10/19/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	88836	20	Orthopedic Surgery	0	In state provider	None	600 N HIGHLAND SPRINGS	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
200620	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
200626	Fee-for-Service	1033987193	1033987193	1	1	RIGAS AND SON, LLC	9/16/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1104 S MAIN AVE	None	FALLBROOK	CA	92028	3325	37	06073	33.37214151	-117.2513319	San Diego County
200637	Fee-for-Service	1780680017	1780680017	1	1	RENO RADIOLOGICAL ASSOCIATES	1/1/1979	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
200641	Fee-for-Service	1336552900	1336552900	1	1	RIOS, DAVID MD	8/23/2021	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	174334	None	None	0	In state provider	None	7590 MIRAMAR RD	STE C	SAN DIEGO	CA	92126	4232	37	06073	32.88443824	-117.1520684	San Diego County
200651	Fee-for-Service	1467980334	1467980334	1	1	RODRIGUEZ, JANELLE MD	10/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159514	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
200655	Fee-for-Service	1487772380	1487772380	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
200665	Fee-for-Service	1003598475	1003598475	1	1	RELEVO HEALTH PC	9/22/2023	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
200677	Fee-for-Service	1861537565	1861537565	1	1	RALSTON, DAVID W MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	32733	41	Internal Medicine	0	In state provider	None	1 GRAND AVE	BLDG 27	SAN LUIS OBISPO	CA	93410	9001	40	06079	35.30048884	-120.6580985	San Luis Obispo County
200678	Fee-for-Service	1619043361	1619043361	1	1	ROSS, GAIL MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	31936	36	Psychiatry	0	In state provider	None	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	30	06059	33.71597598	-117.8819134	Orange County
200743	Fee-for-Service	1174562474	1174562474	1	1	RAMIREZ,RAMIRO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	IMPACT MEDICAL SERVICES	8026 FLOYD CURL DR	None	SAN ANTONIO	TX	78229	0000	00	None	29.51299741	-98.57734975	Bexar County
200758	Fee-for-Service	1063991685	1063991685	1	1	REVIVE PAIN & SPINE CENTER I	11/17/2021	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	NC	255 W COURT ST	STE. D	WOODLAND	CA	95695	4706	57	06113	38.67891354	-121.795488	Yolo County
200777	Fee-for-Service	1528240405	1528240405	1	1	RAMIREZ-AGRAMONTE, SAHIRA G	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153803	41	Internal Medicine	0	In state provider	MD	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
200812	Fee-for-Service	1205491255	1205491255	1	1	RANI ELIAS MD INC	1/10/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	9710 19TH ST	None	RANCHO CUCAMONGA	CA	91737	3538	36	06071	34.13274747	-117.593073	San Bernardino County
200815	Fee-for-Service	1164874012	1164874012	1	1	RIMER, STEPHANIE J LMFT	2/26/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
200840	Fee-for-Service	1144610577	1144610577	1	1	RUBIO, MARIA I S	9/26/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
200910	Fee-for-Service	1710287297	1710287297	1	46	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	300	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
200916	Fee-for-Service	1053312157	1053312157	1	1	READER, AUGUST L III MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	34886	18	Ophthalmology	0	In state provider	None	1237 B ST	None	HAYWARD	CA	94541	2915	01	06001	37.67566503	-122.0786821	Alameda County
200920	Fee-for-Service	1871554741	1871554741	1	1	REMLER, MICHAEL P MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	12436	13	Neurology (M.D. only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
200947	Fee-for-Service	1770519605	1770519605	1	1	ROTHOLZ, STEPHEN S MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	15	Obstetrics (D.O. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
200954	Fee-for-Service	1003598475	1003598475	1	1	RELEVO HEALTH PC	9/22/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
200970	Fee-for-Service	1194277467	1194277467	1	1	ROUSE, BELINDA G NP	12/12/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.41257644	-118.5597683	Los Angeles County
200974	Fee-for-Service	1477040517	1477040517	1	1	RUDENKO, IVAN MD	9/24/2021	207R00000X	NA	Other	026	PHYSICIANS	167288	None	None	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
201030	Fee-for-Service	1982958260	1982958260	1	1	RAY, KILYNDA V PHD	6/4/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
201033	Fee-for-Service	1780613802	1780613802	1	1	RIEBMAN, JEROME B MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	79642	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
201052	Fee-for-Service	1144840943	1144840943	1	1	RASHEED, ANGELA M NP	1/2/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
201145	Fee-for-Service	1538125497	1538125497	1	1	ROACH, WILLIAM J MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50330	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1860 S CENTRAL ST	STE D	VISALIA	CA	93277	4418	54	06107	36.314469	-119.3106195	Tulare County
201237	Fee-for-Service	1770519605	1770519605	1	1	ROTHOLZ, STEPHEN S MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
201250	Fee-for-Service	1669850475	1669850475	1	1	RANDALL, DANIELLA Z LCSW	5/16/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
201279	Fee-for-Service	1265939508	1265939508	1	1	ROJANSKY, REBECCA B MD	6/17/2024	207ZP0102X	NA	Other	026	PHYSICIANS	163564	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
201281	Fee-for-Service	1598774838	1598774838	1	1	REICH, GERALD H MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	35427	01	General Practice	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
201302	Fee-for-Service	1649569658	1649569658	1	1	RIPPER, SUSAN J MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113278	41	Internal Medicine	0	In state provider	None	2340 CLAY STREET	5TH FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
201320	Fee-for-Service	1104418219	1104418219	1	1	RC HARMONY HOSPICE &	9/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1706 PLUM LANE	STE 129	REDLANDS	CA	92374	4578	36	06071	34.06896096	-117.2134285	San Bernardino County
201321	Fee-for-Service	1780613802	1780613802	1	1	RIEBMAN, JEROME B MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	79642	33	Thoracic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
201326	Fee-for-Service	1952627010	1952627010	1	1	RAO, USHA MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118213	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
201333	Fee-for-Service	1417370032	1417370032	1	3	RITTER CENTER	6/30/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97151013	-122.5251246	Marin County
201365	Fee-for-Service	1982091385	1982091385	1	1	REAVES, BRUCE C MD	2/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160353	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
201395	Fee-for-Service	1942505490	1942505490	1	1	RUELAZ, ROBERT A MD PC	6/27/2011	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78097	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4525 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1116	19	06037	34.04062338	-118.1684341	Los Angeles County
201408	Fee-for-Service	1083863518	1083863518	1	1	ROBLES, RUTH A LMFT	3/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	410 GLENDORA	130	GLENDORA	CA	91741	6210	19	06037	34.13122731	-117.863713	Los Angeles County
201435	Fee-for-Service	1538125497	1538125497	1	1	ROACH, WILLIAM J MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50330	08	Family Practice	0	In state provider	None	1860 S CENTRAL ST	STE D	VISALIA	CA	93277	4418	54	06107	36.314469	-119.3106195	Tulare County
201448	Fee-for-Service	1447200480	1447200480	1	1	RANADIVE, RAJINA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84631	41	Internal Medicine	0	In state provider	None	161 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2343	49	06097	38.25155659	-122.6346022	Sonoma County
201513	Fee-for-Service	1417040775	1417040775	1	1	ROJAS, RODRIGO J MD	3/2/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	32285	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
201520	Fee-for-Service	1922525633	1922525633	1	1	RAO, SRINANDINI S DO	8/12/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	18082	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
201522	Fee-for-Service	1982777686	1982777686	1	1	RAI CARE CENTERS OF SO CALIF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	I LLC	5714 E OLYMPIC BLVD	None	LOS ANGELES	CA	90022	5115	19	06037	34.01395453	-118.1476712	Los Angeles County
201534	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	6/4/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
201554	Fee-for-Service	1841352572	1841352572	1	1	ROUX, JOANNE M MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50905	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
201564	Fee-for-Service	1952755795	1952755795	1	1	RAI, SANDEEP LCSW	10/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
201584	Fee-for-Service	1548497241	1548497241	1	1	RADER, KENDALL H. MD	10/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
201597	Fee-for-Service	1285912147	1285912147	1	1	RAMOS, CHRYSTAL LMFT	5/16/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
201609	Fee-for-Service	1104418219	1104418219	1	1	RC HARMONY HOSPICE &	9/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1706 PLUM LANE	STE 129	REDLANDS	CA	92374	4578	36	06071	34.06896096	-117.2134285	San Bernardino County
201611	Fee-for-Service	1508925132	1508925132	1	1	RO, SIMON H MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73880	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
201629	Fee-for-Service	1659688216	1659688216	1	1	ROMBLOM, ERICA L MD	3/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118807	41	Internal Medicine	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
201631	Fee-for-Service	1689290827	1689290827	1	1	RAY, NICOLE NP	6/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
201680	Fee-for-Service	1912995309	1912995309	1	1	RD PRABHU, LATA SHETE	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	MDS LTD	5701 W CHARLESTON BLVD	STE 100	LAS VEGAS	NV	89146	1256	00	None	36.15908651	-115.219719	Clark County
201684	Fee-for-Service	1942505490	1942505490	1	1	RUELAZ, ROBERT A MD PC	6/27/2011	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78097	41	Internal Medicine	0	In state provider	None	4525 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1116	19	06037	34.04062338	-118.1684341	Los Angeles County
201769	Fee-for-Service	1316526817	1316526817	1	1	ROY, ANJALI RANI MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
201772	Fee-for-Service	1942648191	1942648191	1	1	ROJAS, ALEXIS A MD	5/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	136776	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
201792	Fee-for-Service	1508925249	1508925249	1	1	RAGAZA, NORMAN C MD	3/20/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	94702	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
201799	Fee-for-Service	1184161440	1184161440	1	1	RASHIDYAN, LEAH B	9/6/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
201802	Fee-for-Service	1417040775	1417040775	1	1	ROJAS, RODRIGO J MD	3/2/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	32285	40	Pediatrics	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
201826	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
201834	Fee-for-Service	1497704522	1497704522	1	1	RANADIVE, RAJESH K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84630	41	Internal Medicine	0	In state provider	None	161 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2343	49	06097	38.25155659	-122.6346022	Sonoma County
201836	Fee-for-Service	1811212475	1811212475	1	1	RAI, KARANDEV S MD	7/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	118806	13	Neurology (M.D. only)	0	In state provider	None	4234 RIVERWALK PARKWAY	SUITE 280	RIVERSIDE	CA	92505	3307	33	06065	33.90290859	-117.4941562	Riverside County
201838	Fee-for-Service	1417976366	1417976366	1	3	ROGET, VANCE R MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	41460	-	NOT APPLICABLE	0	In state provider	None	3125 MCHENRY AVENUE	SUITE D	MODESTO	CA	95350	1451	50	06099	37.684179	-120.9942555	Stanislaus County
201874	Fee-for-Service	1194335315	1194335315	1	1	RAJMOHAN, DIVYA MD	10/19/2023	207R00000X	NA	Other	026	PHYSICIANS	191270	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
201875	Fee-for-Service	1548516131	1548516131	1	1	REDDY, H SAPNA MD	10/2/2017	207R00000X	NA	Other	026	PHYSICIANS	127394	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
201912	Fee-for-Service	1457496127	1457496127	1	1	RILEY, MICHAEL S MD	4/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28382	41	Internal Medicine	0	In state provider	None	4000 14TH ST	STE 502	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
201930	Fee-for-Service	1861453318	1861453318	1	1	RUSTAMZADEH, EDWARD MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90229	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
201945	Fee-for-Service	1659504991	1659504991	1	1	RIVERSIDE HLTHCARE WELLNESS	10/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9020 GARFIELD AVENUE	None	RIVERSIDE	CA	92503	3903	33	06065	33.92849625	-117.4402587	Riverside County
202009	Fee-for-Service	1467578872	1467578872	1	1	RAULINO, JAMES B OD	4/11/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 NORTH LAKE BLVD	None	TAHOE CITY	CA	96145	7170	31	06061	39.17647058	-120.134634	Placer County
202034	Fee-for-Service	1386081180	1386081180	1	1	RUIZ, ANDREA R	12/19/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
202043	Fee-for-Service	1376026930	1376026930	1	1	RABANAL, MARVIN JOHN M PT	7/9/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	860 JAMACHA ROAD	SUITE 203	EL CAJON	CA	92019	3224	37	06073	32.78430676	-116.9279962	San Diego County
202105	Fee-for-Service	1780657304	1780657304	1	1	ROTH, JASON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W. 16TH AVE	None	DENVER	CO	80204	0000	00	None	39.74280302	-105.0412741	City and County of Denver
202111	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
202131	Fee-for-Service	1609308162	1609308162	1	1	RUSSELL-ROY, LYDIA MD	10/22/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158449	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
202169	Fee-for-Service	1376879007	1376879007	1	1	RO, PETER MD	3/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140454	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
202193	Fee-for-Service	1881603017	1881603017	1	1	RANKIN, RICHARD B III MD	2/11/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54313	None	None	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
202240	Fee-for-Service	1376951707	1376951707	1	1	ROSTON-COOPER, SHANNAH LMFT	9/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
202265	Fee-for-Service	1639525736	1639525736	1	1	ROSVALL, ALEXIS MD	10/15/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	179896	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
202277	Fee-for-Service	1952535981	1952535981	1	1	RILEY, PATRICIA M LCSW	5/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
202325	Fee-for-Service	1407028798	1407028798	1	1	ROSE, KELLI M MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134727	03	Allergy	0	In state provider	None	1551 BISHOP ST	STE 520	SAN LUIS OBISPO	CA	93401	4665	40	06079	35.27475609	-120.6454494	San Luis Obispo County
202350	Fee-for-Service	1619920675	1619920675	1	2	ROH, DAEYOUNG D MD	10/2/2022	208M00000X	NA	Other	026	PHYSICIANS	62251	None	None	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
202358	Fee-for-Service	1891937454	1891937454	1	1	ROZENFELD, MICHAEL N MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16256	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
202401	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	6/9/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
202402	Fee-for-Service	1063876662	1063876662	1	1	ROBKER, JERRICK G DO	1/11/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	15961	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
202425	Fee-for-Service	1447266911	1447266911	1	1	RITTENBERG, JOSHUA D MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96175	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
202452	Fee-for-Service	1376653030	1376653030	1	1	RALEYS	10/13/1983	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	890 SOUTHAMPTON RD.	None	BENICIA	CA	94510	1907	48	06095	38.06656089	-122.1688254	Solano County
202509	Fee-for-Service	1740227594	1740227594	1	1	ROTH, GERALD M MD	2/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76013	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
202592	Fee-for-Service	1073326336	1073326336	1	1	ROOTS, THENEDRA M	3/15/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
202602	Fee-for-Service	1467541508	1467541508	1	1	RECASENS, MARTA A MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69115	18	Ophthalmology	0	In state provider	MACULAR RETINAL VITREAL	50 ALESSANDRO PL	STE 210	PASADENA	CA	91105	4005	19	06037	34.13101049	-118.151532	Los Angeles County
202607	Fee-for-Service	1427354026	1427354026	1	1	ROSALES, ERIKA N LMFT	12/11/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90008	-	NOT APPLICABLE	0	In state provider	None	928 F ST	None	WASCO	CA	93280	2040	15	06029	35.59100106	-119.3337015	Kern County
202623	Fee-for-Service	1871056291	1871056291	1	1	RIANTAWAN, SITH MD	9/15/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176668	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
202626	Fee-for-Service	1831655067	1831655067	1	1	ROSEWOOD HOSPICE &	2/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1241 S GLENDALE AVE	STE 301C	GLENDALE	CA	91205	3386	19	06037	34.13065269	-118.2524619	Los Angeles County
202665	Fee-for-Service	1003042987	1003042987	1	1	RATL MRAD, YASSER S MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102455	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	797 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
202688	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
202703	Fee-for-Service	1609194497	1609194497	1	1	REGENTS OF THE UNIVERSITY OF	7/13/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1328 16TH ST	SECOND FLOOR	SANTA MONICA	CA	90404	1804	19	06037	34.02632404	-118.4846904	Los Angeles County
202717	Fee-for-Service	1902933666	1902933666	1	1	RSCR CALIFORNIA, INC	9/30/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1645 PEREIRA DR	None	SAN LUIS OBISPO	CA	93405	6830	40	06079	35.2564906	-120.6890073	San Luis Obispo County
202721	Fee-for-Service	1326075292	1326075292	1	1	RODRIGUEZ, RAMON G MD	3/16/1998	207R00000X	NA	Other	026	PHYSICIANS	27894	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	528 G ST	None	BRAWLEY	CA	92227	2411	13	06025	32.97748458	-115.5329928	Imperial County
202765	Fee-for-Service	1922408012	1922408012	1	1	RUANO, ADRIANA M LMFT	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
202768	Fee-for-Service	1821013426	1821013426	1	1	RALPHS GROCERY COMPANY	9/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #701	12842 VENTURA BLVD	None	STUDIO CITY	CA	91604	2369	19	06037	34.14497319	-118.4129844	Los Angeles County
202814	Fee-for-Service	1972542173	1972542173	1	1	RICHARD THOMAS DAHLEN MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY	None	MISSOULA	MT	59806	0000	00	None	46.874889	-114.000444	Missoula County
202845	Fee-for-Service	1396846572	1396846572	1	1	REALE, STEPHEN MD	8/19/1995	207R00000X	NA	Other	026	PHYSICIANS	81738	41	Internal Medicine	0	In state provider	None	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
202846	Fee-for-Service	1700878030	1700878030	1	2	RAY FISHER PHARMACY, INC	5/31/2023	332BC3200X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6629 N BLACKSTONE AVE	None	FRESNO	CA	93710	3503	10	06019	36.83421565	-119.7904119	Fresno County
202855	Fee-for-Service	1467118638	1467118638	1	1	RASHO, DALIA	7/13/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.25641704	-119.2199387	Ventura County
202911	Fee-for-Service	1083855787	1083855787	1	1	RYAN, NANCY LPCC	4/18/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10940 FAIR OAKS BLVD STE	None	FAIR OAKS	CA	95628	5958	34	06067	38.650077	-121.263678	Sacramento County
202914	Fee-for-Service	1265406243	1265406243	1	1	ROBERT S MARIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA ST	None	PITTSBURGH	PA	15213	2593	00	None	40.44350017	-79.95952606	Allegheny County
202915	Fee-for-Service	1831655067	1831655067	1	1	ROSEWOOD HOSPICE &	2/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1241 S GLENDALE AVE	STE 301C	GLENDALE	CA	91205	3386	19	06037	34.13065269	-118.2524619	Los Angeles County
202921	Fee-for-Service	1447623095	1447623095	1	1	RENZ, MALTE PHD	9/29/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	136501	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202954	Fee-for-Service	1518084771	1518084771	1	1	REZNIK, TATYANA L MD	7/28/2008	390200000X	NA	Other	026	PHYSICIANS	100965	41	Internal Medicine	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.741948	-121.848921	Butte County
202970	Fee-for-Service	1376002626	1376002626	1	1	ROBLEDO, AURORA MD	9/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183164	None	None	0	In state provider	None	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	19	06037	34.06215064	-117.9453997	Los Angeles County
202974	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	5/28/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
203029	Fee-for-Service	1841378932	1841378932	1	1	RAVISHANKAR, VASANTHA	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52850	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
203096	Fee-for-Service	1124463898	1124463898	1	1	ROBERTSON, KATHRYN R MD	10/22/2020	363LP0222X	NA	Nurse Practitioner	026	PHYSICIANS	147688	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
203106	Fee-for-Service	1275922056	1275922056	1	1	RAPALO GUTIERREZ, ELMER I LM	1/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	11455 PARAMOUNT BLVD	SUITE F	DOWNEY	CA	90241	4550	19	06037	33.94022241	-118.1398143	Los Angeles County
203127	Fee-for-Service	1508252214	1508252214	1	1	RUDIN, AARON S MD	9/24/2019	207L00000X	NA	Other	026	PHYSICIANS	161332	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203161	Fee-for-Service	1255751020	1255751020	1	1	RELIABLE COMFORT AND CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	10523 BURBANK BLVD	SUITE 218	NORTH HOLLYWOOD	CA	91601	2219	19	06037	34.17216449	-118.36017	Los Angeles County
203181	Fee-for-Service	1174624407	1174624407	1	1	ROSE, ANNE M LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
203215	Fee-for-Service	1073691846	1073691846	1	1	REDDY, CHITRA R MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51348	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
203224	Fee-for-Service	1821320524	1821320524	1	1	REBECCA MADIGAN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
203256	Fee-for-Service	1932101763	1932101763	1	1	RAMIREZ, MARIA E MD	8/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60709	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
203263	Fee-for-Service	1710287297	1710287297	1	7	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
203283	Fee-for-Service	1922501758	1922501758	1	1	RENOV, VERONICA MD	9/10/2024	207PP0204X	NA	Other	026	PHYSICIANS	160373	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
203316	Fee-for-Service	1083788392	1083788392	1	1	ROJA, ADELE E MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60386	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
203323	Fee-for-Service	1003058207	1003058207	1	1	REDDY, SIREESHA I MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122438	08	Family Practice	0	In state provider	None	1025 N DOUTY STREET	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
203338	Fee-for-Service	1679807812	1679807812	1	1	REYNOSO, KARLA LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
203347	Fee-for-Service	1265721971	1265721971	1	1	RICE, CAMILLE J MD	4/1/2020	207L00000X	NA	Other	026	PHYSICIANS	165798	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
203350	Fee-for-Service	1912994005	1912994005	1	1	ROBERT BROWN MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	23900 KATY FWY	None	KATY	TX	77494	1323	00	None	29.78594112	-95.78613398	Harris County
203354	Fee-for-Service	1598893232	1598893232	1	1	RAPAN, ROXANNE M MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94506	05	Anesthesiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
203392	Fee-for-Service	1013059385	1013059385	1	1	RODRIGUEZ, JAVIER MD	1/15/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	82639	40	Pediatrics	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
203442	Fee-for-Service	1790940351	1790940351	1	1	RODRIGUEZ, MARILU E OT	5/12/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
203450	Fee-for-Service	1255751020	1255751020	1	1	RELIABLE COMFORT AND CARE	11/10/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	10523 BURBANK BLVD	SUITE 218	NORTH HOLLYWOOD	CA	91601	2219	19	06037	34.17216449	-118.36017	Los Angeles County
203467	Fee-for-Service	1760836795	1760836795	1	1	RIVAS, DANIEL R MFT	4/25/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44572	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVENUE	SUITES A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
203479	Fee-for-Service	1902900046	1902900046	1	1	ROBERTSON, GEORGE T MD	5/28/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22306	40	Pediatrics	0	In state provider	None	1420 S MILLER ST	STE A	SANTA MARIA	CA	93454	6960	42	06083	34.936479	-120.4315845	Santa Barbara County
203488	Fee-for-Service	1063569721	1063569721	1	1	REICHERTER, DARYN S MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80353	36	Psychiatry	0	In state provider	None	39155 LIBERTY ST	STE G700	FREMONT	CA	94538	1513	01	06001	37.55123907	-121.9828956	Alameda County
203571	Fee-for-Service	1720088354	1720088354	1	7	RIDEOUT MEMORIAL HOSPITAL	3/23/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	370 DEL NORTE AVE	SUITE 202	YUBA CITY	CA	95991	4142	51	06101	39.14466521	-121.6166961	Sutter County
203574	Fee-for-Service	1801210638	1801210638	1	1	RIVERA, ANTHONY LMFT	10/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
203585	Fee-for-Service	1780971044	1780971044	1	1	RAO, AARTI K MD	8/19/2019	163WG0100X	NA	Other	026	PHYSICIANS	131796	10	Gastroenterology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
203587	Fee-for-Service	1811951726	1811951726	1	1	ROBINSON, CHERYL R MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
203607	Fee-for-Service	1821418955	1821418955	1	1	RAPPOPORT, LINA	3/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
203617	Fee-for-Service	1760863930	1760863930	1	1	RUHLE, BRIAN C MD	7/8/2022	208600000X	NA	General Surgery	026	PHYSICIANS	177010	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203675	Fee-for-Service	1558716233	1558716233	1	1	RIVERA, RONALD J MD	8/10/2020	390200000X	NA	Other	026	PHYSICIANS	169303	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
203724	Fee-for-Service	1386887974	1386887974	1	1	ROSEN, SHAWN D MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125206	41	Internal Medicine	0	In state provider	None	2160 APPIAN WAY	STE 200	PINOLE	CA	94654	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
203766	Fee-for-Service	1346850757	1346850757	1	1	RYON ACUPUNCTURE CORPORATION	1/18/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	515 CABRILLO PARK DR	SUITE 312	SANTA ANA	CA	92701	5016	30	06059	33.74982861	-117.840493	Orange County
203773	Fee-for-Service	1003924168	1003924168	2	1	RAHBAN, ALFRED MD	8/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51095	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
203802	Fee-for-Service	1265045652	1265045652	1	1	REYNOLDS, LESLIE A CNP	3/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
203803	Fee-for-Service	1730102104	1730102104	1	1	RELAN, ANURAG MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73796	08	Family Practice	0	In state provider	None	1010 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	5929	19	06037	33.886314	-118.395912	Los Angeles County
203822	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
203829	Fee-for-Service	1912066580	1912066580	1	1	ROBLES, ROLANDO D MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65715	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
203837	Fee-for-Service	1326579541	1326579541	1	1	RYAN, VICTORIA MD	10/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159889	08	Family Practice	0	In state provider	None	7115 GREENBACK LN	FL 3	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
203846	Fee-for-Service	1851911911	1851911911	1	1	ROBERTS, SHELBY C MD	8/22/2023	207P00000X	NA	Other	026	PHYSICIANS	187787	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
203856	Fee-for-Service	1538559752	1538559752	1	1	RAMACHANDRAN, ANU MD	10/19/2022	207P00000X	NA	Other	026	PHYSICIANS	167248	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
203864	Fee-for-Service	1326230822	1326230822	1	1	RAGEN, MICHAEL T MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	58648	18	Ophthalmology	0	In state provider	None	3801 LAS POSAS RD	STE 112	CAMARILLO	CA	93010	1477	56	06111	34.24138914	-119.0191887	Ventura County
203926	Fee-for-Service	1811066210	1811066210	1	1	RESA, RAMON MD	8/31/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40400	40	Pediatrics	0	In state provider	None	569 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957307	-119.0296992	Tulare County
204052	Fee-for-Service	1811046485	1811046485	2	1	RODRIGUEZ, CARLOS G MD	6/29/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56502	08	Family Practice	0	In state provider	None	33 W BELLEVUE DR	None	PASADENA	CA	91105	2501	19	06037	34.1383803	-118.151244	Los Angeles County
204059	Fee-for-Service	1043370224	1043370224	2	1	REZAPOUR, ALIREZA MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52542	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
204066	Fee-for-Service	1508122631	1508122631	1	1	RAMIREZ, EDUARDO A MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127363	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
204074	Fee-for-Service	1083097059	1083097059	1	1	ROBLES, MARISA R OD	4/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2746 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97375784	-118.2212008	Los Angeles County
204108	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
204113	Fee-for-Service	1912066580	1912066580	1	1	ROBLES, ROLANDO D MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65715	08	Family Practice	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
204124	Fee-for-Service	1871731729	1871731729	1	1	REGENTS OF THE UNIVERSITY CA	9/28/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	650 CHARLES YOUNG DR S	RM A7-047 CHS	LOS ANGELES	CA	90095	8347	19	06037	34.06693676	-118.4427104	Los Angeles County
204134	Fee-for-Service	1174834857	1174834857	1	1	RHO, GLORIA G MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131521	25	Physical Medicine and Rehabilitation	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
204210	Fee-for-Service	1477632503	1477632503	1	1	REUTTER, THOMAS R DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8248	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
204213	Fee-for-Service	1588838783	1588838783	1	1	REED, AMANDA I MFT	11/19/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51916	-	NOT APPLICABLE	0	In state provider	None	7120 N MARKS AVE	SUITE 110	FRESNO	CA	93711	0268	10	06019	36.83911219	-119.8473805	Fresno County
204224	Fee-for-Service	1346396777	1346396777	1	1	RODGERS, SHACUNDA J B PHD	10/10/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4901 MORENA BLVD	SUITE 109	SAN DIEGO	CA	92117	3370	37	06073	32.82669128	-117.2303448	San Diego County
204227	Fee-for-Service	1750693545	1750693545	1	1	RAHMAN, AMBREEN DO	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13695	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
204271	Fee-for-Service	1841327285	1841327285	1	1	ROCKCREEK INC	6/4/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9939 LA VINE ST	None	ALTA LOMA	CA	91701	5909	36	06071	34.12601907	-117.5884452	San Bernardino County
204325	Fee-for-Service	1275561151	1275561151	1	1	REDDING DERMATOLOGY MEDICAL	2/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	72464	07	Dermatology	0	In state provider	GROUP INC	2107 AIRPARK DR	None	REDDING	CA	96001	2433	45	06089	40.57493327	-122.4048185	Shasta County
204369	Fee-for-Service	1538595590	1538595590	1	1	ROBERTSON, SARAH LCSW	4/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
204395	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
204409	Fee-for-Service	1295993111	1295993111	1	1	RANPURA, VISHAL N MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126956	78	Neoplastic Diseases/Oncology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
204427	Fee-for-Service	1609874114	1609874114	1	1	RASMUS, WILLIAM R MD	3/1/1986	207L00000X	NA	Other	026	PHYSICIANS	50889	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
204475	Fee-for-Service	1023034139	1023034139	1	1	ROBINSON, GENE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1915 E REZANOF DR	None	KODIAK	AK	99615	6602	00	None	57.80140363	-152.3733142	Kodiak Island Borough
204478	Fee-for-Service	1275706756	1275706756	1	1	RUBIN, BECKY S CRNA	3/5/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
204482	Fee-for-Service	1689838658	1689838658	1	1	RASCOFF, NANCI E MD	9/28/2021	2080P0216X	NA	Other	026	PHYSICIANS	166624	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
204499	Fee-for-Service	1134207236	1134207236	1	1	RODGERS, ANDREW W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38016	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
204501	Fee-for-Service	1780706762	1780706762	1	1	ROSALES, MARIA C N MD	3/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54935	45	Nephrology (Renal-Kidney)	0	In state provider	None	2360 MCKEE RD	STE 10	SAN JOSE	CA	95116	1618	43	06085	37.36657971	-121.8479925	Santa Clara County
204526	Fee-for-Service	1568081453	1568081453	1	1	RIOS, MELISSA MD	6/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185350	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
204533	Fee-for-Service	1922155274	1922155274	1	1	ROMMAN, FAYEZ MD INC	9/7/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	79983	None	None	0	In state provider	None	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
204608	Fee-for-Service	1790999795	1790999795	1	1	RANGACHAR, AARATHI MD	6/1/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102454	40	Pediatrics	0	In state provider	None	15825 LAGUNA CANYON RD	STE 102	IRVINE	CA	92618	2126	30	06059	33.66406324	-117.7638431	Orange County
204611	Fee-for-Service	1215501556	1215501556	1	1	RIO BRAVO CONGREGATE LIVING	8/4/2022	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	FACILITY INC	5900 PRESTON COURT	None	BAKERSFIELD	CA	93309	1449	15	06029	35.36121939	-119.0688525	Kern County
204623	Fee-for-Service	1447707351	1447707351	1	2	ROOME, KRISTINA M LMFT	5/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
204631	Fee-for-Service	1235280827	1235280827	1	1	RAGHAVAN, MADHU MD	9/30/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42945	40	Pediatrics	0	In state provider	None	64 ASPEN WAY	STE 102	WATSONVILLE	CA	95076	3084	44	06087	36.93085993	-121.7799849	Santa Cruz County
204684	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
204692	Fee-for-Service	1295993111	1295993111	1	1	RANPURA, VISHAL N MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126956	68	Hematology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
204710	Fee-for-Service	1821416207	1821416207	1	1	ROZA, KATHERINE A MD	8/1/2022	207LH0002X	NA	Other	026	PHYSICIANS	178928	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
204752	Fee-for-Service	1427700186	1427700186	1	1	ROSALES, CRYSTAL LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
204755	Fee-for-Service	1477362937	1477362937	1	1	RIVERA, TONIA S TOLABOR CERT	1/31/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
204776	Fee-for-Service	1992723449	1992723449	1	1	ROBERT M KENNEDY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS PL	None	SAINT LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
204802	Fee-for-Service	1780706762	1780706762	1	1	ROSALES, MARIA C N MD	3/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54935	41	Internal Medicine	0	In state provider	None	2360 MCKEE RD	STE 10	SAN JOSE	CA	95116	1618	43	06085	37.36657971	-121.8479925	Santa Clara County
204810	Fee-for-Service	1164436507	1164436507	1	1	RUSSELL RHOADES	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
204850	Fee-for-Service	1477998912	1477998912	1	1	RAMCHANDAR, NANDA MD	9/21/2021	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	154225	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
204851	Fee-for-Service	1316080104	1316080104	1	1	RABBITTS, JENNIFER A	1/17/2024	207L00000X	NA	Other	026	PHYSICIANS	192398	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
204921	Fee-for-Service	1366731762	1366731762	1	1	RAEESY MD INC	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97308	None	None	0	In state provider	None	16311 VENTURA BLVD,	STE A & E	ENCINO	CA	91436	4339	19	06037	34.15706864	-118.4885978	Los Angeles County
204943	Fee-for-Service	1427307230	1427307230	1	1	RELIANCE CARDIAC CARE INC	10/18/2013	193400000X	NA	Other	026	PHYSICIANS	88958	41	Internal Medicine	0	In state provider	None	222 W EULALIA ST	STE 311	GLENDALE	CA	91204	2550	19	06037	34.12653215	-118.257121	Los Angeles County
204958	Fee-for-Service	1376068932	1376068932	1	1	RODERICKS, GINA A LMFT	2/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
204971	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
204991	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
205080	Fee-for-Service	1295979821	1295979821	1	1	RUPAL PATEL, M.D.	5/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
205149	Fee-for-Service	1073784492	1073784492	1	1	RHEE, SOO S MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115444	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
205175	Fee-for-Service	1376618553	1376618553	1	1	RADY CHILDRENS HOSPITAL SAN	4/1/2002	3140N1450X	NA	Skilled Nursing Facility	065	PEDIATRIC SUBACUTE CARE/LTC	-	-	NOT APPLICABLE	0	In state provider	DIEGO	3020 CHILDRENS WAY	MC 5019	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
205195	Fee-for-Service	1992046890	1992046890	1	1	RAMOS, ELIZABETH LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
205213	Fee-for-Service	1891140588	1891140588	1	1	RAMIREZ, TANIA LPCC	3/26/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
205223	Fee-for-Service	1427167865	1427167865	1	1	RITE AID PHARMACY #5800	9/28/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1076 W KERN ST	None	TAFT	CA	93268	2743	15	06029	35.14581474	-119.46774	Kern County
205229	Fee-for-Service	1427307230	1427307230	1	1	RELIANCE CARDIAC CARE INC	10/18/2013	193400000X	NA	Other	026	PHYSICIANS	88958	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	222 W EULALIA ST	STE 311	GLENDALE	CA	91204	2550	19	06037	34.12653215	-118.257121	Los Angeles County
205259	Fee-for-Service	1073000832	1073000832	1	1	RUSSELL, AMY E MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	165316	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
205262	Fee-for-Service	1710287297	1710287297	1	53	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	540	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
205280	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
205304	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
205337	Fee-for-Service	1720088354	1720088354	1	9	RIDEOUT MEMORIAL HOSPITAL	5/7/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	101 RALEY BLVD	STE 102	CHICO	CA	95928	8352	04	06007	39.7160085	-121.7917665	Butte County
205356	Fee-for-Service	1871657403	1871657403	1	1	RHOADES, PATRICK N MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51949	None	None	0	In state provider	None	1300 MARBLE AVE	STE # 2	MODESTO	CA	95355	1120	50	06099	37.69607582	-120.9757068	Stanislaus County
205366	Fee-for-Service	1780045682	1780045682	1	1	RIVERA, MARK	8/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157872	08	Family Practice	0	In state provider	None	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2244	15	06029	35.36875951	-119.0959206	Kern County
205380	Fee-for-Service	1043368848	1043368848	1	1	REDDY, SUCHITHA M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33991	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
205413	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
205455	Fee-for-Service	1083818694	1083818694	1	1	RASSBACH, CAROLINE E MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111155	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
205527	Fee-for-Service	1215079835	1215079835	1	1	RC HOME HEALTHCARE INC	11/7/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1934 W 9TH ST	UNIT A	UPLAND	CA	91786	5617	36	06071	34.09539405	-117.6881437	San Bernardino County
205567	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
205577	Fee-for-Service	1346233368	1346233368	1	2	REGENTS/UCDPBG/UROLOGY	5/1/1999	208800000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
205595	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
205605	Fee-for-Service	1528727211	1528727211	1	1	RIOS, AMANDA J LMFT	10/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
205623	Fee-for-Service	1063405074	1063405074	1	3	REGENTS OF THE UNIV OF CA	1/5/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
205628	Fee-for-Service	1689917213	1689917213	1	1	REEVES, CAROL S CNM	7/18/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	31180 ROAD 72	None	GOSHEN	CA	93227	9997	54	06107	36.35594779	-119.4124242	Tulare County
205638	Fee-for-Service	1578634499	1578634499	1	1	ROTH, RICHARD M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24391	03	Allergy	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
205672	Fee-for-Service	1700937240	1700937240	1	1	ROBERTS, TIMOTHY	11/22/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
205702	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
205725	Fee-for-Service	1437131976	1437131976	1	1	RHODES, ROBIN L. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13523 BARRETT PARKWAY DR	None	BALLWIN	MO	63021	3802	00	None	38.59556049	-90.46953042	St. Louis County
205758	Fee-for-Service	1679963524	1679963524	1	1	REDDY BIOMEDICAL CORP	12/28/2015	207R00000X	NA	Other	026	PHYSICIANS	120797	41	Internal Medicine	0	In state provider	None	7695 CARDINAL CT	STE 390	SAN DIEGO	CA	92123	3356	37	06073	32.79146985	-117.1578472	San Diego County
205759	Fee-for-Service	1053864009	1053864009	1	1	RUBY, CHARLES P	4/29/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
205762	Fee-for-Service	1164570131	1164570131	1	1	RODGERS, PAULA J MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81453	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
205788	Fee-for-Service	1831435551	1831435551	1	2	ROWLAND, SCOTT A LMFT	3/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205789	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	5/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
205849	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
205855	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
205865	Fee-for-Service	1346233368	1346233368	1	2	REGENTS/UCDPBG/UROLOGY	4/5/2023	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
205878	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	1/22/2021	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
205887	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
205907	Fee-for-Service	1033163902	1033163902	1	1	REILLY, JO MARIE PH.D	2/28/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51016	08	Family Practice	0	In state provider	None	1701 CESAR CHAVEZ AVE	#230	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
205922	Fee-for-Service	1659768802	1659768802	1	1	RASHEDI DMD PC	3/25/2016	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	838 NORDAHL ROAD	SUITE 125	SAN MARCOS	CA	92069	3513	37	06073	33.13569751	-117.1191477	San Diego County
205929	Fee-for-Service	1437652260	1437652260	1	1	RETTIG, ROBERT L MD	6/2/2020	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	163887	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205943	Fee-for-Service	1457325029	1457325029	1	1	RAZA, AHAMED MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89462	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
205984	Fee-for-Service	1295841401	1295841401	1	1	REEVES, JABARI C MD	2/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
205985	Fee-for-Service	1730381385	1730381385	1	1	RAMERS, CHRISTIAN B MD	3/15/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	119631	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
205987	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	9/24/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
205992	Fee-for-Service	1649300088	1649300088	1	1	RAMIREZ, TERESA LCSW	11/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
206046	Fee-for-Service	1679963524	1679963524	1	1	REDDY BIOMEDICAL CORP	12/28/2015	207R00000X	NA	Other	026	PHYSICIANS	120797	45	Nephrology (Renal-Kidney)	0	In state provider	None	7695 CARDINAL CT	STE 390	SAN DIEGO	CA	92123	3356	37	06073	32.79146985	-117.1578472	San Diego County
206047	Fee-for-Service	1356490866	1356490866	1	1	RAMSEY, STEPHANIE A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
206050	Fee-for-Service	1164570131	1164570131	1	1	RODGERS, PAULA J MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81453	84	Surgery-Head and Neck	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
206077	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
206098	Fee-for-Service	1699854596	1699854596	1	1	RYOO, JOAN J MD	6/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98329	02	General Surgery	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
206137	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	6/27/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
206139	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
206143	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	1/27/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
206157	Fee-for-Service	1972853570	1972853570	1	1	RISI, SUSAN A PHD	5/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
206160	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
206163	Fee-for-Service	1255996237	1255996237	1	1	RAMIREZ, JOSE LPCC	6/17/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
206169	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
206188	Fee-for-Service	1578058327	1578058327	1	1	RAJIC, JOVANKA NP	3/13/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
206190	Fee-for-Service	1962408112	1962408112	1	1	ROMEA, RAUL J A MD	1/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53197	83	Rheumatology	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
206203	Fee-for-Service	1972740157	1972740157	1	1	RAMAIAH, PURUSHOTHAM MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109035	None	None	0	In state provider	PURUSHOTHAMA G MD	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
206251	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
206275	Fee-for-Service	1821031584	1821031584	1	1	RAGGIO, MARCIA E INC	12/11/2002	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	595 BUCKINGHAM WAY	STE 437	SAN FRANCISCO	CA	94132	1912	38	06075	37.73012679	-122.4767395	San Francisco County
206276	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
206311	Fee-for-Service	1194087262	1194087262	1	1	RABER, SHANNON H NP	7/18/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
206322	Fee-for-Service	1598801177	1598801177	1	1	RAMOS PEREZ, MARIA M MD	11/14/2020	207L00000X	NA	Other	026	PHYSICIANS	162088	None	None	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
206327	Fee-for-Service	1124059738	1124059738	2	1	ROBERT M BLANCH	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5016 S US HIGHWAY 75	None	DENISON	TX	75020	4584	00	None	33.710211	-96.584958	Grayson County
206341	Fee-for-Service	1164570131	1164570131	1	1	RODGERS, PAULA J MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81453	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
206365	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	5/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
206375	Fee-for-Service	1063025856	1063025856	1	1	RXSB INC	11/1/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3605 STATE ST	None	SANTA BARBARA	CA	93105	2521	42	06083	34.44038124	-119.7409349	Santa Barbara County
206416	Fee-for-Service	1164678181	1164678181	1	1	RANGWALA, ANISA M MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105025	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206425	Fee-for-Service	1619387941	1619387941	1	1	ROSE WOMENS HEALTH INC	1/4/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89018	None	None	0	In state provider	None	289 W HUNTINGTON DRIVE	STE 305	ARCADIA	CA	91007	3439	19	06037	34.13549119	-118.0419175	Los Angeles County
206426	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
206427	Fee-for-Service	1710287297	1710287297	1	108	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	309 W QUINTO STREET	None	SANTA BARBARA	CA	93105	5318	42	06083	34.43214714	-119.7246896	Santa Barbara County
206428	Fee-for-Service	1144727165	1144727165	1	1	RYBA, DANIELLE M MD	4/20/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165452	None	None	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
206432	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	6/6/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
206446	Fee-for-Service	1003158213	1003158213	1	1	RAFIE, CHRISTOPHER A MD	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	141893	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
206451	Fee-for-Service	1225595952	1225595952	1	1	RICHARDSON, EMMA MD	8/5/2022	390200000X	NA	Other	026	PHYSICIANS	180998	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
206453	Fee-for-Service	1306367032	1306367032	1	1	REAGAN, KATHALEEN R LPCC	11/5/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
206454	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
206458	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
206516	Fee-for-Service	1265653802	1265653802	1	1	REIS, FRANCES G MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50368	40	Pediatrics	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
206517	Fee-for-Service	1750044228	1750044228	1	1	RAYES, RAZAN NP	9/10/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
206524	Fee-for-Service	1437269180	1437269180	1	1	RALEYS	1/1/1966	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4840 SAN JUAN AVE	None	FAIR OAKS	CA	95628	9562	34	06067	38.654253	-121.291038	Sacramento County
206554	Fee-for-Service	1023500279	1023500279	1	1	RAMIREZ, BRITTANY M LMFT	7/19/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
206556	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
206563	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	9/24/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
206606	Fee-for-Service	1447576244	1447576244	1	1	RODRIGUEZ-WEBB, POPPI E DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13292	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
206654	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
206681	Fee-for-Service	1588758767	1588758767	1	1	ROE, JOY M MD	3/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81040	01	General Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
206693	Fee-for-Service	1578643615	1578643615	1	1	RETINA EYE SPECIALISTS PC	6/16/2009	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1437 SAN MARINO AVE	None	SAN MARINO	CA	91108	2027	19	06037	34.12279096	-118.1067988	Los Angeles County
206714	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
206715	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
206717	Fee-for-Service	1992104921	1992104921	1	1	RAMOS, SACHELLY A LCSW	2/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
206720	Fee-for-Service	1710287297	1710287297	1	99	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
206739	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
206744	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
206748	Fee-for-Service	1821504101	1821504101	1	1	ROYAL REGENCY HOME HEALTH	3/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1447 E COLORADO	SUITE D	GLENDALE	CA	91205	1447	19	06037	34.14278996	-118.2320585	Los Angeles County
206768	Fee-for-Service	1124439807	1124439807	1	17	REGENTS UNIV OF CALIFORNIA U	8/21/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2 BON AIR RD	SUITE 120	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
206775	Fee-for-Service	1225430580	1225430580	1	5	RIGHT CHOICE SENIOR LIVING	11/4/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6125 COWLES MOUNTAIN	BLVD	LA MESA	CA	91942	1809	37	06073	32.78979847	-117.0307578	San Diego County
206806	Fee-for-Service	1306033519	1306033519	1	1	ROHRER, THOMAS W MFT	2/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20325	-	NOT APPLICABLE	0	In state provider	None	2931 PROSPECT AVE	None	CONCORD	CA	94518	1025	07	06013	37.97161047	-122.026021	Contra Costa County
206808	Fee-for-Service	1376575175	1376575175	1	1	ROWE, MARK R MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55750	84	Surgery-Head and Neck	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
206834	Fee-for-Service	1326263187	1326263187	1	1	RAINS, J'ANN LMFT	9/18/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122551	-	NOT APPLICABLE	0	In state provider	None	380 ENCINAL ST	200, ROOM A	SANTA CRUZ	CA	95060	2178	44	06087	36.98747083	-122.0380148	Santa Cruz County
206844	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
206859	Fee-for-Service	1497711915	1497711915	1	1	RANKIN, BARBARA B MD	12/16/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56522	01	General Practice	0	In state provider	None	800 DOUGLAS RD	None	STOCKTON	CA	95207	3607	39	06077	38.00786919	-121.3210892	San Joaquin County
206863	Fee-for-Service	1710287297	1710287297	1	85	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
206870	Fee-for-Service	1457636466	1457636466	1	1	ROYAL MAJESTY HOSPICE INC	7/2/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	STE 216	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
206878	Fee-for-Service	1568993624	1568993624	1	1	RICHARDSON, CHARLOTTE R LCSW	1/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	831 ALAMO DR	6A	VACAVILLE	CA	95688	5343	48	06095	38.34840279	-121.9987874	Solano County
206913	Fee-for-Service	1235154006	1235154006	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	10	06019	36.62466137	-119.3227461	Fresno County
206929	Fee-for-Service	1750406252	1750406252	1	1	RHIM, CHUN H MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95923	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
206937	Fee-for-Service	1538484175	1538484175	1	1	RUFFINO, LYNN LCSW	9/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
206941	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
206949	Fee-for-Service	1770783466	1770783466	1	1	RODRIGUEZ, JORGE A MD	10/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108535	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
206959	Fee-for-Service	1982840609	1982840609	1	1	RODRIGUEZ, ELENA D NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
206969	Fee-for-Service	1588758767	1588758767	1	1	ROE, JOY M MD	3/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81040	08	Family Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
207001	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
207005	Fee-for-Service	1710287297	1710287297	1	108	REGENTS UNIVERSITY OF CALIFO	10/6/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	309 W QUINTO STREET	None	SANTA BARBARA	CA	93105	5318	42	06083	34.43214714	-119.7246896	Santa Barbara County
207034	Fee-for-Service	1447243548	1447243548	1	1	REGENTS/UCDPBG/PED INF D	5/1/1983	2080P0208X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
207036	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	2/8/2021	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
207037	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
207043	Fee-for-Service	1194825703	1194825703	1	1	ROSSMAN, DAVID J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28883	42	Nuclear Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207055	Fee-for-Service	1124439807	1124439807	1	17	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2 BON AIR RD	SUITE 120	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
207095	Fee-for-Service	1376575175	1376575175	1	1	ROWE, MARK R MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55750	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
207117	Fee-for-Service	1275611873	1275611873	1	1	RAMANATHAN, JANAKI N MD	9/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80398	30	Radiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
207118	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
207137	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
207147	Fee-for-Service	1710042791	1710042791	1	1	RODRIGUEZ, DAWN M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7273 MURRAY DR	STE 16	STOCKTON	CA	95210	3390	39	06077	38.0163181	-121.3013244	San Joaquin County
207152	Fee-for-Service	1245296664	1245296664	1	1	RICCI, MARCO	3/18/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	-	33	Thoracic Surgery	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
207158	Fee-for-Service	1457636466	1457636466	1	1	ROYAL MAJESTY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	STE 216	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
207171	Fee-for-Service	1700815081	1700815081	1	1	RICKWA, SPENCER TED	8/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8580	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
207200	Fee-for-Service	1235154006	1235154006	2	1	REEDLEY COMMUNITY HOSPITAL	11/27/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	10	06019	36.62466137	-119.3227461	Fresno County
207201	Fee-for-Service	1225021249	1225021249	1	2	REGENTS/UCDPBG/IM ENDOCR	5/1/1999	207RE0101X	NA	Endocrinology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
207223	Fee-for-Service	1790808186	1790808186	1	1	REDDING, MARINA R	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	439 MARKET ST	None	COLUSA	CA	95932	2423	06	06011	39.21386467	-122.0073922	Colusa County
207227	Fee-for-Service	1588712566	1588712566	1	1	ROYBAL, LYDIA A MD	3/31/1993	2084P0804X	NA	Psychiatry	026	PHYSICIANS	56168	26	Psychiatry (child)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
207230	Fee-for-Service	1710287297	1710287297	1	78	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
207263	Fee-for-Service	1205820420	1205820420	1	1	RAEES, MUHAMMAD MD	11/28/2007	207RC0200X	NA	Other	026	PHYSICIANS	97480	41	Internal Medicine	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
207273	Fee-for-Service	1063181519	1063181519	1	1	ROWE, SARAH L PT	5/6/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
207289	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
207290	Fee-for-Service	1316472053	1316472053	1	1	REED, THOMAS ALTON JR MD	9/15/2023	1835C0206X	NA	None	026	PHYSICIANS	170358	None	None	0	In state provider	None	315 N THIRD AVE	STE 207	COVINA	CA	91723	1915	19	06037	34.08873786	-117.8923869	Los Angeles County
207291	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
207292	Fee-for-Service	1508994021	1508994021	1	1	RUSSELL, WENDI K LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
207293	Fee-for-Service	1689280562	1689280562	1	1	RHODES, SARAH NP	10/10/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2810 CAMINO DEL RIO S	STE 102	SAN DIEGO	CA	92108	3819	37	06073	32.77081335	-117.1316557	San Diego County
207300	Fee-for-Service	1124439807	1124439807	1	25	REGENTS UNIV OF CALIFORNIA U	12/23/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	18 BON AIR RD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
207321	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
207339	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
207343	Fee-for-Service	1124439807	1124439807	1	17	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2 BON AIR RD	SUITE 120	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
207349	Fee-for-Service	1124118948	1124118948	1	1	REGENTS OF UNIVERSITY CA	2/17/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	UCSD DIALYSIS CLINIC	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
207391	Fee-for-Service	1659927291	1659927291	1	1	RIOS, STEFANIE LMFT	7/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
207406	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
207426	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
207446	Fee-for-Service	1831267822	1831267822	1	1	RACZKO, CYNTHIA S	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
207472	Fee-for-Service	1770556763	1770556763	1	1	ROSEN, ALAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 TRENT DR	None	DURHAM	NC	27710	0001	00	None	36.0049947	-78.93520336	Durham County
207478	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
207489	Fee-for-Service	1235154006	1235154006	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	10	06019	36.62466137	-119.3227461	Fresno County
207490	Fee-for-Service	1225021249	1225021249	1	2	REGENTS/UCDPBG/IM ENDOCR	4/27/2020	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
207492	Fee-for-Service	1407082456	1407082456	1	1	RAHAL, ALEXIS S MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107798	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207493	Fee-for-Service	1104998939	1104998939	1	1	REIDEL, SANDRA L MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	36852	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207500	Fee-for-Service	1518300532	1518300532	1	1	REGENTS OF THE UNIV CA-UCSD	5/6/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 GARDEN VIEW RD	STE 103	ENCINITAS	CA	92024	0871	37	06073	33.0584037	-117.2601559	San Diego County
207549	Fee-for-Service	1205820420	1205820420	1	1	RAEES, MUHAMMAD MD	11/28/2007	207RC0200X	NA	Other	026	PHYSICIANS	97480	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
207576	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
207579	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
207609	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
207611	Fee-for-Service	1487658126	1487658126	1	1	RUBIN, JEFFREY N DO	11/19/2013	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 S HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
207612	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
207616	Fee-for-Service	1912044835	1912044835	1	1	RUSAK, LINDA LCSW	7/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
207656	Fee-for-Service	1174767230	1174767230	1	1	RODRIGUES, DANIALD M MD	12/27/2019	207R00000X	NA	Other	026	PHYSICIANS	164055	10	Gastroenterology (M.D. only)	0	In state provider	None	27871 MEDICAL CENTER RD	STE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
207657	Fee-for-Service	1225522287	1225522287	1	1	REZAPOOR, PARISA MD	8/20/2021	207R00000X	NA	Other	026	PHYSICIANS	173473	None	None	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
207693	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
207715	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
207735	Fee-for-Service	1245486315	1245486315	1	1	RANON, NEALLIE PHD	2/18/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVENUE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
207761	Fee-for-Service	1609491117	1609491117	1	1	REMEDIUM HOSPICE CARE INC	5/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	STE 103	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
207769	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	4/30/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
207777	Fee-for-Service	1235154006	1235154006	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	10	06019	36.62466137	-119.3227461	Fresno County
207824	Fee-for-Service	1437656915	1437656915	1	1	REVIER, MICHELLE MD	11/21/2023	207KA0200X	NA	Other	026	PHYSICIANS	165333	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
207831	Fee-for-Service	1700934023	1700934023	1	1	RIVER DELTA UNIFIED SD	7/1/2015	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	445 MONTEZUMA ST	None	RIO VISTA	CA	94571	1651	48	06095	38.15756229	-121.6946077	Solano County
207837	Fee-for-Service	1790064889	1790064889	1	1	ROBLES, ROBERT J LCSW	9/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
207864	Fee-for-Service	1275627838	1275627838	1	1	ROLAND C NYEGAARD MD INC	5/10/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	19317	01	General Practice	0	In state provider	None	1320 CELESTE DR	None	MODESTO	CA	95355	2402	50	06099	37.67209617	-120.9733006	Stanislaus County
207866	Fee-for-Service	1710287297	1710287297	1	21	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
207867	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
207868	Fee-for-Service	1699925768	1699925768	1	1	RANA, SUMIT H MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109146	20	Orthopedic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
207880	Fee-for-Service	1538880547	1538880547	1	1	RESIDENCE CARE INC	10/6/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5996 SAGEBRUSH RD	None	LA JOLLA	CA	92037	7039	37	06073	32.82795073	-117.242375	San Diego County
207886	Fee-for-Service	1558398362	1558398362	1	1	RHEE, JOHN S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56004	30	Radiology	0	In state provider	None	1425 S. MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
207887	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	1/20/2023	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
207894	Fee-for-Service	1669620621	1669620621	1	1	RANKIN, MARY A LMFT	2/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	122	TEMECULA	CA	92590	4857	33	06065	33.52030169	-117.1659061	Riverside County
207897	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
207898	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
207905	Fee-for-Service	1689917486	1689917486	1	1	ROSS, SAMUEL H MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133185	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
207935	Fee-for-Service	1689611311	1689611311	1	1	REYNAGA, ROSA M MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53875	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
207989	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
208002	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
208029	Fee-for-Service	1699877621	1699877621	1	1	REGENTS OF THE UNIVERSITY OF	1/31/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
208042	Fee-for-Service	1376586529	1376586529	1	1	RICHERT, EDWARD P MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	35911	08	Family Practice	0	In state provider	None	228 MCDOWELL ST	None	ALTURAS	CA	96101	3933	25	06049	41.48012405	-120.539446	Modoc County
208048	Fee-for-Service	1609491117	1609491117	1	1	REMEDIUM HOSPICE CARE INC	5/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22024 LASSEN ST	STE 103	CHATSWORTH	CA	91311	3600	19	06037	34.2499425	-118.6069365	Los Angeles County
208055	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
208057	Fee-for-Service	1174107098	1174107098	1	1	RAWSON, DELANEY M MD	3/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
208089	Fee-for-Service	1639145014	1639145014	1	1	REICHMANN, ROBERT MD III	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83991	41	Internal Medicine	0	In state provider	None	201 S BUENA VISTA ST	STE 440	BURBANK	CA	91505	4577	19	06037	34.15978726	-118.3289164	Los Angeles County
208094	Fee-for-Service	1306083456	1306083456	1	1	REDDY, SUBHASH MD	1/21/2020	174400000X	NA	Other	026	PHYSICIANS	119540	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 420	SACRAMENTO	CA	95816	5242	34	06067	38.570076	-121.4657145	Sacramento County
208104	Fee-for-Service	1750389334	1750389334	1	1	ROPER, JOHN A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68242	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
208108	Fee-for-Service	1609889120	1609889120	1	1	RYDELSKI, MISTY J MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75535	01	General Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
208156	Fee-for-Service	1710287297	1710287297	1	56	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1919 SANTA MONICA BLVD	300	SANTA MONICA	CA	90404	1950	19	06037	34.0284492	-118.4803274	Los Angeles County
208174	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
208182	Fee-for-Service	1720088354	1720088354	1	8	RIDEOUT MEMORIAL HOSPITAL	6/12/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	370 DEL NORTE AVE	SUITE 101	YUBA CITY	CA	95991	4142	51	06101	39.14466521	-121.6166961	Sutter County
208184	Fee-for-Service	1710287297	1710287297	1	12	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
208187	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	9/28/2020	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
208203	Fee-for-Service	1528065752	1528065752	1	1	RADNER, ALLEN B MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70061	66	Emergency Medicine (Urgent Care)	0	In state provider	None	335 EL DORADO ST	STE 9	MONTEREY	CA	93940	4624	27	06053	36.59168391	-121.892381	Monterey County
208204	Fee-for-Service	1881690584	1881690584	1	1	ROSENTHAL, SETH A.	7/31/1991	2085R0001X	NA	Other	026	PHYSICIANS	71038	03	Allergy	0	In state provider	None	52ND & "F" ST.	None	SACRAMENTO	CA	95814	0000	34	06067	38.570607	-121.439502	Sacramento County
208246	Fee-for-Service	1952621930	1952621930	1	1	RAD, ELIKA J NP	1/14/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208278	Fee-for-Service	1033746052	1033746052	1	1	RAJAN, RADHIKA MD	6/21/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	184287	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
208285	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
208291	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
208317	Fee-for-Service	1699877621	1699877621	1	1	REGENTS OF THE UNIVERSITY OF	10/8/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
208344	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
208377	Fee-for-Service	1922516186	1922516186	1	1	RAMIREZ, YESENIA LPCC	9/17/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
208385	Fee-for-Service	1578109302	1578109302	1	1	RANKIN MCDONALD, ARIEL NP	9/18/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
208386	Fee-for-Service	1265271399	1265271399	1	1	ROY, SUZANNE NP	6/19/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 NEWPORT CENTER DR	301	NEWPORT BEACH	CA	92660	7604	30	06059	33.6142606	-117.8726808	Orange County
208392	Fee-for-Service	1750389334	1750389334	1	1	ROPER, JOHN A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68242	41	Internal Medicine	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
208395	Fee-for-Service	1487072146	1487072146	1	1	RABACH, LAUREN A MD	7/15/2019	208600000X	NA	General Surgery	026	PHYSICIANS	160182	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
208398	Fee-for-Service	1609889120	1609889120	1	1	RYDELSKI, MISTY J MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75535	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
208440	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
208443	Fee-for-Service	1710287297	1710287297	1	108	REGENTS UNIVERSITY OF CALIFO	10/6/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	309 W QUINTO STREET	None	SANTA BARBARA	CA	93105	5318	42	06083	34.43214714	-119.7246896	Santa Barbara County
208456	Fee-for-Service	1982083424	1982083424	1	1	ROMERO, MARIA LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
208459	Fee-for-Service	1831383850	1831383850	1	1	RIVERA, CARMEN M CNM	4/7/2010	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
208463	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
208466	Fee-for-Service	1104113331	1104113331	1	1	RUIZ-CORDERO, ROBERTO MD	7/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152447	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208473	Fee-for-Service	1275685083	1275685083	1	1	ROBINSON, DONALD R MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77691	36	Psychiatry	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
208474	Fee-for-Service	1710287297	1710287297	1	47	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
208478	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
208483	Fee-for-Service	1174919237	1174919237	1	1	RODRIGUEZ-GRAZIOSO, RODRIGO	12/1/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	MD	3196 S MARYLAND PKWAY	STE 101A	LAS VEGAS	NV	89109	2317	00	None	36.13194	-115.136873	Clark County
208491	Fee-for-Service	1528065752	1528065752	1	1	RADNER, ALLEN B MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70061	77	Infectious Disease	0	In state provider	None	335 EL DORADO ST	STE 9	MONTEREY	CA	93940	4624	27	06053	36.59168391	-121.892381	Monterey County
208503	Fee-for-Service	1598003923	1598003923	1	1	ROYER, CHELSEA D MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131655	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
208530	Fee-for-Service	1760728380	1760728380	1	1	RIVERSIDE-SAN BERNARDINO COU	4/23/2018	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	C PHARMACY	47001 PALA RD	None	TEMECULA	CA	92592	2925	33	06065	33.44396676	-117.0915085	Riverside County
208532	Fee-for-Service	1881213478	1881213478	1	1	RUIZ, ERIN MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	187143	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
208533	Fee-for-Service	1447237151	1447237151	1	1	REITMAN, BRUCE J MD	3/1/1997	207L00000X	NA	Other	026	PHYSICIANS	75290	05	Anesthesiology	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
208555	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	12/23/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
208568	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
208576	Fee-for-Service	1083891782	1083891782	1	1	ROEHMHOLDT, BRIAN F MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109566	22	Pathology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
208578	Fee-for-Service	1710287297	1710287297	1	57	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
208586	Fee-for-Service	1245684844	1245684844	1	1	RICHARD H GRAVES DPM INC	3/2/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	304 CHERRY AVE	None	LONG BEACH	CA	90802	3848	19	06037	33.769152	-118.167641	Los Angeles County
208608	Fee-for-Service	1699877621	1699877621	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
208613	Fee-for-Service	1043421811	1043421811	1	1	REZVANIAN, SHIVA MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117843	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
208636	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	2/28/2024	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
208646	Fee-for-Service	1104824366	1104824366	1	1	ROBINSON, TRACEY D MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49422	83	Rheumatology	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
208647	Fee-for-Service	1942220710	1942220710	1	1	RODDY, SARAH M MD	2/28/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46919	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	# B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
208699	Fee-for-Service	1053383091	1053383091	1	1	RODARTE, CHRISTOPHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79691	01	General Practice	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
208721	Fee-for-Service	1407900301	1407900301	1	1	ROBINSON, MICHAEL E	5/21/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9033 BASE LINE RD	SUITE F	RANCHO CUCAMONGA	CA	91730	1214	36	06071	34.12151248	-117.6080805	San Bernardino County
208728	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
208747	Fee-for-Service	1427200641	1427200641	1	1	RUCEKOVA, ALICA MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109477	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
208753	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
208763	Fee-for-Service	1710287297	1710287297	1	40	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
208808	Fee-for-Service	1831530682	1831530682	1	1	ROMESHA, ALISHA A LCSW	6/17/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74657	-	NOT APPLICABLE	0	In state provider	None	441 N MAIN ST	None	ALTURAS	CA	96101	3457	25	06049	41.48803571	-120.542554	Modoc County
208811	Fee-for-Service	1891157269	1891157269	1	1	REYES, GABRIEL MD	5/25/2021	207L00000X	NA	Other	026	PHYSICIANS	150576	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	8580	30	06059	33.56008604	-117.6657795	Orange County
208833	Fee-for-Service	1922257146	1922257146	1	1	RITCHIE, SIMON A MD	11/20/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	182608	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
208837	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
208841	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
208858	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	4/22/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
208859	Fee-for-Service	1760832109	1760832109	1	1	REED, SARAH C CRNA	8/10/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
208863	Fee-for-Service	1780231829	1780231829	1	1	RAYO, ANJELICA M OD	6/10/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
208868	Fee-for-Service	1063467017	1063467017	1	1	REBALSKA, MONIKA A	9/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1189 N EUCLID ST	None	ANAHEIM	CA	92801	1938	30	06059	33.849792	-117.941806	Orange County
208869	Fee-for-Service	1548345382	1548345382	1	1	RADNET MEDICAL IMAGING	2/20/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3440 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1837	38	06075	37.78673229	-122.4510148	San Francisco County
208877	Fee-for-Service	1740711266	1740711266	1	1	RAJWANI, TAUFIQ DO	1/26/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	19672	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
208895	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
208926	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	5/28/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
208936	Fee-for-Service	1104824366	1104824366	1	1	ROBINSON, TRACEY D MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49422	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
208985	Fee-for-Service	1447451729	1447451729	1	1	RODE, ANURADHA S MD	3/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111924	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	488 E VALLEY PKWY	STE 310	ESCONDIDO	CA	92025	3373	37	06073	33.12523814	-117.0769715	San Diego County
209015	Fee-for-Service	1710287297	1710287297	1	128	REGENTS UNIVERSITY OF CALIFO	5/19/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
209035	Fee-for-Service	1548680143	1548680143	1	1	REED, STEWART B MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143198	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
209041	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
209059	Fee-for-Service	1780663468	1780663468	1	1	ROGERS, WILLIAM M MD	4/2/2024	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
209073	Fee-for-Service	1447495411	1447495411	1	1	RIOS, MICHELLE F MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110502	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	#365	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
209117	Fee-for-Service	1316952781	1316952781	1	1	RASOULI, MARGARET L MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70058	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3080 BRISTOL ST	STE 600	COSTA MESA	CA	92626	7341	30	06059	33.68480996	-117.8854767	Orange County
209124	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
209131	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
209141	Fee-for-Service	1508845702	1508845702	1	1	REDLANDS PROSTHETIC & ORTHOT	4/4/2005	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1849 W REDLANDS BLVD	STE 103	REDLANDS	CA	92373	3127	36	06071	34.06287354	-117.2162115	San Bernardino County
209144	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	2/28/2024	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
209180	Fee-for-Service	1750368494	1750368494	1	1	RICHARD VIGRAN, MD	11/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN STREET	None	PORTLAND	OR	97213	0000	00	None	45.52655191	-122.6121355	Multnomah County
209184	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
209207	Fee-for-Service	1710287297	1710287297	1	124	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
209221	Fee-for-Service	1104824366	1104824366	1	1	ROBINSON, TRACEY D MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49422	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
209233	Fee-for-Service	1124439807	1124439807	1	14	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	651 1ST ST W	SUITE K	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
209238	Fee-for-Service	1881861540	1881861540	1	1	ROORDA, ANDREW K MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101729	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
209298	Fee-for-Service	1710287297	1710287297	1	121	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
209304	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
209327	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	8/13/2020	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
209348	Fee-for-Service	1093820151	1093820151	1	1	RAINER, ROBERT E II MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130498	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1433 W MERCED AVE	SUITE 103	WEST COVINA	CA	91790	3404	19	06037	34.06252177	-117.9477117	Los Angeles County
209357	Fee-for-Service	1164472791	1164472791	1	1	ROMANO, GENO V MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87682	08	Family Practice	0	In state provider	None	825 N 10TH ST	EMERGENCY DEPT	SANTA PAULA	CA	93060	1309	56	06111	34.36574255	-119.0654422	Ventura County
209372	Fee-for-Service	1336581701	1336581701	1	1	RELIANCE HOSPICE INC	11/21/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	74130 COUNTRY CLUB DRIVE	SUITE 103 A	PALM DESERT	CA	92260	1687	33	06065	33.75805952	-116.3718045	Riverside County
209374	Fee-for-Service	1518327618	1518327618	1	1	RANDALL IV, WILLIAM E LMFT	5/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
209390	Fee-for-Service	1073873733	1073873733	1	1	ROSARIO ROSARIO, GISELA MD	5/2/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	136895	None	None	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
209412	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
209417	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	12/23/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
209424	Fee-for-Service	1104244243	1104244243	1	1	RANDALL, MARTINA R	9/27/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	41889 E FLORIDA AVE	None	HEMET	CA	92544	5042	33	06065	33.7476747	-116.9145363	Riverside County
209443	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	5/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
209454	Fee-for-Service	1063579365	1063579365	1	1	RANDT, RONDA CNM	5/18/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
209472	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
209515	Fee-for-Service	1689775819	1689775819	1	2	REDDY, RAGHUNATH K MD	3/30/2023	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	49255	-	NOT APPLICABLE	0	In state provider	None	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
209519	Fee-for-Service	1124439807	1124439807	1	14	REGENTS UNIV OF CALIFORNIA U	4/19/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	651 1ST ST W	SUITE K	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
209527	Fee-for-Service	1316095128	1316095128	1	1	RUSSAK, STEVEN C MD	10/17/1988	207R00000X	NA	Other	026	PHYSICIANS	64389	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
209552	Fee-for-Service	1558947903	1558947903	1	1	RIDDER, AARON MD	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21053	08	Family Practice	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
209564	Fee-for-Service	1093204554	1093204554	1	1	RUPEL, ANNA-KATRINA LPCC	10/22/2021	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
209587	Fee-for-Service	1710287297	1710287297	1	121	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
209594	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
209611	Fee-for-Service	1407223365	1407223365	1	1	RODRIGUEZ, MARK A CPO	5/3/2018	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	931 BUENA VISTA ST	STE 105	DUARTE	CA	91010	1780	19	06037	34.141635	-117.9775755	Los Angeles County
209615	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
209640	Fee-for-Service	1396386330	1396386330	1	1	RAZO, STEPHANIE LCSW	1/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
209641	Fee-for-Service	1881270734	1881270734	1	1	RELEASE HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5352 LAUREL CANYON BLVD	STE 202	NORTH HOLLYWOOD	CA	91607	4921	19	06037	34.168176	-118.3964725	Los Angeles County
209652	Fee-for-Service	1699049924	1699049924	1	1	RAMIREZ, MILTON R MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125445	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
209658	Fee-for-Service	1073199501	1073199501	1	1	RENGEL, ZACHARY MD	1/24/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	19	06037	34.05897499	-118.4431123	Los Angeles County
209661	Fee-for-Service	1336581701	1336581701	1	1	RELIANCE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	74130 COUNTRY CLUB DRIVE	SUITE 103 A	PALM DESERT	CA	92260	1687	33	06065	33.75805952	-116.3718045	Riverside County
209697	Fee-for-Service	1760519128	1760519128	2	1	RSCR INLAND INC	5/8/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5475 COLLEGE AVE	None	RIVERSIDE	CA	92505	3124	33	06065	33.92613172	-117.5082893	Riverside County
209700	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	4/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
209706	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
209724	Fee-for-Service	1710287297	1710287297	1	126	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
209741	Fee-for-Service	1477506350	1477506350	1	1	RIRIE, DANIEL MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	100 HOSPITAL DR	None	KETCHUM	ID	83340	0100	00	None	43.6482607	-114.3490716	Blaine County
209743	Fee-for-Service	1346398245	1346398245	1	1	RUSSELL, MARCIA M MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	84671	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
209764	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
209772	Fee-for-Service	1598060345	1598060345	1	1	REYES, ESTER E LMFT	3/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	450 BRAND	638	GLENDALE	CA	91203	2347	19	06037	34.152633	-118.254971	Los Angeles County
209792	Fee-for-Service	1891140265	1891140265	1	1	RAZAVI, ROSHAN DO	8/27/2023	261QX0100X	NA	Other	026	PHYSICIANS	17479	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
209808	Fee-for-Service	1124439807	1124439807	1	14	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	651 1ST ST W	SUITE K	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
209855	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
209875	Fee-for-Service	1710287297	1710287297	1	121	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
209880	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
209892	Fee-for-Service	1740206218	1740206218	1	1	ROSE, CATHERINE L	3/23/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2211 POST ST	STE 300	SAN FRANCISCO	CA	94115	3442	38	06075	37.78446663	-122.4382772	San Francisco County
209903	Fee-for-Service	1710287297	1710287297	1	37	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
209924	Fee-for-Service	1467728394	1467728394	1	1	RAKHSHAN, ELNAZ MD	11/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144899	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
209927	Fee-for-Service	1881270734	1881270734	1	1	RELEASE HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5352 LAUREL CANYON BLVD	STE 202	NORTH HOLLYWOOD	CA	91607	4921	19	06037	34.168176	-118.3964725	Los Angeles County
209952	Fee-for-Service	1881722817	1881722817	1	1	REMY, REINA LCSW	11/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8765 AERO DR	STE 311	SAN DIEGO	CA	92123	1767	37	06073	32.80965252	-117.139383	San Diego County
209957	Fee-for-Service	1124414479	1124414479	1	1	RAZA, ADNAN	8/15/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
209976	Fee-for-Service	1356307672	1356307672	1	1	REICHER, DANIELLE MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	48286	05	Anesthesiology	0	In state provider	None	320 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
209977	Fee-for-Service	1104060169	1104060169	1	1	ROOZENDAAL, SUZANNE MARIE DO	8/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
209988	Fee-for-Service	1689665820	1689665820	2	1	REXMED RX INC	4/15/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	REXMED PHARMACY	507 S ALVARADO ST	None	LOS ANGELES	CA	90057	2903	19	06037	34.06049857	-118.2742874	Los Angeles County
209989	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
209994	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
209997	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
210050	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
210097	Fee-for-Service	1427011709	1427011709	1	1	ROSSI-FOULKES, RITA M MD	3/21/2023	207R00000X	NA	Other	026	PHYSICIANS	87096	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
210125	Fee-for-Service	1568859171	1568859171	1	1	REINLIEB, MICHELLE E PHD	5/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8631	19	06037	34.07067	-118.4432445	Los Angeles County
210144	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
210162	Fee-for-Service	1710287297	1710287297	1	121	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
210171	Fee-for-Service	1710287297	1710287297	1	128	REGENTS UNIVERSITY OF CALIFO	5/19/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
210197	Fee-for-Service	1659861631	1659861631	1	1	RUEBSAMEN, REBECCA DO	10/10/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17631	09	Gynecology (D.O. only)	0	In state provider	None	220 S PALISADE DR STE 20	None	SANTA MARIA	CA	93454	8903	42	06083	34.95143521	-120.412098	Santa Barbara County
210217	Fee-for-Service	1841463353	1841463353	1	2	ROMERO, ELIOTT MD INC	4/17/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48383	08	Family Practice	0	In state provider	None	57340 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	2927	36	06071	34.12390751	-116.4127432	San Bernardino County
210259	Fee-for-Service	1831782077	1831782077	1	1	RONI MACCABEE PSYCHOLOGICAL	6/5/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	1816 PROSSER AVE	4	LOS ANGELES	CA	90025	4829	19	06037	34.0530999	-118.428901	Los Angeles County
210270	Fee-for-Service	1215065677	1215065677	1	1	RXALL PHARMACY INC	6/18/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1125 S BEVERLY BLVD	STE 100	LOS ANGELES	CA	90035	1148	19	06037	34.05696658	-118.3966613	Los Angeles County
210274	Fee-for-Service	1710287297	1710287297	1	55	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
210280	Fee-for-Service	1023351863	1023351863	1	1	REINERT, DAVID A DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13617	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
210282	Fee-for-Service	1710287297	1710287297	1	95	REGENTS UNIVERSITY OF CALIFO	12/23/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1000 N SEPULVEDA BLVD	190	MANHATTAN BEACH	CA	90266	5974	19	06037	33.885882	-118.395911	Los Angeles County
210293	Fee-for-Service	1467929703	1467929703	1	1	ROBLES, RICARDO R LMFT	1/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
210299	Fee-for-Service	1134169535	1134169535	2	5	REACH AIR MEDICAL SERVICES L	11/30/2009	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3700 E JAHANT RD	STE A	ACAMPO	CA	95220	9537	39	06077	38.2037187	-121.273839	San Joaquin County
210301	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
210305	Fee-for-Service	1033130679	1033130679	1	1	REZAEI, ROSS	5/25/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16257 LAGUNA CANYON RD	STE 150	IRVINE	CA	92618	3607	30	06059	33.65872327	-117.7683934	Orange County
210339	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
210344	Fee-for-Service	1396816393	1396816393	1	1	RESTREPO, DALILAH H MD	1/19/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	171192	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
210381	Fee-for-Service	1336226281	1336226281	1	1	RAMA, ARUN N MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77577	08	Family Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210431	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
210442	Fee-for-Service	1669495107	1669495107	1	1	REID, BETH E NP	3/11/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	16015	-	NOT APPLICABLE	0	In state provider	None	582, 584, 586, 588, & 59	None	CHICO	CA	95926	1817	04	06007	0	0	None
210454	Fee-for-Service	1710287297	1710287297	1	128	REGENTS UNIVERSITY OF CALIFO	5/19/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
210471	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
210486	Fee-for-Service	1659861631	1659861631	1	1	RUEBSAMEN, REBECCA DO	10/10/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17631	15	Obstetrics (D.O. only)	0	In state provider	None	220 S PALISADE DR STE 20	None	SANTA MARIA	CA	93454	8903	42	06083	34.95143521	-120.412098	Santa Barbara County
210493	Fee-for-Service	1700045796	1700045796	1	1	ROBBIANO, KATHLEEN A CRNA	1/31/1988	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5333 HOLLISTER AVE	STE 120	SANTA BARBARA	CA	93111	3314	42	06083	34.43491982	-119.8105484	Santa Barbara County
210533	Fee-for-Service	1588223044	1588223044	1	1	RODRIGUEZ, PAULA BIANCA MD	4/19/2023	207R00000X	NA	Other	026	PHYSICIANS	180312	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
210587	Fee-for-Service	1154595957	1154595957	1	1	RODRIGUEZ, DORA C MD	12/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109796	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
210592	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
210597	Fee-for-Service	1174987960	1174987960	1	1	RISTAU, JESSICA MD	8/29/2019	207R00000X	NA	Other	026	PHYSICIANS	151989	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210608	Fee-for-Service	1811306079	1811306079	1	1	ROSSETTO, RACHEL K	2/17/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 N SUNRISE AVE	STE 100	ROSEVILLE	CA	95661	3097	31	06061	38.7576732	-121.2534645	Placer County
210625	Fee-for-Service	1710287297	1710287297	1	92	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	120 S SPALDING DR	401	BEVERLY HILLS	CA	90212	1842	19	06037	34.06625419	-118.4088854	Los Angeles County
210651	Fee-for-Service	1124439807	1124439807	1	12	REGENTS UNIV OF CALIFORNIA U	4/19/2023	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	651 1ST ST WEST	STE H	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
210656	Fee-for-Service	1083679781	1083679781	1	1	RACKER, DAVID R MD	1/5/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50474	30	Radiology	0	In state provider	None	600 SANITARIUM RD	None	DEER PARK	CA	94576	9710	28	06055	38.53732081	-122.47447	Napa County
210668	Fee-for-Service	1336226281	1336226281	1	1	RAMA, ARUN N MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77577	05	Anesthesiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210690	Fee-for-Service	1730642141	1730642141	1	1	ROSENBERRY, KELLY	5/2/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7741 GODDARD AVE	None	LOS ANGELES	CA	90045	3221	19	06037	33.96571196	-118.372879	Los Angeles County
210704	Fee-for-Service	1558311597	1558311597	1	1	RAPP, JEFFREY A MD	1/1/2003	207P00000X	NA	Other	026	PHYSICIANS	33498	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
210721	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
210741	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
210748	Fee-for-Service	1508803495	1508803495	1	1	REAGAN, ZED M MD	9/14/2011	207L00000X	NA	Other	026	PHYSICIANS	79788	None	None	0	In state provider	None	PUEBLO AT BATH STREET	None	SANTA BARBARA	CA	93105	6219	42	06083	34.430526	-119.72196	Santa Barbara County
210759	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
210782	Fee-for-Service	1215504196	1215504196	1	1	RETINA CONSULTANTS OF NEVADA	2/23/2022	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	3475 GS RICHARDS BLVD	STE 130	CARSON CITY	NV	89703	8462	00	None	39.190617	-119.776275	Consolidated Municipality of Carson City
210806	Fee-for-Service	1922636141	1922636141	1	1	REDDY, NAVEENKUMAR M MD	6/13/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	189151	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210836	Fee-for-Service	1255974275	1255974275	1	1	RSCR CALIFORNIA INC	5/15/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	932 CHANTILLY STREET	None	ANAHEIM	CA	92806	4814	30	06059	33.826419	-117.8751805	Orange County
210851	Fee-for-Service	1043501364	1043501364	1	1	RAVI, DAVE P MD	11/28/2023	390200000X	NA	Other	026	PHYSICIANS	156663	36	Psychiatry	0	In state provider	None	1131 6TH ST	STE 232	ONTARIO	CA	91762	1121	36	06071	34.084404	-117.6717015	San Bernardino County
210865	Fee-for-Service	1881767606	1881767606	1	1	RANDOLPH OTTO, MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
210874	Fee-for-Service	1336151455	1336151455	1	1	REID, JAMES J MD	7/7/2005	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	78619	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
210876	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	5/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
210896	Fee-for-Service	1457168858	1457168858	1	1	READING, ANGELA LCSW	1/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
210911	Fee-for-Service	1851586960	1851586960	1	1	RAZI, SALMAN S MD INC	9/1/2003	208800000X	NA	Other	026	PHYSICIANS	55879	34	Urology and Urological Surgery	0	In state provider	None	2160 W GRANT LINE RD	#140	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
210939	Fee-for-Service	1124439807	1124439807	1	12	REGENTS UNIV OF CALIFORNIA U	12/5/2023	163WG0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	651 1ST ST WEST	STE H	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
210961	Fee-for-Service	1700065968	1700065968	2	1	RIGHTCARE HOME HEALTH	8/15/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	600 WEST BROADWAY	SUITE 110	GLENDALE	CA	91204	1023	19	06037	34.14678282	-118.2666498	Los Angeles County
210963	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
210978	Fee-for-Service	1730642141	1730642141	1	1	ROSENBERRY, KELLY	5/2/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7741 GODDARD AVE	None	LOS ANGELES	CA	90045	3221	19	06037	33.96571196	-118.372879	Los Angeles County
210991	Fee-for-Service	1558311597	1558311597	1	1	RAPP, JEFFREY A MD	1/1/2003	207P00000X	NA	Other	026	PHYSICIANS	33498	08	Family Practice	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
211009	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
211022	Fee-for-Service	1467228155	1467228155	1	1	RUTLEDGE, SARA LAUREN LCSW	2/12/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 MILL ST	STE 210	HEALDSBURG	CA	95448	4462	49	06097	38.60873636	-122.8682221	Sonoma County
211032	Fee-for-Service	1710287297	1710287297	1	10	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1411 S GARFIELD AVE	STE 200	ALHAMBRA	CA	91801	5024	19	06037	34.07787	-118.1230385	Los Angeles County
211044	Fee-for-Service	1922340504	1922340504	1	1	RITZ, LAUREN C MD	8/2/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158747	08	Family Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
211049	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
211058	Fee-for-Service	1275740102	1275740102	1	1	ROBINSON, MATTHEW D DO	2/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12151	20	Orthopedic Surgery	0	In state provider	None	40949 WINCHESTER RD	None	TEMECULA	CA	92591	6031	33	06065	33.52574268	-117.1589811	Riverside County
211137	Fee-for-Service	1639857485	1639857485	1	1	RANJANA SAXENA MD INC	2/6/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
211146	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
211154	Fee-for-Service	1154759413	1154759413	1	1	ROBBINS, AMY S LCSW	3/18/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21965	-	NOT APPLICABLE	0	In state provider	None	180 SIERRA COLLEGE DR	None	GRASS VALLEY	CA	95945	5768	29	06057	39.23235449	-121.0475561	Nevada County
211227	Fee-for-Service	1619685708	1619685708	1	1	RICKERT, LAURA J PT	5/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
211230	Fee-for-Service	1124439807	1124439807	1	12	REGENTS UNIV OF CALIFORNIA U	9/5/2023	163WG0000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	651 1ST ST WEST	STE H	SONOMA	CA	95476	7045	49	06097	38.28938482	-122.4593996	Sonoma County
211239	Fee-for-Service	1710936976	1710936976	1	1	RICE, REGINALD D JR MD	11/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	70357	04	Otology, Laryngology, Rhinology	0	In state provider	None	4300 GOLDEN CENTER DRIVE	SUITE D	PLACERVILLE	CA	95667	6278	09	06017	38.70657265	-120.82856	El Dorado County
211252	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
211282	Fee-for-Service	1215063136	1215063136	1	1	RES-CARE CALIFORNIA INC	11/17/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1948 AUGUSTA LN	None	YUBA CITY	CA	95993	8289	51	06101	39.10497011	-121.6511662	Sutter County
211298	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
211318	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	1/28/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
211323	Fee-for-Service	1710287297	1710287297	1	128	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
211333	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
211349	Fee-for-Service	1790170991	1790170991	1	1	ROBLES, DIANA C MD	9/2/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146925	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
211352	Fee-for-Service	1720492812	1720492812	1	1	RENDON, JUAN MD	3/6/2024	208200000X	NA	General Surgery	026	PHYSICIANS	172824	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
211399	Fee-for-Service	1568817419	1568817419	1	1	REGAL HOME HEALTH INC	9/12/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14549 ARCHWOOD ST	SUITE 321	VAN NUYS	CA	91405	4633	19	06037	34.19296379	-118.4505327	Los Angeles County
211436	Fee-for-Service	1710287297	1710287297	1	96	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
211441	Fee-for-Service	1902861602	1902861602	1	1	RED BLUFF PHYSICAL THERAPY	6/8/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	100 JACKSON ST	None	RED BLUFF	CA	96080	3954	52	06103	40.17030473	-122.2378182	Tehama County
211449	Fee-for-Service	1861493173	1861493173	1	1	RAGSDALE, RICHARD A MD	5/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56937	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2510 AIRPARK DR	STE 205	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
211450	Fee-for-Service	1467095935	1467095935	1	1	RSCR CALIFORNIA INC	10/17/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1592 W LORANE WAY	None	ANAHEIM	CA	92802	3930	30	06059	33.7944435	-117.936468	Orange County
211517	Fee-for-Service	1841259041	1841259041	1	1	RUTTEN, MICHAEL D MD	5/31/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	78366	45	Nephrology (Renal-Kidney)	0	In state provider	None	1310 W STEWART DR	STE 607	ORANGE	CA	92868	3857	30	06059	33.78236048	-117.8664975	Orange County
211533	Fee-for-Service	1881715456	1881715456	1	1	ROJAS, HEATHER L MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89131	22	Pathology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
211538	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
211543	Fee-for-Service	1386717023	1386717023	1	1	RITTENHOUSE, DOUGLAS E MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67775	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SOUTHGATE AVE	STE 112	DALY CITY	CA	94015	2205	41	06081	37.67558248	-122.4750825	San Mateo County
211561	Fee-for-Service	1467586149	1467586149	1	1	RUSSELL, PATRICIA S MD	1/1/1998	174400000X	NA	Other	026	PHYSICIANS	26095	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 W TEMPLE ST	None	LOS ANGELES	CA	90026	4607	19	06037	34.07382028	-118.2777667	Los Angeles County
211581	Fee-for-Service	1104906478	1104906478	1	1	ROSANO, JASON R DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	PREMIERE HEALTH CARE	7203 GREENLEAF AVE	STE G	WHITTIER	CA	90602	1372	19	06037	33.97685542	-118.0374041	Los Angeles County
211583	Fee-for-Service	1710287297	1710287297	1	90	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
211591	Fee-for-Service	1780145334	1780145334	1	1	RACE, NICHOLAS S MD	9/18/2024	2081P0301X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
211609	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
211621	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
211646	Fee-for-Service	1457438301	1457438301	1	1	REICHERT, MARCEL MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88063	41	Internal Medicine	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
211665	Fee-for-Service	1336492800	1336492800	1	1	REAL TIME NEUROMONITORING AS	4/26/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOCIATES OF CA PC	200 JOSE FIGUERES AVE	SUITE 475	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
211675	Fee-for-Service	1710943667	1710943667	1	1	RARON, SURINDER S MD	4/8/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49303	40	Pediatrics	0	In state provider	None	3132 WEST MARCH LANE	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
211681	Fee-for-Service	1477518520	1477518520	1	1	REYNOLDS, RICHARD J MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36017	41	Internal Medicine	0	In state provider	None	591 E ELDER ST	STE C	FALLBROOK	CA	92028	5001	37	06073	33.3801147	-117.2454154	San Diego County
211685	Fee-for-Service	1134112295	1134112295	1	2	REGENTS/UCDPBG/NEUROSURG	1/28/2021	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
211737	Fee-for-Service	1710287297	1710287297	1	103	REGENTS UNIVERSITY OF CALIFO	5/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
211758	Fee-for-Service	1851117162	1851117162	1	1	ROYER, MELINA PT	2/10/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
211817	Fee-for-Service	1144511668	1144511668	1	1	ROUND, PAUL E MD	2/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13034	40	Pediatrics	0	In state provider	None	45104 10TH STREET WEST	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
211828	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
211891	Fee-for-Service	1760941983	1760941983	1	1	RAI, BALJEET S MD	10/15/2024	207RR0500X	NA	Other	026	PHYSICIANS	177382	83	Rheumatology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
211892	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
211907	Fee-for-Service	1134203847	1134203847	1	1	REDDING, MARSHALL E MD	8/31/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2530 ATLANTIC AVE	STE A	LONG BEACH	CA	90806	2741	19	06037	33.803172	-118.185004	Los Angeles County
211911	Fee-for-Service	1710287297	1710287297	1	41	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	111	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
211920	Fee-for-Service	1104323112	1104323112	1	1	RAMINFAR, LEILA MD	1/23/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20642 JOHN DR	None	CASTRO VALLEY	CA	94546	5103	01	06001	37.69270814	-122.090934	Alameda County
211931	Fee-for-Service	1154772259	1154772259	1	1	RIMPAU MEDICAL CLINIC INC	12/28/2016	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1451 S RIMPAU AVE	SUITE 109	CORONA	CA	92879	7521	33	06065	33.86546916	-117.5455079	Riverside County
211973	Fee-for-Service	1194732644	1194732644	1	1	ROBBINS, BRUCE MD	1/1/1989	207ZP0102X	NA	Other	026	PHYSICIANS	47156	01	General Practice	0	In state provider	#300C	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
211974	Fee-for-Service	1134112295	1134112295	1	2	REGENTS/UCDPBG/NEUROSURG	5/1/1999	207T00000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
211980	Fee-for-Service	1477154722	1477154722	1	1	ROMARATE, MYLEEN D NP	1/14/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
211991	Fee-for-Service	1124063110	1124063110	1	1	RICHARDSON, MICHAEL A	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30569	None	None	0	In state provider	None	601 E MICHELTORENA ST	None	SANTA BARBARA	CA	93103	2216	42	06083	34.43292239	-119.701137	Santa Barbara County
212000	Fee-for-Service	1922761550	1922761550	1	1	REGAN, MELISSA B LMFT	11/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2034 COTNER AVE	200	LOS ANGELES	CA	90025	5664	19	06037	34.0413463	-118.441113	Los Angeles County
212012	Fee-for-Service	1871503490	1871503490	1	1	RAO, YALLAPRAGADA S MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32771	01	General Practice	0	In state provider	None	1910 ROYALTY DR	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
212015	Fee-for-Service	1710287297	1710287297	1	5	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	804 7TH STREET	None	SANTA MONICA	CA	90403	1408	19	06037	34.02668952	-118.5017444	Los Angeles County
212108	Fee-for-Service	1902055429	1902055429	1	1	RAMIREZ, NICOLE C	12/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
212115	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
212125	Fee-for-Service	1760548374	1760548374	1	1	RAWALT, GEORGE PHD	9/5/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6335 ELMQUIST AVE	None	WHITTIER	CA	90601	3822	19	06037	33.98363583	-118.022455	Los Angeles County
212154	Fee-for-Service	1740771005	1740771005	1	1	RIVERA, ELIZABETH	1/27/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
212160	Fee-for-Service	1356455299	1356455299	1	1	RUBIDOUX FAMILY CARE CTR	1/8/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	COUNTY OF RIVERSIDE	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
212168	Fee-for-Service	1437536216	1437536216	1	1	RIEDLER, KIERSTEN L MD	3/1/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	135480	04	Otology, Laryngology, Rhinology	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
212179	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	1/28/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
212180	Fee-for-Service	1316398431	1316398431	1	1	RAVINUTALA, ARVIND K MD	5/13/2020	207R00000X	NA	Other	026	PHYSICIANS	154366	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
212194	Fee-for-Service	1134203847	1134203847	1	1	REDDING, MARSHALL E MD	8/31/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	2530 ATLANTIC AVE	STE A	LONG BEACH	CA	90806	2741	19	06037	33.803172	-118.185004	Los Angeles County
212200	Fee-for-Service	1154862431	1154862431	1	1	RAZMJOU, AMIR A MD	7/28/2023	207RR0500X	NA	Other	026	PHYSICIANS	159666	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
212206	Fee-for-Service	1962414003	1962414003	1	1	RAKHSHANI, ROYA MD	7/26/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55112	None	None	0	In state provider	None	ONE HOAG DR	6100	NEWPORT BEACH	CA	92658	6100	30	06059	33.62421676	-117.9309656	Orange County
212237	Fee-for-Service	1295250264	1295250264	1	1	ROSA, ADAM T OD	11/21/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	318 E COMPTON BLVD	None	COMPTON	CA	90221	3206	19	06037	33.89597324	-118.2191747	Los Angeles County
212289	Fee-for-Service	1992124309	1992124309	1	1	RASHID, NAILA MD	8/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
212301	Fee-for-Service	1871503490	1871503490	1	1	RAO, YALLAPRAGADA S MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32771	30	Radiology	0	In state provider	None	1910 ROYALTY DR	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
212303	Fee-for-Service	1710287297	1710287297	1	5	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	804 7TH STREET	None	SANTA MONICA	CA	90403	1408	19	06037	34.02668952	-118.5017444	Los Angeles County
212323	Fee-for-Service	1740390525	1740390525	1	1	RITE AID #6197	5/26/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	2121 COWELL BLVD	None	DAVIS	CA	95616	6388	57	06113	38.54020357	-121.7243875	Yolo County
212334	Fee-for-Service	1902819261	1902819261	1	1	RIVAS, DEBRA C NP	9/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
212355	Fee-for-Service	1265484794	1265484794	1	1	REED, PEILIN C MD	8/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53755	None	None	0	In state provider	None	43830 N 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
212380	Fee-for-Service	1023058518	1023058518	1	1	RAMIREZ, LUZ G MD	7/10/2015	207L00000X	NA	Other	026	PHYSICIANS	69267	05	Anesthesiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
212394	Fee-for-Service	1386982353	1386982353	1	1	RESTIVO, ELIZABETH K OT	12/7/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
212397	Fee-for-Service	1699842534	1699842534	1	1	ROGERS, JEFFREY J MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56941	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
212403	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
212411	Fee-for-Service	1083975270	1083975270	1	1	ROYER, ELIZABETH E CCC-SLP	4/14/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	30428 HAUN RD.	STE. 810	MENIFEE	CA	92584	6824	33	06065	33.67819649	-117.1755448	Riverside County
212449	Fee-for-Service	1356455299	1356455299	1	1	RUBIDOUX FAMILY CARE CTR	2/22/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	COUNTY OF RIVERSIDE	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
212451	Fee-for-Service	1568965069	1568965069	1	1	RAMOS, KARA A CNP	3/13/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
212457	Fee-for-Service	1427450725	1427450725	1	1	RIESELBACH, KAREN LCSW	5/17/2023	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
212461	Fee-for-Service	1417961699	1417961699	1	1	RICHARDSON, PHILLIP J MD	7/16/2001	207L00000X	NA	Other	026	PHYSICIANS	66782	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 800	ORANGE	CA	92868	4247	30	06059	33.78029455	-117.864369	Orange County
212465	Fee-for-Service	1174693337	1174693337	1	1	ROESSLER, FRIEDRICH C MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	60680	None	None	0	In state provider	None	301 N SAN JACINTO ST	None	HEMET	CA	92543	3119	33	06065	33.75162	-116.9586895	Riverside County
212469	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
212487	Fee-for-Service	1124559596	1124559596	1	1	RUBIN, CAROLINE NP	10/18/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
212568	Fee-for-Service	1639140791	1639140791	1	1	RUSSOM, JILL MARTINE MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71632	08	Family Practice	0	In state provider	None	12586 AVENUE 408	None	OROSI	CA	93647	9454	54	06107	36.53030229	-119.2915122	Tulare County
212592	Fee-for-Service	1710287297	1710287297	1	5	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	804 7TH STREET	None	SANTA MONICA	CA	90403	1408	19	06037	34.02668952	-118.5017444	Los Angeles County
212615	Fee-for-Service	1801803705	1801803705	1	1	RANCHO LOS AMIGOS	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	NATIONAL REHAB CTR	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
212616	Fee-for-Service	1346550969	1346550969	1	1	ROSENTHAL, LAUREN J LMFT	4/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
212618	Fee-for-Service	1396846507	1396846507	1	1	ROSTERMUNDT, SHANE DO	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9637	40	Pediatrics	0	In state provider	None	1430 E MAIN ST	None	SANTA MARIA	CA	93454	4809	42	06083	34.9528467	-120.4127301	Santa Barbara County
212623	Fee-for-Service	1447414263	1447414263	1	1	REYES, VILMA D PSYD	11/19/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
212631	Fee-for-Service	1598745143	1598745143	1	1	REGENTS OF THE UNIV CA	7/1/1997	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3160 FOLSOM BOULEVARD	STE 2900	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
212632	Fee-for-Service	1306929633	1306929633	1	1	RODERICK WOODS	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4824 MCMAHON BLVD NW	STE 115	ALBUQUERQUE	NM	87114	5412	00	None	35.20685659	-106.6784817	Bernalillo County
212645	Fee-for-Service	1326720996	1326720996	1	1	RIZO, MELISSA LCSW	1/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RAL HEALTH SERVICES	930 TRUXTUN AVE	206	BAKERSFIELD	CA	93301	4700	15	06029	35.37343547	-119.012751	Kern County
212690	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
212735	Fee-for-Service	1356455299	1356455299	1	1	RUBIDOUX FAMILY CARE CTR	7/17/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	COUNTY OF RIVERSIDE	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
212757	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	1/28/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
212763	Fee-for-Service	1144262072	1144262072	1	1	ROMEN,JHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	0000	00	None	33.38982	-111.8760885	Maricopa County
212782	Fee-for-Service	1275601775	1275601775	1	1	REDDY, SANDEEP K MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65510	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
212855	Fee-for-Service	1972539039	1972539039	1	1	RIVERSIDE EMERGENCY	8/29/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MED GRP	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
212872	Fee-for-Service	1609133800	1609133800	1	1	ROUBIDOUX, TYLER J MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127481	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
212880	Fee-for-Service	1710287297	1710287297	1	5	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	804 7TH STREET	None	SANTA MONICA	CA	90403	1408	19	06037	34.02668952	-118.5017444	Los Angeles County
212899	Fee-for-Service	1669670907	1669670907	1	1	REEVES, EUGENIA G LCSW	7/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
212919	Fee-for-Service	1598745143	1598745143	1	1	REGENTS OF THE UNIV CA	5/16/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3160 FOLSOM BOULEVARD	STE 2900	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
212936	Fee-for-Service	1922447499	1922447499	1	1	RAJYAGURU, MAULIK P DO	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13810	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
212944	Fee-for-Service	1457397903	1457397903	1	1	RAO, RAMAKRISHNA P MD	6/15/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55282	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
212971	Fee-for-Service	1235115072	1235115072	1	1	RODRIGUEZ, JOSE L	7/31/1984	207T00000X	NA	General Surgery	026	PHYSICIANS	49547	01	General Practice	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
212983	Fee-for-Service	1710287297	1710287297	1	25	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
212991	Fee-for-Service	1891074977	1891074977	1	1	ROUHI, MAHTAB M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
212999	Fee-for-Service	1972576189	1972576189	1	1	ROSENBURG, JEFFREY M MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53269	66	Emergency Medicine (Urgent Care)	0	In state provider	None	488 E VALLEY PKWY	STE 210	ESCONDIDO	CA	92025	3369	37	06073	33.12523814	-117.0769715	San Diego County
213013	Fee-for-Service	1548305444	1548305444	1	1	RAFAELOFF, PARVANEH MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52350	40	Pediatrics	0	In state provider	None	1030 S GLENDALE AVE	STE 308	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
213023	Fee-for-Service	1356455299	1356455299	1	1	RUBIDOUX FAMILY CARE CTR	7/17/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COUNTY OF RIVERSIDE	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
213043	Fee-for-Service	1922268598	1922268598	1	1	REVATHI BALAKRISHNAN	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
213047	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	5/25/2022	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
213057	Fee-for-Service	1548419526	1548419526	1	1	REGENTS OF UNIVERSITY OF	9/2/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1200 GARDEN VIEW RD	STE 210	ENCINITAS	CA	92024	2475	37	06073	33.0584037	-117.2601559	San Diego County
213071	Fee-for-Service	1649339268	1649339268	1	1	ROCKOFF, ARLEEN M MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40491	77	Infectious Disease	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
213074	Fee-for-Service	1639387731	1639387731	1	1	RASO, VIRGINIA D	7/14/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SUNBURST CARE CENTER	19815 ARMINTA ST	None	WINNETKA	CA	91306	2339	19	06037	34.21320297	-118.5649055	Los Angeles County
213077	Fee-for-Service	1255794889	1255794889	1	1	RAMKUMAR, PREM N MD	3/27/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	180372	None	None	0	In state provider	None	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
213093	Fee-for-Service	1811331739	1811331739	1	1	RIGGIO, LORI B PHD	1/16/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
213118	Fee-for-Service	1568705226	1568705226	1	1	RIESTENBERG, CARRIE K MD	3/18/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	134807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
213124	Fee-for-Service	1376089490	1376089490	1	1	ROBINS, WILLIAM Z LMFT	3/23/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118459	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
213156	Fee-for-Service	1285997247	1285997247	1	1	ROH, ALBERT T MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147026	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
213168	Fee-for-Service	1710287297	1710287297	1	5	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	804 7TH STREET	None	SANTA MONICA	CA	90403	1408	19	06037	34.02668952	-118.5017444	Los Angeles County
213253	Fee-for-Service	1386789238	1386789238	1	1	ROCHA, SEAN B MD	3/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118563	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
213278	Fee-for-Service	1225082910	1225082910	1	1	REDDY, RAVINDRANATH A MD	7/1/1982	207R00000X	NA	Other	026	PHYSICIANS	34260	41	Internal Medicine	0	In state provider	None	591 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957649	-119.0302065	Tulare County
213288	Fee-for-Service	1972576189	1972576189	1	1	ROSENBURG, JEFFREY M MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53269	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	488 E VALLEY PKWY	STE 210	ESCONDIDO	CA	92025	3369	37	06073	33.12523814	-117.0769715	San Diego County
213335	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	12/18/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
213351	Fee-for-Service	1154421576	1154421576	1	1	RASHEED, SHAHEEN MD	1/21/2016	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	112746	None	None	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
213395	Fee-for-Service	1275063000	1275063000	1	1	ROSE, MELINDA	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
213509	Fee-for-Service	1285818534	1285818534	1	1	RANGARAJAN, SURESH B MD	10/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99161	41	Internal Medicine	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
213510	Fee-for-Service	1841286549	1841286549	1	1	RICHARDS, KENT L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2405 S TELSHOR BLVD	None	LAS CRUCES	NM	88011	5049	00	None	32.29295149	-106.7350978	Doña Ana County
213542	Fee-for-Service	1831673144	1831673144	1	1	REACHWELL HOSPICE CARE, INC	5/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	805 W DUARTE RD	SUITE 103C	ARCADIA	CA	91007	7538	19	06037	34.125718	-118.0575351	Los Angeles County
213574	Fee-for-Service	1972576189	1972576189	1	1	ROSENBURG, JEFFREY M MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53269	33	Thoracic Surgery	0	In state provider	None	488 E VALLEY PKWY	STE 210	ESCONDIDO	CA	92025	3369	37	06073	33.12523814	-117.0769715	San Diego County
213575	Fee-for-Service	1336144633	1336144633	1	1	RIGBERG, A LEON M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	GASTROENTEROLOGY&ENDOSCO	3501 N SCOTTSDALE RD	# 3320	SCOTTSDALE	AZ	85251	5648	00	None	33.489027	-111.9254265	Maricopa County
213580	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
213588	Fee-for-Service	1114091055	1114091055	1	1	RADY CHILDREN'S HOSPITAL	9/22/1972	3140N1450X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3020 CHILDRENS WAY	MC 5019	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
213621	Fee-for-Service	1225436132	1225436132	1	1	RAMIREZ-TORRES, MARILYN LCS	8/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
213623	Fee-for-Service	1518236272	1518236272	1	1	RAFI, NAS N MD	11/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119377	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DRIVE	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
213624	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	2/10/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
213652	Fee-for-Service	1871679837	1871679837	1	1	RAJAH, R S MD INC	6/1/1980	174400000X	NA	Other	026	PHYSICIANS	29661	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	13847 E 14TH STREET	#216	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
213667	Fee-for-Service	1407051675	1407051675	1	1	ROHEWAL, UPINDER MD	11/26/2008	207R00000X	NA	Other	026	PHYSICIANS	100168	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95355	1575	50	06099	37.66508443	-120.9962589	Stanislaus County
213706	Fee-for-Service	1619159860	1619159860	1	1	REYES, CHRISTIAN L MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97481	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
213718	Fee-for-Service	1730192196	1730192196	1	1	RAY, NEIL P MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132924	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
213724	Fee-for-Service	1568443059	1568443059	2	1	RAMISETTI, DATTATREYA K MD	11/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	36545	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	320 SUPERIOR AVE	SUITE 240	NEWPORT BEACH	CA	92663	2779	30	06059	33.62657138	-117.9330754	Orange County
213772	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
213797	Fee-for-Service	1285818534	1285818534	1	1	RANGARAJAN, SURESH B MD	10/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99161	40	Pediatrics	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
213818	Fee-for-Service	1467787135	1467787135	1	1	ROSCOE, STEFANI I LCSW	2/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 W SLAUSON AVE	STE 178	CULVER CITY	CA	90230	6582	19	06037	33.98900447	-118.37979	Los Angeles County
213833	Fee-for-Service	1831673144	1831673144	1	1	REACHWELL HOSPICE CARE, INC	5/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	805 W DUARTE RD	SUITE 103C	ARCADIA	CA	91007	7538	19	06037	34.125718	-118.0575351	Los Angeles County
213836	Fee-for-Service	1740468057	1740468057	1	1	RANASURIYA, DUNISHA G MD	5/1/2019	2080P0204X	NA	Other	026	PHYSICIANS	161114	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
213851	Fee-for-Service	1376643361	1376643361	1	1	ROSENMAN, AMY ELLEN MD	5/10/2013	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	32922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
213868	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	5/8/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
213875	Fee-for-Service	1134277965	1134277965	1	1	ROGAWSKI, JULIE A MD	12/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54827	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
213907	Fee-for-Service	1710287297	1710287297	1	101	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
213922	Fee-for-Service	1255378089	1255378089	1	1	REBECCA KIRSCH	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	645 E 5TH ST	None	WEISER	ID	83672	2202	00	None	44.248716	-116.9617265	Washington County
213931	Fee-for-Service	1356391080	1356391080	1	1	ROSSITER, STEPHEN MD INC	12/1/1987	208G00000X	NA	General Surgery	026	PHYSICIANS	23293	33	Thoracic Surgery	0	In state provider	None	22451 CITATION DR	None	LOS GATOS	CA	95030	8518	43	06085	37.142243	-121.992522	Santa Cruz County
213940	Fee-for-Service	1871679837	1871679837	1	1	RAJAH, R S MD INC	6/1/1980	174400000X	NA	Other	026	PHYSICIANS	29661	41	Internal Medicine	0	In state provider	None	13847 E 14TH STREET	#216	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
213955	Fee-for-Service	1326139932	1326139932	1	2	RAVI S SHANKAR MD PROFESSION	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64181	None	None	0	In state provider	AL CORP	44215 15TH ST	105	LANCASTER	CA	93534	4014	19	06037	34.68666415	-118.1568572	Los Angeles County
213961	Fee-for-Service	1669677365	1669677365	1	1	RIZVI, SYED M MD	12/6/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96440	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
213972	Fee-for-Service	1548403173	1548403173	1	1	RAVICHANDRAN KUMAR, PREETHI	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	DO	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
213975	Fee-for-Service	1316108947	1316108947	1	1	RODEN, CHRISTOPHER DO	10/14/2020	207P00000X	NA	Other	026	PHYSICIANS	12104	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
213988	Fee-for-Service	1770360851	1770360851	1	1	RHIZOME WELLNESS COLLECTIVE	5/9/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	822 G ST	STE 4	ARCATA	CA	95521	6247	12	06023	40.86821305	-124.0859305	Humboldt County
214011	Fee-for-Service	1568443059	1568443059	2	1	RAMISETTI, DATTATREYA K MD	11/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	36545	41	Internal Medicine	0	In state provider	None	320 SUPERIOR AVE	SUITE 240	NEWPORT BEACH	CA	92663	2779	30	06059	33.62657138	-117.9330754	Orange County
214020	Fee-for-Service	1619726742	1619726742	1	1	RIVERA, JESUS M PHD	5/29/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
214024	Fee-for-Service	1700965498	1700965498	1	1	ROBINS, DAVID MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51384	18	Ophthalmology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
214041	Fee-for-Service	1598795775	1598795775	2	1	RIZI, H ROGER MD	6/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35863	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 E 27TH	None	LONG BEACH	CA	90806	1601	19	06037	33.80615859	-118.1885497	Los Angeles County
214048	Fee-for-Service	1376606772	1376606772	1	1	ROSE-LERMAN, LORRAINE	12/19/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
214063	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
214070	Fee-for-Service	1336482827	1336482827	1	1	RAZANI, BAHRAM MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133477	07	Dermatology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
214074	Fee-for-Service	1568973071	1568973071	1	2	REALOPTIONS	1/9/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1671 THE ALAMEDA	STE 101	SAN JOSE	CA	95126	1109	43	06085	37.33686811	-121.9186321	Santa Clara County
214104	Fee-for-Service	1023308145	1023308145	1	1	ROGERS, NICHOLAS A MD INC	4/18/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	112189	None	None	0	In state provider	None	1245 WILSHIRE BLVD	STE 916	LOS ANGELES	CA	90017	4809	19	06037	34.05362775	-118.2661889	Los Angeles County
214114	Fee-for-Service	1467595777	1467595777	1	1	RUSSELL, SARAH L MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127860	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
214124	Fee-for-Service	1740468057	1740468057	1	1	RANASURIYA, DUNISHA G MD	5/1/2019	2080P0204X	NA	Other	026	PHYSICIANS	161114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
214151	Fee-for-Service	1386174449	1386174449	1	1	RYAN HOUGHTON	11/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 W NORFOLK AVE	None	NORFOLK	NE	68701	4438	00	None	42.034779	-97.452981	Madison County
214156	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
214182	Fee-for-Service	1669544326	1669544326	1	1	RAYGOR, JYOTSANA P MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41862	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
214186	Fee-for-Service	1417913476	1417913476	1	1	ROSENTHAL, JONATHAN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63277	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
214193	Fee-for-Service	1508022781	1508022781	1	1	REZVAN, AZADEH MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110360	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
214194	Fee-for-Service	1386903821	1386903821	1	1	REARICK, TIMOTHY MD	11/15/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	120958	20	Orthopedic Surgery	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
214221	Fee-for-Service	1356391080	1356391080	1	1	ROSSITER, STEPHEN MD INC	12/1/1987	208G00000X	NA	General Surgery	026	PHYSICIANS	23293	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	22451 CITATION DR	None	LOS GATOS	CA	95030	8518	43	06085	37.142243	-121.992522	Santa Cruz County
214230	Fee-for-Service	1689772170	1689772170	1	1	ROQUE CENTER, INC	1/31/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10936 DALE AVE	None	STANTON	CA	90680	2724	30	06059	33.80467405	-117.9844767	Orange County
214273	Fee-for-Service	1770360851	1770360851	1	1	RHIZOME WELLNESS COLLECTIVE	5/9/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	822 G ST	STE 4	ARCATA	CA	95521	6247	12	06023	40.86821305	-124.0859305	Humboldt County
214274	Fee-for-Service	1508874173	1508874173	2	1	ROMANO, NOEMI G MD	6/13/2023	207R00000X	NA	Other	026	PHYSICIANS	174795	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
214293	Fee-for-Service	1861013344	1861013344	1	1	RIVAS, KATHERINE CNP	8/10/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
214346	Fee-for-Service	1639117989	1639117989	1	1	REGAN, KATHLEEN C	6/21/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
214349	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	12/5/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
214366	Fee-for-Service	1043395064	1043395064	1	1	RANDHAWA MEDICAL GROUP	4/24/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	1349 MAIN ST	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
214388	Fee-for-Service	1720459514	1720459514	1	1	REEDLEY COMMUNITY HOSPITAL	3/17/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	11976 ROAD 37	None	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
214404	Fee-for-Service	1407433105	1407433105	1	1	READING, JULIA I MD	5/9/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
214410	Fee-for-Service	1164807533	1164807533	1	1	REDDING RANCHERIA	7/30/2015	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	3184 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56138796	-122.3531253	Shasta County
214412	Fee-for-Service	1598750861	1598750861	1	1	RHONDA L DODGE SYATA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 PLEASANT ST	None	DES MOINES	IA	50309	0000	00	None	41.58886035	-93.63191864	Polk County
214432	Fee-for-Service	1730344235	1730344235	1	1	ROBINSON, PANY T MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	96694	08	Family Practice	0	In state provider	None	488 E VALLEY PKWY	SUITE 201	ESCONDIDO	CA	92025	3398	37	06073	33.12523814	-117.0769715	San Diego County
214441	Fee-for-Service	1841381548	1841381548	1	1	ROBERTS, GARY A MD	11/30/1988	207P00000X	NA	Other	026	PHYSICIANS	52311	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
214444	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
214452	Fee-for-Service	1922016062	1922016062	1	1	RANDHAWA, HARPREET MD	3/9/2010	207R00000X	NA	Other	026	PHYSICIANS	84144	41	Internal Medicine	0	In state provider	None	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
214473	Fee-for-Service	1700953635	1700953635	1	1	RUIZ, VICTOR R MD	10/31/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40372	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
214475	Fee-for-Service	1417913476	1417913476	1	1	ROSENTHAL, JONATHAN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63277	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
214478	Fee-for-Service	1942429741	1942429741	1	1	ROBERT A FOX INC	4/7/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	25858	13	Neurology (M.D. only)	0	In state provider	None	2101 VALE RD	STE 101	SAN PABLO	CA	94806	3844	07	06013	37.95420174	-122.3372902	Contra Costa County
214515	Fee-for-Service	1184147159	1184147159	1	1	RELIABLE HOME HEALTH CARE	12/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	13701 RIVERSIDE DR	STE 610	SHERMAN OAKS	CA	91423	2449	19	06037	34.15762986	-118.4316325	Los Angeles County
214522	Fee-for-Service	1528194487	1528194487	1	1	RSCR CALIFORNIA, INC	3/15/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	720 W ROSEWOOD CT	None	ONTARIO	CA	91762	1831	36	06071	34.07715	-117.6614055	San Bernardino County
214531	Fee-for-Service	1295767523	1295767523	1	1	RENNIE, CHARLES J III MD	1/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38458	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
214532	Fee-for-Service	1851597926	1851597926	1	1	RACHAKONDA, VIKRANT MD	8/26/2020	207R00000X	NA	Other	026	PHYSICIANS	169290	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
214535	Fee-for-Service	1770701542	1770701542	1	1	REZVANI, MARYAM MD	6/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0001	00	None	40.77197161	-111.8352608	Salt Lake County
214592	Fee-for-Service	1679572564	1679572564	1	1	RAO, AROOR K R MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
214599	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
214610	Fee-for-Service	1124261946	1124261946	1	1	ROMERO, VICTORIANO MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131574	34	Urology and Urological Surgery	0	In state provider	None	2624 EDITH AVENUE	None	REDDING	CA	96001	3043	45	06089	40.57136027	-122.397513	Shasta County
214625	Fee-for-Service	1033176581	1033176581	1	1	RUGO, HOPE S MD	2/1/1990	207RX0202X	NA	Oncology	026	PHYSICIANS	56942	None	None	0	In state provider	None	400 PARNASSUS AVE	APT 502	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
214636	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
214649	Fee-for-Service	1649371261	1649371261	1	1	ROTHMAN, ELLEN L MD	10/16/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	52696	-	NOT APPLICABLE	0	In state provider	None	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
214655	Fee-for-Service	1043395064	1043395064	1	1	RANDHAWA MEDICAL GROUP	4/24/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	1349 MAIN ST	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
214670	Fee-for-Service	1710440169	1710440169	1	1	RICK, JONATHAN	6/6/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	182777	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
214677	Fee-for-Service	1720459514	1720459514	1	1	REEDLEY COMMUNITY HOSPITAL	12/4/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	11976 ROAD 37	None	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
214698	Fee-for-Service	1164807533	1164807533	1	1	REDDING RANCHERIA	7/30/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3184 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56138796	-122.3531253	Shasta County
214706	Fee-for-Service	1154051308	1154051308	1	1	RYAN DERBY, MD CORP.	7/11/2022	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1330 TARA HILLS DR	STE E105	PINOLE	CA	94564	2531	07	06013	37.99580466	-122.3048363	Contra Costa County
214732	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
214782	Fee-for-Service	1912273582	1912273582	1	1	RAUCH, MELISSA	3/27/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
214802	Fee-for-Service	1417949629	1417949629	1	1	REYES, ALAN B MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52897	41	Internal Medicine	0	In state provider	None	6327 N FRESNO ST	STE 104	FRESNO	CA	93710	5236	10	06019	36.82875536	-119.781417	Fresno County
214818	Fee-for-Service	1851597926	1851597926	1	1	RACHAKONDA, VIKRANT MD	8/26/2020	207R00000X	NA	Other	026	PHYSICIANS	169290	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
214834	Fee-for-Service	1336613975	1336613975	1	1	RODRIGUEZ, ROCHELL A LMFT	6/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
214838	Fee-for-Service	1285654350	1285654350	1	1	RAMIREZ, JUAN C MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90483	08	Family Practice	0	In state provider	None	200 MED PLAZA STE 530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
214840	Fee-for-Service	1447335260	1447335260	1	1	RALPH DAVID D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	MS 359110 C/O UWP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
214850	Fee-for-Service	1609842335	1609842335	1	1	RICHARD WEHSELER MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 BECKER AVE SW	None	WILLMAR	MN	56201	3302	00	None	45.1205233	-95.04619753	Kandiyohi County
214874	Fee-for-Service	1114167293	1114167293	1	1	ROZENFELD, GRIGORIY A DO	11/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	28062 BAXTER ROAD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
214886	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
214922	Fee-for-Service	1952755365	1952755365	1	1	ROQUE, VALERIE CAMILLE MD	10/7/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165777	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
214923	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
214946	Fee-for-Service	1043395064	1043395064	1	1	RANDHAWA MEDICAL GROUP	6/1/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	1349 MAIN ST	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
214966	Fee-for-Service	1720459514	1720459514	1	1	REEDLEY COMMUNITY HOSPITAL	3/17/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	11976 ROAD 37	None	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
214980	Fee-for-Service	1043678188	1043678188	1	1	ROBERTS, MATTHEW B CO	2/8/2016	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1755 GRASS VALLEY HWY	None	AUBURN	CA	95603	2854	31	06061	38.92773221	-121.0870403	Placer County
215020	Fee-for-Service	1710287297	1710287297	1	67	REGENTS UNIVERSITY OF CALIFO	5/8/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1304 15TH STREET	102	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
215032	Fee-for-Service	1740065739	1740065739	1	1	READY 2 GO SOLUTIONS LLC	3/25/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	18564 US HIGHWAY 18	205 B3	APPLE VALLEY	CA	92307	2312	36	06071	34.53926652	-117.2592564	San Bernardino County
215063	Fee-for-Service	1588678460	1588678460	1	1	RILEY, MICHELLE A LCSW	3/16/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1612 W OLIVE AVE	STE 300	BURBANK	CA	91506	2423	19	06037	34.1676558	-118.3226651	Los Angeles County
215114	Fee-for-Service	1326305483	1326305483	1	1	ROEDER, ZACHARY S MD	1/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158804	30	Radiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
215141	Fee-for-Service	1477942258	1477942258	1	1	RAYGOR, VIRAJ P MD	7/14/2022	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150918	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
215154	Fee-for-Service	1003886490	1003886490	1	1	RUIZ, CARMEN MD	3/20/2017	208C00000X	NA	General Surgery	026	PHYSICIANS	146537	02	General Surgery	0	In state provider	None	222 W EULALIA ST	STE 100A	GLENDALE	CA	91204	2508	19	06037	34.12653215	-118.257121	Los Angeles County
215159	Fee-for-Service	1376530576	1376530576	1	1	RICHARD C NAVITSKY, MD	11/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 PROVIDENCE DR	None	ANCHORAGE	AK	99508	4615	00	None	61.188354	-149.8187475	Municipality of Anchorage
215175	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
215179	Fee-for-Service	1679986152	1679986152	1	1	ROBLEDO, BERENICE OCEGUERA	9/10/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1433 LAKE STREET	None	CALISTOGA	CA	94515	1456	28	06055	38.58212836	-122.5827652	Napa County
215197	Fee-for-Service	1083345193	1083345193	1	1	REITSMA-CHO, AMY M LCSW	11/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
215201	Fee-for-Service	1306994389	1306994389	1	1	ROTT, EDWARD J MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53096	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
215214	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
215218	Fee-for-Service	1750941712	1750941712	1	1	ROY CHOWDHURY, IRENE DO	11/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19558	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
215223	Fee-for-Service	1447470554	1447470554	1	1	RAHMAN, MD MAHFUZUR MD	4/21/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	116452	45	Nephrology (Renal-Kidney)	0	In state provider	None	333 UNIVERSITY AVE	STE 120	SACRAMENTO	CA	95825	6532	34	06067	38.570976	-121.416651	Sacramento County
215252	Fee-for-Service	1720459514	1720459514	1	1	REEDLEY COMMUNITY HOSPITAL	11/27/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	11976 ROAD 37	None	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
215278	Fee-for-Service	1649884941	1649884941	1	1	ROSSON, DANIELLE L OT	3/24/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5870 EL CAMINO REAL	100	CARLSBAD	CA	92008	8816	37	06073	33.13309467	-117.2697522	San Diego County
215290	Fee-for-Service	1619030921	1619030921	1	1	RAHBAR,NASROLLAH MD INC	2/16/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	HUNTINGTON BCH DIAGNOSTI	17822 BEACH BLVD	STE 101	HUNTINGTON BEACH	CA	92647	7179	30	06059	33.70331388	-117.9890471	Orange County
215296	Fee-for-Service	1508930819	1508930819	1	1	RUBIN, MARTIN N MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54286	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
215307	Fee-for-Service	1184079287	1184079287	1	1	RICE, KERRILYNN G MD	7/22/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	150941	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
215309	Fee-for-Service	1346285384	1346285384	1	1	RICARDO SALINAS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 E RIDGE RD	None	MCALLEN	TX	78503	0000	00	None	26.18538627	-98.22039454	Hidalgo County
215317	Fee-for-Service	1588831440	1588831440	1	1	RATANASEN, MILIN M MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105506	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
215328	Fee-for-Service	1649725276	1649725276	1	1	RESENDES, ANA C CRNA	11/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
215329	Fee-for-Service	1487732087	1487732087	1	1	REGENSTEIN, ANNE C MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65588	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3838 CALIFORNIA ST	RM 103	SAN FRANCISCO	CA	94118	1504	38	06075	37.78591809	-122.4575439	San Francisco County
215331	Fee-for-Service	1225610710	1225610710	1	1	ROQUE-BULILAN INC.	12/5/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1905 HILLHURST AVE	None	LOS ANGELES	CA	90027	2711	19	06037	34.10550606	-118.2874787	Los Angeles County
215360	Fee-for-Service	1962482919	1962482919	2	1	RAWAL, RACHNA A MD	3/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	82575	40	Pediatrics	0	In state provider	None	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
215436	Fee-for-Service	1730229261	1730229261	1	1	ROMUALDO, GLENN R MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50863	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
215464	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
215468	Fee-for-Service	1679986152	1679986152	1	1	ROBLEDO, BERENICE OCEGUERA	9/10/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1433 LAKE STREET	None	CALISTOGA	CA	94515	1456	28	06055	38.58212836	-122.5827652	Napa County
215475	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
215499	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
215506	Fee-for-Service	1942388657	1942388657	1	1	RAMUNDINO, STEPHEN MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77721	36	Psychiatry	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
215517	Fee-for-Service	1104144120	1104144120	1	1	RAO, RASHMI MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119862	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
215518	Fee-for-Service	1710287297	1710287297	1	114	REGENTS UNIVERSITY OF CALIFO	11/30/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	2701 OCEAN PARK BLVD	130	SANTA MONICA	CA	90405	5223	19	06037	34.01830697	-118.4569168	Los Angeles County
215527	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	5/1/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
215584	Fee-for-Service	1508930819	1508930819	1	1	RUBIN, MARTIN N MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54286	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
215593	Fee-for-Service	1962636928	1962636928	1	1	RAMIREZ-BOYD, LILLY F MD INC	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	59399	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1140 W LA VETA AVE	STE 410	ORANGE	CA	92868	4226	30	06059	33.7802984	-117.8651669	Orange County
215602	Fee-for-Service	1750647947	1750647947	1	1	ROHA-FUENTES, MOLLY L LMFT	9/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8291 UTICA AVE	103	RANCHO CUCAMONGA	CA	91730	7614	36	06071	34.10254043	-117.5711583	San Bernardino County
215620	Fee-for-Service	1265097448	1265097448	1	1	REA, JOY ANN S PT	4/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	331 N 11TH AVE	None	HANFORD	CA	93230	4511	16	06031	36.32682132	-119.6548811	Kings County
215674	Fee-for-Service	1518962539	1518962539	1	1	RABBANI, RAMIN MD	4/9/1999	173000000X	NA	Other	026	PHYSICIANS	85130	41	Internal Medicine	0	In state provider	None	1355 S SAN PEDRO ST	None	LOS ANGELES	CA	90015	3117	19	06037	34.03243628	-118.2543121	Los Angeles County
215716	Fee-for-Service	1811232911	1811232911	1	2	REDDY, HARI M MD	2/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56371	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
215738	Fee-for-Service	1356119390	1356119390	1	1	REYNOLDS, STEPHANIE A BIRTH	4/12/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	23	06045	0	0	None
215750	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	6/12/2020	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
215758	Fee-for-Service	1215215231	1215215231	1	1	ROSENBLIT, PAUL D MD INC	2/23/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18821 DELAWARE ST	STE 202	HUNTINGTON BEACH	CA	92648	1926	30	06059	33.68906927	-117.9932048	Orange County
215762	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
215769	Fee-for-Service	1538455282	1538455282	1	1	REYNOSO TRUJILLO, CYNTHIA N	5/1/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
215787	Fee-for-Service	1710287297	1710287297	1	29	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
215799	Fee-for-Service	1720328610	1720328610	1	1	ROMAN, ABIGAIL LMFT	10/3/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
215801	Fee-for-Service	1013337278	1013337278	1	1	REUBEN, SHARON C MD	1/31/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	192330	None	None	0	In state provider	None	36955 COOK ST	STE 102	PALM DESERT	CA	92211	6084	33	06065	33.77893112	-116.355881	Riverside County
215808	Fee-for-Service	1710287297	1710287297	1	114	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2701 OCEAN PARK BLVD	130	SANTA MONICA	CA	90405	5223	19	06037	34.01830697	-118.4569168	Los Angeles County
215811	Fee-for-Service	1104144120	1104144120	1	1	RAO, RASHMI MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119862	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
215816	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	10/31/2022	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
215837	Fee-for-Service	1871566679	1871566679	1	1	RICHARD K HOWE MD	2/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
215838	Fee-for-Service	1073141222	1073141222	1	1	REYES, ANTHONY DO	12/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22152	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
215902	Fee-for-Service	1871837120	1871837120	1	2	RENTERIA, HORACIO	8/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	740 G ST	STE G	REEDLEY	CA	93654	2629	10	06019	36.60007621	-119.4547214	Fresno County
215922	Fee-for-Service	1619132461	1619132461	1	1	RIESS, JONATHAN W MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103441	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
215944	Fee-for-Service	1013394253	1013394253	1	1	ROSALES, DAISY N	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
215964	Fee-for-Service	1124439807	1124439807	1	10	REGENTS UNIV OF CALIFORNIA U	12/14/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4000 CIVIC CENTER DRIVE	200A	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
215966	Fee-for-Service	1518962539	1518962539	1	1	RABBANI, RAMIN MD	4/9/1999	173000000X	NA	Other	026	PHYSICIANS	85130	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1355 S SAN PEDRO ST	None	LOS ANGELES	CA	90015	3117	19	06037	34.03243628	-118.2543121	Los Angeles County
216005	Fee-for-Service	1023540259	1023540259	1	1	REICHARDT, ANNA D MD	7/17/2023	207L00000X	NA	Other	026	PHYSICIANS	172177	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216017	Fee-for-Service	1548291321	1548291321	1	1	RAY, ANDREA O MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84525	24	Plastic Surgery	0	In state provider	None	11370 ANDERSON ST	# 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
216038	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
216043	Fee-for-Service	1629539820	1629539820	1	1	RENGARAJAN, SOPHIE MD	1/6/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	182441	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
216051	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
216082	Fee-for-Service	1508914425	1508914425	1	1	ROYSTER, LINDA D	2/3/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
216096	Fee-for-Service	1710287297	1710287297	1	114	REGENTS UNIVERSITY OF CALIFO	11/30/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	2701 OCEAN PARK BLVD	130	SANTA MONICA	CA	90405	5223	19	06037	34.01830697	-118.4569168	Los Angeles County
216105	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
216118	Fee-for-Service	1649613464	1649613464	1	1	RHOADS, DOROTA K MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137621	01	General Practice	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
216168	Fee-for-Service	1972150324	1972150324	1	1	RODRIGUEZ, LIZETTE MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	187800	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
216203	Fee-for-Service	1295866614	1295866614	1	1	RODRIGUEZ, BEVERLY I MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94749	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
216220	Fee-for-Service	1215453113	1215453113	1	1	RUSH HOME HEALTH INC	9/25/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7560 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2117	19	06037	34.2539204	-118.2971599	Los Angeles County
216230	Fee-for-Service	1124439807	1124439807	1	9	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5000 CIVIC CENTER DR	None	SAN RAFAEL	CA	94903	4184	21	06041	38.006091	-122.539414	Marin County
216247	Fee-for-Service	1700091295	1700091295	1	1	RONALD A ARAKELIAN MD &	3/1/1980	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MONTE VISTA LABORATORY	920 DELBON AVE	None	TURLOCK	CA	95382	2019	50	06099	37.51045858	-120.8376324	Stanislaus County
216253	Fee-for-Service	1124439807	1124439807	1	10	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4000 CIVIC CENTER DRIVE	200A	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
216254	Fee-for-Service	1447698808	1447698808	1	1	RANOLA, AMANDA I ID	1/25/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5163 LONE TREE WAY	None	ANTIOCH	CA	94531	8689	07	06013	37.96179103	-121.7556082	Contra Costa County
216257	Fee-for-Service	1437144540	1437144540	1	1	RODRIGUEZ, JAN L	2/21/2001	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	QUALITY CARE/DME SOLUTIO	22077 BARTON RD	STE A	GRAND TERRACE	CA	92313	5001	36	06071	34.03377541	-117.3230904	San Bernardino County
216258	Fee-for-Service	1588939847	1588939847	1	1	REECE, ROSLYN	2/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
216272	Fee-for-Service	1578699104	1578699104	1	1	RANGI, JASBIR S MD	3/4/2005	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	88569	None	None	0	In state provider	None	2 MEDICAL PLAZA DR	STE 270	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
216310	Fee-for-Service	1922059849	1922059849	1	1	RAO, VYSHALI S MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72520	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	50 ALESSANDRO PL	STE 200	PASADENA	CA	91105	4002	19	06037	34.13101049	-118.151532	Los Angeles County
216329	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
216335	Fee-for-Service	1568662252	1568662252	1	1	RYAN DOUGLAS REYNOLDS M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
216340	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
216376	Fee-for-Service	1780628842	1780628842	1	1	RAHMAN, JAMAL MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53308	08	Family Practice	0	In state provider	None	9645 MONTE VISTA AVE	STE 302	MONTCLAIR	CA	91763	2236	36	06071	34.0800785	-117.6982299	San Bernardino County
216385	Fee-for-Service	1710287297	1710287297	1	114	REGENTS UNIVERSITY OF CALIFO	11/30/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	2701 OCEAN PARK BLVD	130	SANTA MONICA	CA	90405	5223	19	06037	34.01830697	-118.4569168	Los Angeles County
216391	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
216404	Fee-for-Service	1609872639	1609872639	1	1	RICHARDS,KIRK PM	3/16/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5725 RALSTON ST	STE 103	VENTURA	CA	93003	6053	56	06111	34.26095488	-119.2125269	Ventura County
216407	Fee-for-Service	1700034691	1700034691	1	1	RODRIGUEZ ADORNO, DANELLA M	11/16/2023	2085P0229X	NA	Other	026	PHYSICIANS	188361	None	None	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216437	Fee-for-Service	1992899512	1992899512	1	1	RABIN, NINA R MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71115	01	General Practice	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
216463	Fee-for-Service	1316320914	1316320914	1	1	REINHARDT IANNI, KATIE LMFT	3/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	419 SPRING STREET	SUITE A	NEVADA CITY	CA	95959	2446	29	06057	39.26252155	-121.0210988	Nevada County
216487	Fee-for-Service	1295866614	1295866614	1	1	RODRIGUEZ, BEVERLY I MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94749	26	Psychiatry (child)	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
216506	Fee-for-Service	1982790085	1982790085	1	1	REIDER, MELISSA M RN	6/2/1999	2084N0402X	NA	Neurology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
216517	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	3/26/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
216518	Fee-for-Service	1124439807	1124439807	1	9	REGENTS UNIV OF CALIFORNIA U	1/23/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5000 CIVIC CENTER DR	None	SAN RAFAEL	CA	94903	4184	21	06041	38.006091	-122.539414	Marin County
216540	Fee-for-Service	1699941484	1699941484	1	1	REED, JASON T DO	11/12/2008	207L00000X	NA	Other	026	PHYSICIANS	9385	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
216542	Fee-for-Service	1124439807	1124439807	1	10	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4000 CIVIC CENTER DRIVE	200A	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
216559	Fee-for-Service	1962630863	1962630863	1	1	RYAN SWAPP	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
216602	Fee-for-Service	1699877621	1699877621	1	2	REGENTS OF THE UNIVERSITY OF	1/31/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
216614	Fee-for-Service	1710287297	1710287297	1	17	REGENTS UNIVERSITY OF CALIFO	4/12/2023	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
216629	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
216630	Fee-for-Service	1730267444	1730267444	1	1	ROBINSON, KRISTEN A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60629	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
216678	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
216680	Fee-for-Service	1972581627	1972581627	1	1	ROSS, ARNOLD S DPM	6/30/1982	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2288 WESTWOOD BLVD	None	LOS ANGELES	CA	90064	2000	19	06037	34.04264646	-118.4306181	Los Angeles County
216685	Fee-for-Service	1720491285	1720491285	1	1	ROCK, ROCHELLE C MD	8/1/2017	207P00000X	NA	Other	026	PHYSICIANS	148017	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
216708	Fee-for-Service	1124157953	1124157953	1	1	ROHDE, ERIN S	5/30/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
216715	Fee-for-Service	1114539343	1114539343	1	1	REYES, ERIC LCSW	3/7/2024	225XM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
216791	Fee-for-Service	1851656631	1851656631	1	1	RENDE, ALEXANDER K MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150167	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
216803	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
216806	Fee-for-Service	1124439807	1124439807	1	9	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5000 CIVIC CENTER DR	None	SAN RAFAEL	CA	94903	4184	21	06041	38.006091	-122.539414	Marin County
216809	Fee-for-Service	1578855904	1578855904	1	1	RHOADS, RYAN W PT	8/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
216833	Fee-for-Service	1124439807	1124439807	1	15	REGENTS UNIV OF CALIFORNIA U	11/22/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	230	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
216844	Fee-for-Service	1669211314	1669211314	1	1	RAMIREZ, ERIN CRNA	7/10/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
216869	Fee-for-Service	1467529818	1467529818	1	1	RATTER, PAULA M LMFT	5/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
216889	Fee-for-Service	1699877621	1699877621	1	2	REGENTS OF THE UNIVERSITY OF	12/30/1990	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
216902	Fee-for-Service	1154759413	1154759413	1	2	ROBBINS, AMY S LCSW	10/15/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 FREEMAN LN	SUITE 305	GRASS VALLEY	CA	95949	7737	29	06057	39.19949606	-121.0633507	Nevada County
216907	Fee-for-Service	1154479566	1154479566	1	1	RUPP, CARA M LCSW	12/22/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22158	-	NOT APPLICABLE	0	In state provider	None	676 LOUGHBOROUGH DRIVE	None	MERCED	CA	95348	2601	24	06047	37.32268062	-120.4793547	Merced County
216914	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	9/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
216920	Fee-for-Service	1962415208	1962415208	1	1	RADIOLOGY MEDICAL GROUP	1/1/1979	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SANTA CRUZ COUNTY INC	1661 SOQUEL DR	STE G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
216922	Fee-for-Service	1780143560	1780143560	1	1	ROSARIO, SANTANO L MD	12/21/2023	207P00000X	NA	Other	026	PHYSICIANS	182438	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
216931	Fee-for-Service	1265598585	1265598585	1	1	RAYMOND, ERIC MD	2/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81666	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
216957	Fee-for-Service	1609186584	1609186584	1	1	ROBILLARD, CAYLA	5/31/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
216960	Fee-for-Service	1780296608	1780296608	1	1	RAMOS, MONICA OD	10/8/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 E VENTURA BLVD.	None	OXNARD	CA	93036	1813	56	06111	34.22378048	-119.1501106	Ventura County
216962	Fee-for-Service	1003909821	1003909821	1	1	RAMAYA, MEERA S MD	1/16/2017	2080P0205X	NA	Endocrinology	026	PHYSICIANS	146915	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	STES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
216968	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
216977	Fee-for-Service	1689831570	1689831570	1	1	RAMIREZ, OSCAR O JR MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131409	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
216994	Fee-for-Service	1669002192	1669002192	1	1	RIVERA, PRISCILLA LPCC	7/27/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
217011	Fee-for-Service	1114963170	1114963170	2	1	RULLAN, PETER P MD	2/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42243	07	Dermatology	0	In state provider	None	256 LANDIS AVE	FL 3	CHULA VISTA	CA	91910	2650	37	06073	32.64258295	-117.0815646	San Diego County
217065	Fee-for-Service	1790939148	1790939148	1	1	RAMOS, EDUARDO MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
217079	Fee-for-Service	1649659681	1649659681	1	1	RENWANZ, INGRID NP	10/8/2024	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
217092	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	11/10/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
217111	Fee-for-Service	1881810380	1881810380	1	1	ROSS, MELANIE A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217120	Fee-for-Service	1720510126	1720510126	1	1	RICCI, LINDSEY R	3/17/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169513	None	None	0	In state provider	None	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
217121	Fee-for-Service	1124439807	1124439807	1	15	REGENTS UNIV OF CALIFORNIA U	6/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	75 ROWLAND WAY	230	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
217176	Fee-for-Service	1699877621	1699877621	1	2	REGENTS OF THE UNIVERSITY OF	6/27/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
217201	Fee-for-Service	1710287297	1710287297	1	87	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	19	06037	33.8375955	-118.358748	Los Angeles County
217216	Fee-for-Service	1366760175	1366760175	1	1	ROSEN, LYNNE N MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111157	40	Pediatrics	0	In state provider	None	5400 TELEGRAPH AVENUE	None	OAKLAND	CA	94618	1965	01	06001	37.83925524	-122.2620144	Alameda County
217219	Fee-for-Service	1124897962	1124897962	1	1	RODRIGUEZ, HEATHER P CRNA	8/21/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
217255	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	1/15/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
217256	Fee-for-Service	1073692133	1073692133	1	1	REDEEMER, DIANA L LPCC	10/25/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
217262	Fee-for-Service	1417033911	1417033911	1	1	REDDY, PRASHANTHI G MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78871	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
217283	Fee-for-Service	1073538674	1073538674	1	1	RALPH'S GROCERY COMPANY	7/13/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPH'S #645	500 N SEPULVEDA BLVD	None	EL SEGUNDO	CA	90245	4447	19	06037	33.92297527	-118.3961325	Los Angeles County
217302	Fee-for-Service	1376613406	1376613406	2	1	RYCHKOV, ANDREY I MD	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83326	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
217324	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
217329	Fee-for-Service	1356583983	1356583983	1	2	RODAN HOME HEALTH SERVICES	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2140 W OLYMPIC BLVD	SUITE 501	LOS ANGELES	CA	90006	2273	19	06037	34.05206987	-118.2806804	Los Angeles County
217330	Fee-for-Service	1437155496	1437155496	1	1	ROGERS-NEUFELD, BONNA MD	12/31/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46068	None	None	0	In state provider	None	6191 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.826362	-119.7831265	Fresno County
217349	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
217382	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
217383	Fee-for-Service	1154409811	1154409811	1	1	RINZLER, GARY S MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67994	25	Physical Medicine and Rehabilitation	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
217407	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
217408	Fee-for-Service	1124439807	1124439807	1	15	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207Q00000X	NA	Adult Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	75 ROWLAND WAY	230	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
217451	Fee-for-Service	1124146329	1124146329	1	1	RYALL, MEGHAN E MD	11/10/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	95454	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
217478	Fee-for-Service	1487781753	1487781753	1	1	ROCKCREEK INC	7/29/1991	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1574 LILLIAN LN	None	HIGHLAND	CA	92346	3001	36	06071	34.12787232	-117.2139986	San Bernardino County
217536	Fee-for-Service	1053523001	1053523001	1	1	REDDING, PATRICIA L R	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	REDDING'S SPCH & LNG CTR	2005 CANAL DR	None	REDDING	CA	96001	1204	45	06089	40.58085127	-122.3788709	Shasta County
217541	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
217546	Fee-for-Service	1124198312	1124198312	1	1	RAHBAN, MASOUD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89779	77	Infectious Disease	0	In state provider	None	5901 WEST OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
217579	Fee-for-Service	1093178329	1093178329	1	1	REEDER, SAMANTHA	5/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
217591	Fee-for-Service	1366768723	1366768723	1	1	RIMLER, SHELLY B MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119632	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
217598	Fee-for-Service	1497833883	1497833883	1	2	RUSU, DAN C MD	11/7/2019	208M00000X	NA	Other	026	PHYSICIANS	100840	None	None	0	In state provider	None	2801 EUREKA WAY	None	REDDING	CA	96001	0222	45	06089	40.58569445	-122.4137153	Shasta County
217611	Fee-for-Service	1710287297	1710287297	1	80	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
217621	Fee-for-Service	1063511814	1063511814	1	1	RICK, TRACY R MSW LCSW	8/29/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
217622	Fee-for-Service	1124439807	1124439807	1	4	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7120 REDWOOD BLVD	STE B	NOVATO	CA	94945	4114	21	06041	38.10102188	-122.5683289	Marin County
217634	Fee-for-Service	1972589554	1972589554	1	1	RANDHAWA, SUNDEEP K MD	8/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80068	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
217635	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	10/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
217654	Fee-for-Service	1275556607	1275556607	1	15	REDWOOD REGIONAL MEDICAL	6/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	1165 S DORA ST	STE H	UKIAH	CA	95482	8325	23	06045	39.13602308	-123.2095502	Mendocino County
217667	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	11/10/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
217672	Fee-for-Service	1609971290	1609971290	1	1	RAHIMI, MOHAMMAD B MD	10/31/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77508	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
217684	Fee-for-Service	1902803315	1902803315	1	1	REGENTS OF THE UNIVERSITY OF	7/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
217697	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
217710	Fee-for-Service	1922404870	1922404870	1	1	ROYAL OAK RESIDENCE INC	5/8/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10458 PLAINVIEW AVE	None	TUJUNGA	CA	91042	1716	19	06037	34.25905616	-118.2978965	Los Angeles County
217715	Fee-for-Service	1568557478	1568557478	1	1	RGP ORTHOPEDIC APPLIANCE	7/1/1996	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	DBA RGP PROSTHETIC RSRCH	6147 UNIVERSITY AVE	None	SAN DIEGO	CA	92115	5720	37	06073	32.7531363	-117.0634686	San Diego County
217721	Fee-for-Service	1912433947	1912433947	1	1	ROCHA CABRERO, FRANKLYN MD	2/14/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	171493	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
217734	Fee-for-Service	1891092334	1891092334	1	1	RAPADA, MAILAH F PT	9/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
217791	Fee-for-Service	1467863951	1467863951	1	1	ROGERS, MICHAEL MD	10/15/2018	207R00000X	NA	Other	026	PHYSICIANS	151521	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
217832	Fee-for-Service	1710287297	1710287297	1	4	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CALIFORNIA LOS ANGELES	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
217848	Fee-for-Service	1124198312	1124198312	1	1	RAHBAN, MASOUD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89779	41	Internal Medicine	0	In state provider	None	5901 WEST OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
217864	Fee-for-Service	1417005380	1417005380	1	1	REDDY, NEERAJA B MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42882	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
217876	Fee-for-Service	1679653711	1679653711	1	1	RAYBIN, DANIEL M MD	5/20/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30516	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
217881	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	1/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
217900	Fee-for-Service	1710287297	1710287297	1	80	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
217912	Fee-for-Service	1124439807	1124439807	1	4	REGENTS UNIV OF CALIFORNIA U	9/28/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	7120 REDWOOD BLVD	STE B	NOVATO	CA	94945	4114	21	06041	38.10102188	-122.5683289	Marin County
217916	Fee-for-Service	1326617697	1326617697	1	1	REDWOODS RURAL HEALTH CENTER	7/20/2021	261QF0400X	NMT Provider	Federally Qualified Health Center	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	, INC.	101 WEST COAST RD	None	REDWAY	CA	95560	0769	12	06023	40.11704433	-123.8133408	Humboldt County
217920	Fee-for-Service	1972589554	1972589554	1	1	RANDHAWA, SUNDEEP K MD	8/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80068	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
217922	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	5/31/2023	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
217939	Fee-for-Service	1083950737	1083950737	1	1	ROBERTSON, ERIN M LMFT	5/29/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
217953	Fee-for-Service	1962770636	1962770636	1	1	RADMAN, MIRKA A NP	4/14/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6402 EL CAJON BLVD	SUITE 102	SAN DIEGO	CA	92115	2645	37	06073	32.76516432	-117.0605937	San Diego County
217955	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
217973	Fee-for-Service	1902803315	1902803315	1	1	REGENTS OF THE UNIVERSITY OF	7/1/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
217974	Fee-for-Service	1417125246	1417125246	1	1	RISSE, ALMA M LCSW	6/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13033 PENN ST	STE 800	WHITTIER	CA	90602	1603	19	06037	33.97545878	-118.03636	Los Angeles County
217982	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
217997	Fee-for-Service	1659534535	1659534535	1	1	RODGERS-OHLAU, MELISSA M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110503	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
218053	Fee-for-Service	1184265894	1184265894	1	1	RAMIREZ, TONYA R	3/16/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	28071 BRADLEY ROAD	None	SUN CITY	CA	92586	2207	33	06065	33.71361844	-117.1907555	Riverside County
218125	Fee-for-Service	1871690016	1871690016	1	1	RUTH RECALDE	5/1/1988	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AABLE MEDICAL PRODUCTS	2309 PALMETTO AVE	STE B1	PACIFICA	CA	94044	2736	41	06081	37.631124	-122.492562	San Mateo County
218150	Fee-for-Service	1417005380	1417005380	1	1	REDDY, NEERAJA B MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42882	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
218161	Fee-for-Service	1215923792	1215923792	1	1	ROBIN M. MANTOOTH, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 N PORTER AVE	None	NORMAN	OK	73071	6404	00	None	35.23022019	-97.44110859	Cleveland County
218171	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
218188	Fee-for-Service	1710287297	1710287297	1	80	REGENTS UNIVERSITY OF CALIFO	5/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
218199	Fee-for-Service	1124439807	1124439807	1	4	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7120 REDWOOD BLVD	STE B	NOVATO	CA	94945	4114	21	06041	38.10102188	-122.5683289	Marin County
218200	Fee-for-Service	1700555802	1700555802	1	1	RENTON, RACHAEL NP	4/23/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
218210	Fee-for-Service	1184078990	1184078990	1	1	REDDY, VENNELA	7/30/2019	207L00000X	NA	Other	026	PHYSICIANS	162760	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
218211	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	10/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
218214	Fee-for-Service	1568973071	1568973071	1	4	REALOPTIONS	7/13/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	801 BREWSTER AVE	STE 210	REDWOOD CITY	CA	94063	1556	41	06081	37.48853111	-122.2341386	San Mateo County
218222	Fee-for-Service	1902807670	1902807670	1	1	RANNEY, ROBERT E MD	10/17/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	42364	08	Family Practice	0	In state provider	None	2720 N HARBOR BLVD	STE 100	FULLERTON	CA	92835	2625	30	06059	33.90126238	-117.9292154	Orange County
218244	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
218260	Fee-for-Service	1174936454	1174936454	1	1	ROYSTER, JAMES A NP	4/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1525 W FLORIDA AVE	STE D	HEMET	CA	92543	3869	33	06065	33.7473507	-116.9878543	Riverside County
218271	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
218290	Fee-for-Service	1073237327	1073237327	1	1	RICHARDSON, KIARA PT	11/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
218303	Fee-for-Service	1073836060	1073836060	1	1	REGENTS UNIVERSITY OF CA	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	SFGH DEPT OF MEDICINE	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
218329	Fee-for-Service	1902197734	1902197734	1	1	RESNICK, SHELBY MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116185	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
218344	Fee-for-Service	1952380446	1952380446	1	1	RULISON, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61453	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3177 TURNER ST	None	PLACERVILLE	CA	95667	5724	09	06017	38.72620307	-120.7900368	El Dorado County
218359	Fee-for-Service	1699844613	1699844613	1	1	RIVERSIDE RADIOLOGY	10/17/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	4000 14TH STREET	STE 109	RIVERSIDE	CA	92501	4083	33	06065	33.97771007	-117.3818381	Riverside County
218393	Fee-for-Service	1700944899	1700944899	1	1	ROSEMARY PATTERSON D	3/19/2007	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	430 N CEDAR ST	STE A	ESCONDIDO	CA	92025	4650	37	06073	33.12984675	-117.0701934	San Diego County
218432	Fee-for-Service	1811277122	1811277122	1	1	RHEE, SARAH S	4/15/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	750 THE CITY DRIVE S	SUITE 130	ORANGE	CA	92868	6943	30	06059	33.77566163	-117.8903781	Orange County
218447	Fee-for-Service	1457803090	1457803090	1	1	RADACH, KYLE B PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
218458	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	1/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
218475	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
218499	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	10/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
218507	Fee-for-Service	1699102004	1699102004	1	1	ROBERTS, DAYLEN C LCSW	12/1/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	14715 EAST HIGHWAY 20	None	CLEARLAKE OAKS	CA	95423	0366	17	06033	39.01323418	-122.6330714	Lake County
218509	Fee-for-Service	1912085754	1912085754	1	1	ROSSNER, REBECCA A MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63402	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
218514	Fee-for-Service	1437337532	1437337532	1	1	RANSBARGER, KRISTIANE M MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104819	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
218533	Fee-for-Service	1710287297	1710287297	1	94	REGENTS UNIVERSITY OF CALIFO	11/10/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
218557	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
218577	Fee-for-Service	1336104538	1336104538	1	1	ROUNAGHI, AMIR MD	12/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	73517	20	Orthopedic Surgery	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
218624	Fee-for-Service	1760420053	1760420053	1	1	RODRIGUEZ, JOSEPH L MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87545	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
218636	Fee-for-Service	1952380446	1952380446	1	1	RULISON, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61453	08	Family Practice	0	In state provider	None	3177 TURNER ST	None	PLACERVILLE	CA	95667	5724	09	06017	38.72620307	-120.7900368	El Dorado County
218644	Fee-for-Service	1730709064	1730709064	1	1	ROXAS, HAZELANN MD	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
218657	Fee-for-Service	1376193177	1376193177	1	1	ROMA, VINCENZO G PHD	7/26/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	28480 SAGE GLEN TRL	None	ESCONDIDO	CA	92026	6617	37	06073	33.22566006	-117.1184834	San Diego County
218669	Fee-for-Service	1538266424	1538266424	1	1	RAMIREZ, ALEXANDER J MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74102	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
218675	Fee-for-Service	1154445377	1154445377	1	1	RODELA, MARY E LMFT	10/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LY COUNSELING	13033 PENN STREET	800	WHITTIER	CA	90602	1603	19	06037	33.97545878	-118.03636	Los Angeles County
218682	Fee-for-Service	1851329981	1851329981	1	1	RIVERA, MARTHA E MD	4/29/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58728	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
218728	Fee-for-Service	1699821660	1699821660	1	1	RAMIREZ, VICTORIA N MD	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79596	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
218747	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
218764	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	5/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
218788	Fee-for-Service	1710287297	1710287297	1	110	REGENTS UNIVERSITY OF CALIFO	8/10/2023	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
218802	Fee-for-Service	1194712315	1194712315	1	1	RAINCROSS MEDICAL GROUP	10/28/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	4646 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
218843	Fee-for-Service	1427185883	1427185883	1	1	RSCR INLAND INC	8/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	KEVIN HOUSE	2662 KEVIN CT	None	RIVERSIDE	CA	92506	5117	33	06065	33.93501879	-117.37857	Riverside County
218848	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
218917	Fee-for-Service	1043254907	1043254907	1	1	ROTH, RONALD C MD	5/13/1997	174400000X	NA	Other	026	PHYSICIANS	27020	04	Otology, Laryngology, Rhinology	0	In state provider	None	2175 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
218922	Fee-for-Service	1104479559	1104479559	1	1	ROMO ROMO, MARIA G LCSW	8/1/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
218961	Fee-for-Service	1285995431	1285995431	1	1	RIVAZ, MALIHE MD	5/20/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	140272	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
218987	Fee-for-Service	1952338600	1952338600	1	1	ROBERSON, ANDREA A DO	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4958	01	General Practice	0	In state provider	None	15 MAREBLU	STE 240	ALISO VIEJO	CA	92656	3047	30	06059	33.5729913	-117.703431	Orange County
219010	Fee-for-Service	1891873378	1891873378	1	2	ROYLE, KENNETH M MD	1/20/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43958	None	None	0	In state provider	None	250 WEST 5TH STREET	None	HANFORD	CA	93230	5029	16	06031	36.32439821	-119.6472235	Kings County
219011	Fee-for-Service	1700926862	1700926862	1	1	RICKLES, DAVID J MD	1/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	56693	30	Radiology	0	In state provider	None	150 N ROBERTSON BLVD	STE 160	BEVERLY HILLS	CA	90211	2197	19	06037	34.06812722	-118.3837146	Los Angeles County
219034	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	9/8/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
219051	Fee-for-Service	1710287297	1710287297	1	80	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
219067	Fee-for-Service	1174591812	1174591812	1	1	RANCHO PHYSICAL THERAPY, INC	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	521 E ELDER ST	SUITE 106/107	FALLBROOK	CA	92028	3081	37	06073	33.38015149	-117.246267	San Diego County
219089	Fee-for-Service	1194712315	1194712315	1	1	RAINCROSS MEDICAL GROUP	10/28/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	INC	4646 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
219102	Fee-for-Service	1942605456	1942605456	1	1	REHABILITATION CENTER OF	1/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SANTA MONICA OPERATING	1338 20TH ST	None	SANTA MONICA	CA	90404	2034	19	06037	34.02920248	-118.4806725	Los Angeles County
219119	Fee-for-Service	1639739147	1639739147	1	1	ROCHELLE, ANGELIQUE LMFT	9/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
219134	Fee-for-Service	1710287297	1710287297	1	93	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
219136	Fee-for-Service	1437237518	1437237518	1	1	ROSSI, JOHN M MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67553	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
219158	Fee-for-Service	1619397338	1619397338	1	1	RATNAYAKE, RUWAN MD	2/2/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	141625	None	None	0	In state provider	None	2801 K ST	SUITE 410	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
219169	Fee-for-Service	1306062179	1306062179	1	1	RODRIGUEZ, DAVID MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51153	-	NOT APPLICABLE	0	In state provider	None	5628 E SLAUSON AVENUE	None	COMMERCE	CA	90040	2922	19	06037	33.98593459	-118.163681	Los Angeles County
219175	Fee-for-Service	1669865747	1669865747	1	1	RETINA INSTITUTE OF CALIFORN	3/1/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	500 SOUTH ANAHEIM HILLS	234	ANAHEIM	CA	92856	6526	30	06059	33.8427954	-117.7772895	Orange County
219179	Fee-for-Service	1245201680	1245201680	1	1	RAGHEB, DINA M MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84745	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
219208	Fee-for-Service	1649898743	1649898743	1	1	RODRIGUEZ, AIMEE	4/10/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1400 REYNOLDS AVE	SUITE 201	IRVINE	CA	92614	5563	30	06059	33.6957272	-117.8542013	Orange County
219210	Fee-for-Service	1043254907	1043254907	1	1	ROTH, RONALD C MD	5/13/1997	174400000X	NA	Other	026	PHYSICIANS	27020	01	General Practice	0	In state provider	None	2175 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
219213	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
219248	Fee-for-Service	1962521047	1962521047	1	1	ROSE, CHARLENE A LMFT	1/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	426 14TH STREET	SUITE 110	MODESTO	CA	95354	2661	50	06099	37.63834873	-120.9904519	Stanislaus County
219279	Fee-for-Service	1538606215	1538606215	1	1	ROBINSON, MECHELLE LMFT	5/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1101 CALIFORNIA AVE.	STE. 202	CORONA	CA	92881	4278	33	06065	33.86171794	-117.5440764	Riverside County
219283	Fee-for-Service	1669550299	1669550299	1	1	RECHTIN, LISSA K MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68768	36	Psychiatry	0	In state provider	THE PERMANENTE MED GRP	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
219291	Fee-for-Service	1831101609	1831101609	1	1	ROBERTSON, KENNETH L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
219298	Fee-for-Service	1700926862	1700926862	1	1	RICKLES, DAVID J MD	1/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	56693	78	Neoplastic Diseases/Oncology	0	In state provider	None	150 N ROBERTSON BLVD	STE 160	BEVERLY HILLS	CA	90211	2197	19	06037	34.06812722	-118.3837146	Los Angeles County
219323	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	1/27/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
219341	Fee-for-Service	1710287297	1710287297	1	80	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
219366	Fee-for-Service	1326346677	1326346677	1	1	RAINWATER, DEBORAH L LMFT	4/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1651 E FOURTH ST	STE 240	SANTA ANA	CA	92701	5169	30	06059	33.74814742	-117.8454019	Orange County
219375	Fee-for-Service	1417977992	1417977992	1	1	RODRIGUES, MARK J MD	4/30/1992	207R00000X	NA	Other	026	PHYSICIANS	46340	41	Internal Medicine	0	In state provider	None	1201 W LA VETA AVE	STE 306	ORANGE	CA	92868	4208	30	06059	33.78034779	-117.8655767	Orange County
219376	Fee-for-Service	1194712315	1194712315	1	1	RAINCROSS MEDICAL GROUP	10/28/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	4646 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
219447	Fee-for-Service	1790399004	1790399004	1	1	ROSENBERG, RONELLA N AU	10/19/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	100A SAN PABLO TOWNE CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
219464	Fee-for-Service	1669865747	1669865747	1	1	RETINA INSTITUTE OF CALIFORN	3/1/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 SOUTH ANAHEIM HILLS	234	ANAHEIM	CA	92856	6526	30	06059	33.8427954	-117.7772895	Orange County
219477	Fee-for-Service	1013900075	1013900075	1	1	REGENTS/UCDPBG/SUR TRANS	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
219500	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
219510	Fee-for-Service	1982921276	1982921276	1	1	ROMEROSO, BRIANNE D MD	8/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119863	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
219536	Fee-for-Service	1659459550	1659459550	1	1	REITZ, MICHAEL D MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40946	30	Radiology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
219571	Fee-for-Service	1629056692	1629056692	1	1	REZAEE, MEHRDAD MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83930	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
219602	Fee-for-Service	1013202738	1013202738	1	1	RUSH, LAURA A MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11685	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
219610	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
219615	Fee-for-Service	1407891641	1407891641	1	1	REISSMANN, PETER T MD	7/26/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	57545	68	Hematology	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2198	37	06073	32.75053781	-117.1627168	San Diego County
219627	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	5/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
219664	Fee-for-Service	1851657530	1851657530	1	1	ROHRHOFF, NICHOLAS MD	4/12/2024	207R00000X	NA	Other	026	PHYSICIANS	159224	41	Internal Medicine	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
219688	Fee-for-Service	1730264268	1730264268	2	1	ROBERG, SCOT L DPM	6/24/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
219725	Fee-for-Service	1225198591	1225198591	1	1	REVECAMP, CONNIE L	7/3/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
219736	Fee-for-Service	1255561122	1255561122	1	1	RAHNAMAYI, BAHAR MD	3/15/2011	390200000X	NA	Other	026	PHYSICIANS	113410	08	Family Practice	0	In state provider	None	901 OLIVE DR	None	BAKERSFIELD	CA	93308	4137	15	06029	35.41225153	-119.0396655	Kern County
219749	Fee-for-Service	1326055963	1326055963	1	1	RAJARAM, KASTURI MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	31628	40	Pediatrics	0	In state provider	MEDICAL CLINIC	1320 APPLE AVE	STE 102	HAYWARD	CA	94541	1552	01	06001	37.68451068	-122.0927751	Alameda County
219754	Fee-for-Service	1295929909	1295929909	1	1	RINCON, ALEJANDRINA I MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94705	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
219764	Fee-for-Service	1871720987	1871720987	1	1	REZNIK, ALENA K MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113775	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
219788	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
219842	Fee-for-Service	1902924111	1902924111	1	1	RAMIREZ, DEBBIE G LCSW	10/30/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
219853	Fee-for-Service	1124435342	1124435342	1	1	RUDIE, JEFFREY D MD	6/2/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159716	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
219865	Fee-for-Service	1740220755	1740220755	1	1	RUFF, RONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 COTTONWOOD ST	None	SALT LAKE CTY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
219870	Fee-for-Service	1497833883	1497833883	1	1	RUSU, DAN C MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100840	None	None	0	In state provider	None	1645 PINE ST	None	REDDING	CA	96001	1018	45	06089	40.58295477	-122.3888377	Shasta County
219898	Fee-for-Service	1710287297	1710287297	1	16	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
219906	Fee-for-Service	1407891641	1407891641	1	1	REISSMANN, PETER T MD	7/26/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	57545	78	Neoplastic Diseases/Oncology	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2198	37	06073	32.75053781	-117.1627168	San Diego County
219908	Fee-for-Service	1013337781	1013337781	1	1	ROSOFF, ERIC D MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156080	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
219909	Fee-for-Service	1366822348	1366822348	1	1	RUBY, ALEXANDER MD	9/3/2019	207P00000X	NA	Other	026	PHYSICIANS	159865	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
219916	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
219943	Fee-for-Service	1497162440	1497162440	1	1	RUBIO GARCIA, MANOLO MD	6/13/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	148566	None	None	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
219966	Fee-for-Service	1992802680	1992802680	1	1	ROFIM MEDICAL GROUP INC	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	68455	40	Pediatrics	0	In state provider	None	1920 E KATELLA AVE	STE M	ORANGE	CA	92867	5146	30	06059	33.80935	-117.8339093	Orange County
220035	Fee-for-Service	1326055963	1326055963	1	1	RAJARAM, KASTURI MD	5/13/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL CLINIC	1320 APPLE AVE	STE 102	HAYWARD	CA	94541	1552	01	06001	37.68451068	-122.0927751	Alameda County
220036	Fee-for-Service	1881676377	1881676377	1	2	RICHARD P CARR PHYSICAL THER	11/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	3097 MOORPARK AVE STE 10	None	SAN JOSE	CA	95128	2543	43	06085	37.31611151	-121.9497092	Santa Clara County
220049	Fee-for-Service	1124386719	1124386719	1	1	ROOPTOWN EMERGENCY PHYSICIAN	5/26/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1800 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
220077	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
220124	Fee-for-Service	1265158703	1265158703	1	1	RIVERSIDE EYECARE PROFESSION	3/27/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ALS INC A MEDICAL CORPOR	2801 PARK MARINA DR	None	REDDING	CA	96001	2822	45	06089	40.5736108	-122.3737048	Shasta County
220194	Fee-for-Service	1407891641	1407891641	1	1	REISSMANN, PETER T MD	7/26/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	57545	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2198	37	06073	32.75053781	-117.1627168	San Diego County
220197	Fee-for-Service	1437174034	1437174034	1	1	RALPHS GROCERY CO	6/4/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #700	12201 HIGHLAND AVE	None	RANCHO CUCAMONGA	CA	91739	2573	36	06071	34.13559255	-117.5390001	San Bernardino County
220205	Fee-for-Service	1710287297	1710287297	1	81	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
220209	Fee-for-Service	1275778847	1275778847	1	1	REDWOOD COAST MEDICAL	10/1/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	30 MILL ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90849634	-123.6916637	Mendocino County
220239	Fee-for-Service	1972953230	1972953230	1	1	RIDGELINE EMERGENCY	4/1/2017	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
220254	Fee-for-Service	1588894331	1588894331	1	1	RAMIREZ, NESSER Q MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119041	01	General Practice	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
220269	Fee-for-Service	1871618496	1871618496	1	1	RAMIREZ-VASQUEZ, CORA LMFT	7/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 W 8TH ST	None	SAN PEDRO	CA	90731	2934	19	06037	33.73698652	-118.2882195	Los Angeles County
220285	Fee-for-Service	1538573068	1538573068	1	1	RANA, SAURABH C MD	9/21/2021	207R00000X	NA	Other	026	PHYSICIANS	170135	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
220355	Fee-for-Service	1134624430	1134624430	1	1	ROBINSON, CHELSEA E MD	8/16/2022	2279E0002X	NA	Other	026	PHYSICIANS	166112	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
220364	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
220367	Fee-for-Service	1861566366	1861566366	1	1	RAMOS, PEDRO R MD	12/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91945	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
220386	Fee-for-Service	1356411003	1356411003	1	1	RHODEN, KEVIN L CRNA	3/18/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
220388	Fee-for-Service	1861873812	1861873812	1	1	RANGINWALA, MOHAMMAD A MD	1/11/2019	207R00000X	NA	Other	026	PHYSICIANS	156776	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
220411	Fee-for-Service	1235384314	1235384314	1	1	REED, JULIETA N LMFT	1/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
220413	Fee-for-Service	1265158703	1265158703	1	1	RIVERSIDE EYECARE PROFESSION	3/27/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ALS INC A MEDICAL CORPOR	2801 PARK MARINA DR	None	REDDING	CA	96001	2822	45	06089	40.5736108	-122.3737048	Shasta County
220431	Fee-for-Service	1083607022	1083607022	1	1	REID, JAMES G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29602	41	Internal Medicine	0	In state provider	None	528 W 27TH ST	None	MERCED	CA	95340	2833	24	06047	37.31170395	-120.4784444	Merced County
220433	Fee-for-Service	1386794188	1386794188	1	1	RICHARDSON, BONNIE L MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87670	08	Family Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
220486	Fee-for-Service	1710287297	1710287297	1	106	REGENTS UNIVERSITY OF CALIFO	7/27/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
220498	Fee-for-Service	1275778847	1275778847	1	1	REDWOOD COAST MEDICAL	10/1/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	30 MILL ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90849634	-123.6916637	Mendocino County
220502	Fee-for-Service	1952362915	1952362915	2	1	ROSS, GILBERT N MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	19408	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA	SUITE 518	BURBANK	CA	91505	4817	19	06037	34.1577056	-118.329779	Los Angeles County
220523	Fee-for-Service	1205435971	1205435971	1	1	RINALDI PHARMACY, INC.	11/30/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11237 TAMPA AVE	None	PORTER RANCH	CA	91326	1610	19	06037	34.27438144	-118.5565018	Los Angeles County
220544	Fee-for-Service	1689995110	1689995110	1	1	REID, KRISTEN J MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141900	36	Psychiatry	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
220551	Fee-for-Service	1679893820	1679893820	1	1	ROSICA, DILLENIA	6/4/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
220561	Fee-for-Service	1588605174	1588605174	1	1	ROSENBERG,DAVID I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
220572	Fee-for-Service	1881657559	1881657559	1	1	RHEE, JOON W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77852	41	Internal Medicine	0	In state provider	None	34675 YUCAIPA BLVD	STE 102	YUCAIPA	CA	92399	4155	36	06071	34.03384452	-117.048195	San Bernardino County
220597	Fee-for-Service	1205148954	1205148954	1	1	ROSS M MALTZ	5/12/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
220629	Fee-for-Service	1316021975	1316021975	1	1	REED, MARTY E MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85621	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
220654	Fee-for-Service	1710287297	1710287297	1	70	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
220687	Fee-for-Service	1194135723	1194135723	1	1	RITUAL ACUPUNCTURE INC	7/1/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	127 HOSPITAL DR	SUITE #203	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
220706	Fee-for-Service	1194776948	1194776948	1	1	RICE, GEOFFREY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54691	18	Ophthalmology	0	In state provider	None	248 HOSPITAL DR	None	UKIAH	CA	95482	4555	23	06045	39.15280713	-123.2037723	Mendocino County
220708	Fee-for-Service	1215193990	1215193990	1	1	RIXTER, DAVIDA D MD	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119541	25	Physical Medicine and Rehabilitation	0	In state provider	None	3434 VILLA LANE	SUITE 150	NAPA	CA	94558	6405	28	06055	38.32515937	-122.2938358	Napa County
220710	Fee-for-Service	1669474235	1669474235	1	1	RANK, CHRISTIAN L MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73486	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
220747	Fee-for-Service	1710172242	1710172242	1	1	RIVERSIDE HEALTH CLINIC	11/5/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	OF COLUSA INC	717 BRIDGE ST	None	COLUSA	CA	95932	2851	06	06011	39.20776226	-122.0029803	Colusa County
220769	Fee-for-Service	1326359175	1326359175	1	1	RANDHAWA, NAVTEJ K MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141921	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
220774	Fee-for-Service	1710287297	1710287297	1	106	REGENTS UNIVERSITY OF CALIFO	7/27/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
220787	Fee-for-Service	1275778847	1275778847	1	1	REDWOOD COAST MEDICAL	10/4/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	30 MILL ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90849634	-123.6916637	Mendocino County
220802	Fee-for-Service	1982986352	1982986352	1	1	ROBERTSON, DORIS N LCSW	6/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	19	06037	33.89475493	-118.2080292	Los Angeles County
220814	Fee-for-Service	1710287297	1710287297	1	2	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
220826	Fee-for-Service	1124439807	1124439807	1	28	REGENTS UNIV OF CALIFORNIA U	4/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	335 S MCDOWELL BLVD	None	PETALUMA	CA	94954	3507	49	06097	38.24752168	-122.6228023	Sonoma County
220832	Fee-for-Service	1245260298	1245260298	1	2	ROMESH K JAPRA MD A MEDICAL	3/28/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORPORATION	3155 KEARNEY ST	STE 210	FREMONT	CA	94538	2268	01	06001	37.5490951	-121.974815	Alameda County
220858	Fee-for-Service	1548360415	1548360415	1	1	RUCKLE, HERBERT C MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61617	34	Urology and Urological Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
220859	Fee-for-Service	1881657559	1881657559	1	1	RHEE, JOON W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77852	01	General Practice	0	In state provider	None	34675 YUCAIPA BLVD	STE 102	YUCAIPA	CA	92399	4155	36	06071	34.03384452	-117.048195	San Bernardino County
220908	Fee-for-Service	1982608501	1982608501	1	1	RUSSELL F. KING II M.D.	3/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 MACCORKLE AVE SE	None	CHARLESTON	WV	25304	1227	00	None	38.32862458	-81.60299546	Kanawha County
220940	Fee-for-Service	1003840018	1003840018	1	1	RIKER, JEFFREY B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	19160	41	Internal Medicine	0	In state provider	None	701 E 28TH ST	STE 100	LONG BEACH	CA	90806	2769	19	06037	33.80803441	-118.1847137	Los Angeles County
220957	Fee-for-Service	1619427713	1619427713	1	1	RIVER ISLAND TECHNOLOGY	7/1/2016	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ACADEMY #2	1175 MARINA DR	None	LATHROP	CA	95330	8586	39	06077	37.801809	-121.3180065	San Joaquin County
220967	Fee-for-Service	1043218589	1043218589	1	1	ROSENTHAL, SARA G MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	28150	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
221011	Fee-for-Service	1386755999	1386755999	1	1	RATANASIRIPONG, APHISIT	2/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72918	25	Physical Medicine and Rehabilitation	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
221013	Fee-for-Service	1932768728	1932768728	1	1	RELIABLE HOSPICE GROUP	7/14/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	STE 107	RESEDA	CA	91335	4000	19	06037	34.2011975	-118.5419835	Los Angeles County
221027	Fee-for-Service	1790554814	1790554814	1	1	RODRIGUES, ANGELA DOULA	1/17/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
221036	Fee-for-Service	1710172242	1710172242	1	1	RIVERSIDE HEALTH CLINIC	10/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OF COLUSA INC	717 BRIDGE ST	None	COLUSA	CA	95932	2851	06	06011	39.20776226	-122.0029803	Colusa County
221037	Fee-for-Service	1003153115	1003153115	1	1	REYNARD, LORRI PHD	7/21/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
221062	Fee-for-Service	1821165838	1821165838	1	1	RAINES, ERNEST G MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	24820	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
221064	Fee-for-Service	1710287297	1710287297	1	106	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
221065	Fee-for-Service	1558422154	1558422154	1	1	ROBINSON'S PHARMACY	1/6/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ROBINSON'S PHARMACY	359 MAIN ST	None	PLACERVILLE	CA	95667	5689	09	06017	38.72861746	-120.8017971	El Dorado County
221076	Fee-for-Service	1275778847	1275778847	1	1	REDWOOD COAST MEDICAL	10/1/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	30 MILL ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90849634	-123.6916637	Mendocino County
221105	Fee-for-Service	1710287297	1710287297	1	118	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1187 COAST VILLAGE ROAD	10A	MONTECITO	CA	93108	2764	42	06083	34.4210386	-119.6449357	Santa Barbara County
221108	Fee-for-Service	1013900075	1013900075	1	2	REGENTS/UCDPBG/SUR TRANS	7/27/2020	204F00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1563	34	06067	38.546091	-121.447305	Sacramento County
221116	Fee-for-Service	1366618167	1366618167	1	1	RAHIMAN, ABDUL MD	8/9/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
221119	Fee-for-Service	1245260298	1245260298	1	2	ROMESH K JAPRA MD A MEDICAL	3/28/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	3155 KEARNEY ST	STE 210	FREMONT	CA	94538	2268	01	06001	37.5490951	-121.974815	Alameda County
221133	Fee-for-Service	1386685584	1386685584	1	1	RICHEIMER, STEVEN H MD	7/21/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51560	36	Psychiatry	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
221138	Fee-for-Service	1861785982	1861785982	1	1	RIZK, LEVI DO	6/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14861	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
221165	Fee-for-Service	1831810928	1831810928	1	1	REINKING, EMILY PT	3/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
221177	Fee-for-Service	1871144667	1871144667	1	1	ROSSI, CATHERINE LCSW	3/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
221227	Fee-for-Service	1003840018	1003840018	1	1	RIKER, JEFFREY B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	19160	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	701 E 28TH ST	STE 100	LONG BEACH	CA	90806	2769	19	06037	33.80803441	-118.1847137	Los Angeles County
221234	Fee-for-Service	1982241592	1982241592	1	1	RELYABLE HOME HEALTH INC	10/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	SUITE 105	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
221264	Fee-for-Service	1619331295	1619331295	1	1	REUSCHE, RYAN D MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	156493	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
221297	Fee-for-Service	1174818454	1174818454	1	1	REDONDO, RAQUEL MD	4/29/2024	208600000X	NA	General Surgery	026	PHYSICIANS	152751	02	General Surgery	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
221301	Fee-for-Service	1992307573	1992307573	1	1	REPUTABLE HOSPICE CARE	1/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1122 E LINCOLN AVE	STE B500	ORANGE	CA	92865	1942	30	06059	33.83616558	-117.8412916	Orange County
221303	Fee-for-Service	1932768728	1932768728	1	1	RELIABLE HOSPICE GROUP	7/14/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	STE 107	RESEDA	CA	91335	4000	19	06037	34.2011975	-118.5419835	Los Angeles County
221320	Fee-for-Service	1093904153	1093904153	1	1	RICHAND INC	3/1/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	RICHAND MEDICAL SUPPLY	17852 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	36	06071	34.54007505	-117.2746931	San Bernardino County
221321	Fee-for-Service	1326579525	1326579525	1	1	RANCHO PHYSICIANS CHOICE A M	9/15/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AR	1871 E 4TH ST	None	ONTARIO	CA	91764	2601	36	06071	34.079184	-117.611775	San Bernardino County
221326	Fee-for-Service	1710172242	1710172242	1	1	RIVERSIDE HEALTH CLINIC	3/28/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	OF COLUSA INC	717 BRIDGE ST	None	COLUSA	CA	95932	2851	06	06011	39.20776226	-122.0029803	Colusa County
221327	Fee-for-Service	1104841824	1104841824	1	1	ROLLINS, ROBERT C MD	12/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
221351	Fee-for-Service	1821165838	1821165838	1	1	RAINES, ERNEST G MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	24820	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
221352	Fee-for-Service	1710287297	1710287297	1	106	REGENTS UNIVERSITY OF CALIFO	7/27/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	6633 TELEPHONE RD	200, 210	VENTURA	CA	93003	5569	56	06111	34.26667679	-119.20405	Ventura County
221355	Fee-for-Service	1295137602	1295137602	1	1	RAPOPORT, ZHANNA MD INC	10/4/2018	193400000X	NA	Other	026	PHYSICIANS	76035	13	Neurology (M.D. only)	0	In state provider	None	7677 CENTER AVE	STE 200	HUNTINGTON BEACH	CA	92647	3030	30	06059	33.736257	-117.995535	Orange County
221370	Fee-for-Service	1902889652	1902889652	1	1	ROBERTS, TERENCE J MD	3/13/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50801	30	Radiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
221382	Fee-for-Service	1851463657	1851463657	4	1	RELIANCE CASTLE PHARMACY LLC	8/18/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3605 HOSPITAL RD	STE D	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
221390	Fee-for-Service	1710287297	1710287297	1	2	REGENTS UNIVERSITY OF CALIFO	2/25/2021	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
221393	Fee-for-Service	1013900075	1013900075	1	2	REGENTS/UCDPBG/SUR TRANS	5/1/1999	204F00000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1563	34	06067	38.546091	-121.447305	Sacramento County
221400	Fee-for-Service	1457661530	1457661530	1	1	RAMIREZ, ERICA A LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
221409	Fee-for-Service	1174582845	1174582845	1	1	RESTREPO, MIGUEL S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87656	40	Pediatrics	0	In state provider	None	1415 N ACACIA AVE	STE 101	REEDLEY	CA	93654	2102	10	06019	36.60882634	-119.4510393	Fresno County
221415	Fee-for-Service	1497701619	1497701619	1	1	RASHID, TARIQ MD	11/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	128801	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
221422	Fee-for-Service	1366470270	1366470270	1	1	ROBERT SEARCY	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
221424	Fee-for-Service	1942794383	1942794383	1	1	RECOVER HOME HEALTH	10/8/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19531 VENTURA BLVD	STE 18	TARZANA	CA	91356	2957	19	06037	34.17281748	-118.5590745	Los Angeles County
221425	Fee-for-Service	1851036941	1851036941	1	1	RUNYON, BRADLEY C CRNA	8/3/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
221428	Fee-for-Service	1174010052	1174010052	1	1	RICIOLI, JOSEPH J DO	11/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19137	None	None	0	In state provider	None	801 E STREET	None	PATTERSON	CA	95363	2670	50	06099	37.46668786	-121.1342171	Stanislaus County
221436	Fee-for-Service	1609946847	1609946847	1	1	RYU, JOHN I OD	7/21/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14434 HAMLIN ST	STE 1	VAN NUYS	CA	91401	1461	19	06037	34.18863848	-118.447749	Los Angeles County
221463	Fee-for-Service	1760825806	1760825806	1	1	REJAI, SEPEHR MD	9/20/2021	208VP0000X	NA	Other	026	PHYSICIANS	134426	None	None	0	In state provider	None	2850 TELEGRAPH AVE	110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
221487	Fee-for-Service	1821200700	1821200700	1	1	RIO ELEMENTARY SCHOOL	3/18/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1800 SOLAR DR	3RD FLOOR	OXNARD	CA	93030	2655	56	06111	34.21748414	-119.1449177	Ventura County
221563	Fee-for-Service	1831462712	1831462712	1	1	ROMAN, RICARDO MD INC	5/24/2012	207R00000X	NA	Other	026	PHYSICIANS	79013	41	Internal Medicine	0	In state provider	None	4708 EAGLE ROCK BLVD	None	EAGLE ROCK	CA	90041	2712	19	06037	34.13048242	-118.2165574	Los Angeles County
221581	Fee-for-Service	1710332150	1710332150	1	1	RAMIREZ, ALMA V LMFT	4/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11800 ERNESTINE AVE	None	LYNWOOD	CA	90262	4427	19	06037	33.91865193	-118.2011034	Los Angeles County
221588	Fee-for-Service	1992307573	1992307573	1	1	REPUTABLE HOSPICE CARE	1/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1122 E LINCOLN AVE	STE B500	ORANGE	CA	92865	1942	30	06059	33.83616558	-117.8412916	Orange County
221615	Fee-for-Service	1710172242	1710172242	1	1	RIVERSIDE HEALTH CLINIC	10/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	OF COLUSA INC	717 BRIDGE ST	None	COLUSA	CA	95932	2851	06	06011	39.20776226	-122.0029803	Colusa County
221627	Fee-for-Service	1902973811	1902973811	1	1	RADPARVAR, SINA MD	9/1/1994	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	77334	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
221652	Fee-for-Service	1932572286	1932572286	1	1	REDDING INPATIENT SERVICES	1/5/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	A MEDICAL CORPORATION	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
221658	Fee-for-Service	1902889652	1902889652	1	1	ROBERTS, TERENCE J MD	3/13/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50801	78	Neoplastic Diseases/Oncology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
221673	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
221677	Fee-for-Service	1710287297	1710287297	1	2	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	RNIA	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
221699	Fee-for-Service	1114248242	1114248242	1	1	ROBERTS, JOAN B MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117574	08	Family Practice	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
221728	Fee-for-Service	1346468840	1346468840	1	1	RADIATION ONCOLOGY MED	6/13/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	ASSOC	2420 N CALIFORNIA ST	STE 30	STOCKTON	CA	95204	5508	39	06077	37.97566901	-121.2910661	San Joaquin County
221742	Fee-for-Service	1770746174	1770746174	1	1	RANGAVAJHULA, RAMANI N MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130194	01	General Practice	0	In state provider	None	13925 INDIAN STREET	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
221749	Fee-for-Service	1184299927	1184299927	1	1	RABAEY, SOFIA MD	9/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
221785	Fee-for-Service	1033410675	1033410675	1	1	RONALD J BELCZYK DPM INC	10/22/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	RD	903 W, SEVENTH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516303	-119.1889271	Ventura County
221828	Fee-for-Service	1912108275	1912108275	1	1	RAGSDALECOFFMAN, LISA A	11/9/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	1133 HIGH ST	SUITE F	AUBURN	CA	95603	5152	31	06061	38.89754086	-121.0711279	Placer County
221851	Fee-for-Service	1750343604	1750343604	1	1	RUTGERS, JOANNE K.L.	3/1/1995	207ZP0102X	NA	Other	026	PHYSICIANS	60455	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
221883	Fee-for-Service	1649463506	1649463506	1	1	RED SEA HEART CENTER PLC	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	2281 W 24TH STREET	SUITE 3	YUMA	AZ	85364	6197	00	None	32.68368	-114.64776	Yuma County
221900	Fee-for-Service	1710172242	1710172242	1	1	RIVERSIDE HEALTH CLINIC	3/28/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	OF COLUSA INC	717 BRIDGE ST	None	COLUSA	CA	95932	2851	06	06011	39.20776226	-122.0029803	Colusa County
221914	Fee-for-Service	1215133079	1215133079	1	1	ROSSER, MEAGAN R LMFT	3/30/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53889	-	NOT APPLICABLE	0	In state provider	None	1318 GATEVIEW STREET	UNITS A-F	SAN FRANCISCO	CA	94130	1418	38	06075	37.82649536	-122.3774212	San Francisco County
221962	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
221965	Fee-for-Service	1063457059	1063457059	1	1	RAZAVI, AMIR B MD	10/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55482	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
221968	Fee-for-Service	1669826228	1669826228	1	1	RAZA, SARAH DO	5/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19921	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
221970	Fee-for-Service	1619374741	1619374741	1	1	RMS CHERUBIM HEALTH CARE SER	3/7/2025	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	VICES INC	1338 CENTER COURT DR,	STE 101	COVINA	CA	91724	9233	19	06037	34.0724419	-117.8624967	Los Angeles County
221971	Fee-for-Service	1710287297	1710287297	1	118	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1187 COAST VILLAGE ROAD	10A	MONTECITO	CA	93108	2764	42	06083	34.4210386	-119.6449357	Santa Barbara County
222015	Fee-for-Service	1346468840	1346468840	1	1	RADIATION ONCOLOGY MED	6/13/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ASSOC	2420 N CALIFORNIA ST	STE 30	STOCKTON	CA	95204	5508	39	06077	37.97566901	-121.2910661	San Joaquin County
222026	Fee-for-Service	1669532750	1669532750	1	2	ROUND VALLEY INDIAN HEALTH C	6/30/2020	261Q00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ENTER, INC.	24065 BIGGAR LN	None	COVELO	CA	95428	9669	23	06045	39.80972354	-123.2469688	Mendocino County
222028	Fee-for-Service	1750588257	1750588257	1	1	RICHARDSON, MADISON F MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	18826	04	Otology, Laryngology, Rhinology	0	In state provider	None	8500 WILSHIRE BLVD	STE 908	BEVERLY HILLS	CA	90211	3107	19	06037	34.06521956	-118.3764689	Los Angeles County
222054	Fee-for-Service	1750519898	1750519898	1	1	RASHEED, SARAH S MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116354	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
222072	Fee-for-Service	1104049196	1104049196	1	1	ROWLAND UNIF SCHOOL DIST	3/6/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1830 NOGALES ST	None	ROWLAND HEIGHTS	CA	91748	2945	19	06037	33.98516605	-117.8891254	Los Angeles County
222088	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	9/28/2022	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
222160	Fee-for-Service	1073695698	1073695698	1	1	RYAN, JOHN K MD	12/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93000	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
222200	Fee-for-Service	1366850802	1366850802	1	1	RAMSEY, CHISATO S LMFT	2/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6695 E PACIFIC COAST HWY	SUITE 135	LONG BEACH	CA	90803	4235	19	06037	33.75412596	-118.1075029	Los Angeles County
222237	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
222248	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
222254	Fee-for-Service	1710287297	1710287297	1	2	REGENTS UNIVERSITY OF CALIFO	6/10/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
222261	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	9/9/2021	261QM1300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
222275	Fee-for-Service	1700934205	1700934205	1	1	ROBERTSON, NELTON JR	10/4/2022	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	NATIONAL HEARING AID CTR	4477 W 118TH ST	SUITE 103	HAWTHORNE	CA	90250	2255	19	06037	33.92734752	-118.354221	Los Angeles County
222279	Fee-for-Service	1548948284	1548948284	1	1	ROSER, ALEXANDRA PT	2/28/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
222312	Fee-for-Service	1942487160	1942487160	1	1	RANCHO LOS AMIGOS	12/1/1977	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	NATIONAL REHAB CTR	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
222334	Fee-for-Service	1821264862	1821264862	1	1	RAGHAVAN, ANITHA MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121514	41	Internal Medicine	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
222340	Fee-for-Service	1417050956	1417050956	1	1	REGENTS OF THE UNIVERSITY OF	4/1/1985	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
222362	Fee-for-Service	1104049196	1104049196	1	1	ROWLAND UNIF SCHOOL DIST	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	None	1830 NOGALES ST	None	ROWLAND HEIGHTS	CA	91748	2945	19	06037	33.98516605	-117.8891254	Los Angeles County
222376	Fee-for-Service	1831175413	1831175413	1	1	REMY, CELIA MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66994	40	Pediatrics	0	In state provider	None	251 TURNPIKE DR	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
222377	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	10/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
222403	Fee-for-Service	1942254115	1942254115	1	1	RUIZ, GILBERTO V MD	2/28/1994	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	740 NORTH SEUOIA	None	LINDSAY	CA	93247	0000	54	06107	36.21153089	-119.0960162	Tulare County
222405	Fee-for-Service	1164540126	1164540126	1	1	ROCHE, ALEXANDRA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94044	40	Pediatrics	0	In state provider	None	455 SOUTH MAIN STREET	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
222501	Fee-for-Service	1174529135	1174529135	1	1	RINDAHL, MARTIN A MD	8/1/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69216	01	General Practice	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
222524	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
222537	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
222543	Fee-for-Service	1710287297	1710287297	1	118	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1187 COAST VILLAGE ROAD	10A	MONTECITO	CA	93108	2764	42	06083	34.4210386	-119.6449357	Santa Barbara County
222554	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	3/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
222566	Fee-for-Service	1417301466	1417301466	1	1	ROYAL, LAURA B MD	8/16/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	150438	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
222575	Fee-for-Service	1710087846	1710087846	1	1	REZNIK, BORIS MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91193	10	Gastroenterology (M.D. only)	0	In state provider	None	470 GREENFIELD AVE	STE 37	HANFORD	CA	93230	3578	16	06031	36.32996137	-119.6580167	Kings County
222602	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
222606	Fee-for-Service	1336624667	1336624667	1	1	RONQUILLO, ELENA L PT	11/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
222648	Fee-for-Service	1063740074	1063740074	1	1	RANA, JEEGAR R DO	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11046	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
222649	Fee-for-Service	1104049196	1104049196	1	1	ROWLAND UNIF SCHOOL DIST	5/19/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1830 NOGALES ST	None	ROWLAND HEIGHTS	CA	91748	2945	19	06037	33.98516605	-117.8891254	Los Angeles County
222664	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	1/7/2022	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
222678	Fee-for-Service	1114996089	1114996089	1	1	REMLER, ILAN Z MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65712	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
222723	Fee-for-Service	1932257730	1932257730	1	1	REINSCH, CARYL S MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55024	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
222737	Fee-for-Service	1518956804	1518956804	1	1	ROONGSRITONG, CHANWIT MD	3/15/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
222751	Fee-for-Service	1356711931	1356711931	1	1	RICK, WENDY	9/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1350 HAYES ST	SUITE B-100CC	BENICIA	CA	94510	2945	48	06095	38.04764833	-122.139033	Solano County
222790	Fee-for-Service	1275556607	1275556607	1	18	REDWOOD REGIONAL MEDICAL	6/6/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
222791	Fee-for-Service	1063648483	1063648483	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3066 CAMINO ALETA	None	SAN DIEGO	CA	92154	4633	37	06073	32.57572017	-117.0661806	San Diego County
222792	Fee-for-Service	1881676377	1881676377	1	1	RICHARD P CARR PHYSICAL THER	11/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	1045 BROKAW RD	None	SAN JOSE	CA	95131	2310	43	06085	37.38297952	-121.8981915	Santa Clara County
222814	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
222824	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
222832	Fee-for-Service	1710287297	1710287297	1	118	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1187 COAST VILLAGE ROAD	10A	MONTECITO	CA	93108	2764	42	06083	34.4210386	-119.6449357	Santa Barbara County
222838	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	8/15/2019	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
222863	Fee-for-Service	1710087846	1710087846	1	1	REZNIK, BORIS MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91193	41	Internal Medicine	0	In state provider	None	470 GREENFIELD AVE	STE 37	HANFORD	CA	93230	3578	16	06031	36.32996137	-119.6580167	Kings County
222872	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
222892	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
222897	Fee-for-Service	1346402443	1346402443	1	1	RAMEZANI, ROSHANAK MD	6/1/2018	2084P0805X	NA	Psychiatry	026	PHYSICIANS	110796	36	Psychiatry	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
222910	Fee-for-Service	1043461114	1043461114	1	1	ROSS, MICHAEL A PHD	12/4/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9696 STEPHENS ST	None	DELHI	CA	95315	9550	24	06047	37.42956785	-120.7755208	Merced County
222955	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
222998	Fee-for-Service	1366963217	1366963217	1	1	RODRIGUEZ, JENNIFER LCSW	8/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
223032	Fee-for-Service	1770523359	1770523359	1	1	ROACH, MACK III MD	8/1/2002	2085R0001X	NA	Other	026	PHYSICIANS	42845	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223064	Fee-for-Service	1790730174	1790730174	1	1	ROBERTSON, MANDY D H MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143490	78	Neoplastic Diseases/Oncology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
223092	Fee-for-Service	1578553921	1578553921	1	1	RICHARDSON, DAVID D MD	9/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68240	18	Ophthalmology	0	In state provider	None	207 S SANTA ANITA STREET	STE P25	SAN GABRIEL	CA	91776	1146	19	06037	34.10072807	-118.1066296	Los Angeles County
223103	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	12/9/2020	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
223113	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
223117	Fee-for-Service	1710287297	1710287297	1	2	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
223119	Fee-for-Service	1033297072	1033297072	1	1	RHYNE, DENNIS A MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18948	20	Orthopedic Surgery	0	In state provider	None	2441 HEALTH CENTER DR	STE 420	LAGUNA HILLS	CA	92653	4342	30	06059	33.60797363	-117.7080927	Orange County
223126	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	1/15/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
223137	Fee-for-Service	1447440433	1447440433	1	1	ROTHMAN, ILAN J MD	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122560	05	Anesthesiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
223143	Fee-for-Service	1184617102	1184617102	1	1	REGENTS/UCDPBG/DERMATOLO	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
223156	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223177	Fee-for-Service	1538932074	1538932074	1	1	ROSAS RIDERS CORP	12/18/2023	342000000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7887 HIGHWAY 99E	None	LOS MOLINOS	CA	96055	9782	52	06103	40.02510307	-122.0999155	Tehama County
223180	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
223203	Fee-for-Service	1568709475	1568709475	1	1	RYAN, MARK PSYD	3/19/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
223215	Fee-for-Service	1225021249	1225021249	1	1	REGENTS/UCDPBG/IM ENDOCR	5/1/1983	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
223217	Fee-for-Service	1851858211	1851858211	1	1	ROBERSON, LEE JR	1/14/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	53815 MARIAN VIEW DR	None	IDYLLWILD	CA	92549	4221	33	06065	33.73613967	-116.7223775	Riverside County
223221	Fee-for-Service	1588614077	1588614077	1	1	ROSSI, DAVID A MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
223239	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	10/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223287	Fee-for-Service	1346417599	1346417599	1	1	ROCCO, FRANCISCO PHD	2/24/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1426 FILLMORE ST	317	SAN FRANCISCO	CA	94115	5236	38	06075	37.78283156	-122.432588	San Francisco County
223320	Fee-for-Service	1770523359	1770523359	1	1	ROACH, MACK III MD	8/1/2002	2085R0001X	NA	Other	026	PHYSICIANS	42845	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223328	Fee-for-Service	1548562523	1548562523	1	1	RAQUENO, BRIAN A	4/18/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
223352	Fee-for-Service	1790730174	1790730174	1	1	ROBERTSON, MANDY D H MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143490	68	Hematology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
223353	Fee-for-Service	1467618991	1467618991	1	1	REAVIS, KELLY M	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5842 E NAPLES PLAZA	None	LONG BEACH	CA	90803	5039	19	06037	33.75610548	-118.1200075	Los Angeles County
223389	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
223400	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
223412	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	3/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
223432	Fee-for-Service	1134374911	1134374911	1	1	ROXAS, JENNIFER S MD	1/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122345	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
223446	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	5/31/2023	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223467	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
223475	Fee-for-Service	1649298670	1649298670	1	2	RETINA CONSULTANTS	3/22/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	OF LOS ANGELES INC	1808 VERDUGO BLVD	STE 206	GLENDALE	CA	91208	1412	19	06037	34.2056211	-118.2154553	Los Angeles County
223482	Fee-for-Service	1073617023	1073617023	1	1	ROGERS, RODMAN S MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62450	34	Urology and Urological Surgery	0	In state provider	None	3838 CALIFORNIA ST	RM 803	SAN FRANCISCO	CA	94118	1510	38	06075	37.78591809	-122.4575439	San Francisco County
223500	Fee-for-Service	1578881264	1578881264	1	1	REBECCA BURTON	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
223508	Fee-for-Service	1851858211	1851858211	1	1	ROBERSON, LEE JR	1/14/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	53815 MARIAN VIEW DR	None	IDYLLWILD	CA	92549	4221	33	06065	33.73613967	-116.7223775	Riverside County
223517	Fee-for-Service	1194219782	1194219782	1	1	ROHR, JOSEPH M MD	11/6/2023	207ZP0102X	NA	Other	026	PHYSICIANS	191647	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223528	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	12/7/2021	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223558	Fee-for-Service	1669463675	1669463675	1	1	RADIOLOGY CONSULTANTS	3/1/1983	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
223580	Fee-for-Service	1679899801	1679899801	1	1	RILEY, LISA A MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119242	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
223587	Fee-for-Service	1679645493	1679645493	1	1	RAZI, DARYOUSH MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54086	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
223602	Fee-for-Service	1366467961	1366467961	1	1	RALPHS GROCERY COMPANY	11/8/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #759	10861 WEYBURN AVE	None	LOS ANGELES	CA	90024	2922	19	06037	34.06257705	-118.4440955	Los Angeles County
223627	Fee-for-Service	1942299797	1942299797	1	1	RATTET, JEFFREY P MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32586	07	Dermatology	0	In state provider	None	399 E HIGHLAND AVE	STE 524	SAN BERNARDINO	CA	92404	3878	36	06071	34.1358627	-117.2757898	San Bernardino County
223666	Fee-for-Service	1437132792	1437132792	1	1	ROCCI V TRUMPER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 E PROSPECT RD	None	FORT COLLINS	CO	80525	9718	00	None	40.5672666	-105.0316926	Larimer County
223679	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
223681	Fee-for-Service	1316618523	1316618523	1	1	ROUNDS, JULIA LMFT	2/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1147 E GRAND AVE	106	ARROYO GRANDE	CA	93420	4731	40	06079	35.12000133	-120.5981053	San Luis Obispo County
223683	Fee-for-Service	1174825053	1174825053	1	1	ROLLINS, JESSIE E DO	1/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	11517	01	General Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
223687	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
223703	Fee-for-Service	1518947167	1518947167	1	1	REGENTS OF THE UNIV CA	9/2/2021	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	550 W RANCH VIEW DR	2005	ROCKLIN	CA	95765	5396	31	06061	38.83760761	-121.2972372	Placer County
223708	Fee-for-Service	1043372618	1043372618	2	1	RIVERBANK PRIMARY CARE	1/20/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CLINIC INC	3227 STANISLAUS ST	SUITE A	RIVERBANK	CA	95367	2464	50	06099	37.73504644	-120.9365506	Stanislaus County
223734	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223752	Fee-for-Service	1154392249	1154392249	1	1	RURAL MEDICAL CLINIC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RURAL MEDICAL CLINIC	804 S WALNUT	None	FREEMAN	SD	57029	0000	00	None	43.34721789	-97.43172616	Hutchinson County
223756	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
223804	Fee-for-Service	1902812795	1902812795	1	1	RYHAL, BRUCE T MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	48675	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
223811	Fee-for-Service	1760739148	1760739148	1	1	RANGANATHA BURLI, PRATIBHA	12/23/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158288	15	Obstetrics (D.O. only)	0	In state provider	MD	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
223817	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	1/31/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
223830	Fee-for-Service	1598122038	1598122038	1	1	ROYAL TERRACE HEALTHCARE	1/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1340 HIGHLAND AVE	None	DUARTE	CA	91010	2520	19	06037	34.137342	-117.9665925	Los Angeles County
223838	Fee-for-Service	1306804406	1306804406	1	1	REITER, GARY S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34721	18	Ophthalmology	0	In state provider	None	1901 WESTCLIFF DR	STE 9	NEWPORT BEACH	CA	92660	5505	30	06059	33.62715196	-117.906991	Orange County
223893	Fee-for-Service	1508339847	1508339847	1	1	RASMUSSEN, RAQUEL O CCC-SLP	10/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE STE 114	None	TUSTIN	CA	92780	7247	30	06059	33.70954889	-117.8043627	Orange County
223911	Fee-for-Service	1346539707	1346539707	1	1	RINDERKNECHT, TANYA N MD	8/1/2019	390200000X	NA	Other	026	PHYSICIANS	122099	89	Surgery-Traumatic	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
223965	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
223966	Fee-for-Service	1598303646	1598303646	1	1	RAMOS, CHENYKA LMFT	12/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	206A	CHINO	CA	91710	8417	36	06071	33.99723746	-117.7140555	San Bernardino County
223979	Fee-for-Service	1699013193	1699013193	1	1	RICHPATH INTEGRATED SERVICES	1/7/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LIMITED	2121 REDWOOD	D	VALLEJO	CA	94590	3603	48	06095	38.1221345	-122.2367231	Solano County
223980	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
223994	Fee-for-Service	1659463263	1659463263	1	1	RAGGIO, CHRISTOPHER MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64293	05	Anesthesiology	0	In state provider	None	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	30	06059	33.746805	-117.834147	Orange County
223997	Fee-for-Service	1043372618	1043372618	2	1	RIVERBANK PRIMARY CARE	1/20/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CLINIC INC	3227 STANISLAUS ST	SUITE A	RIVERBANK	CA	95367	2464	50	06099	37.73504644	-120.9365506	Stanislaus County
224020	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	7/24/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
224043	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
224061	Fee-for-Service	1710287297	1710287297	1	130	REGENTS UNIVERSITY OF CALIFO	1/29/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	RNIA	1304 15TH ST	102	SANTA MONICA	CA	90404	1809	19	06037	34.02600773	-118.486172	Los Angeles County
224087	Fee-for-Service	1912975020	1912975020	1	1	RICHARD J BEAN	10/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MEDICAL PKWY	None	DENISON	IA	51442	2607	00	None	42.02440608	-95.38002595	Crawford County
224105	Fee-for-Service	1710287297	1710287297	1	109	REGENTS UNIVERSITY OF CALIFO	10/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
224113	Fee-for-Service	1982801361	1982801361	1	1	ROSENBERG, JEFFREY MD	7/22/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	53269	33	Thoracic Surgery	0	In state provider	INC	488 E VALLEY PKWY	#210	ESCONDIDO	CA	92025	3369	37	06073	33.12523814	-117.0769715	San Diego County
224125	Fee-for-Service	1306804406	1306804406	1	1	REITER, GARY S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34721	01	General Practice	0	In state provider	None	1901 WESTCLIFF DR	STE 9	NEWPORT BEACH	CA	92660	5505	30	06059	33.62715196	-117.906991	Orange County
224173	Fee-for-Service	1275638942	1275638942	1	1	REDDY, JAIPAL M MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62448	08	Family Practice	0	In state provider	None	830 W OLIVE AVE	STE C	MERCED	CA	95348	2420	24	06047	37.31914899	-120.4828231	Merced County
224198	Fee-for-Service	1417966870	1417966870	1	1	RAMOS-SCOTT, CHEREAMIE C	10/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7999 GATEWAY BLVD	SUITE 200	NEWARK	CA	94560	1188	01	06001	37.53814232	-122.0629661	Alameda County
224202	Fee-for-Service	1407052459	1407052459	1	1	RICHARDSON, HENRY A MD	1/9/2019	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	105294	25	Physical Medicine and Rehabilitation	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
224246	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
224255	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
224265	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
224290	Fee-for-Service	1740285600	1740285600	1	1	ROSEN, BARBARA A PHD	1/1/1979	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	161 FASHION LN	STE 209	TUSTIN	CA	92780	3342	30	06059	33.74704269	-117.8176805	Orange County
224310	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
224331	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
224335	Fee-for-Service	1396328589	1396328589	1	1	RAZIKEEN, AZAR T MD	5/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191389	08	Family Practice	0	In state provider	None	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
224341	Fee-for-Service	1205047545	1205047545	1	1	RAMOS, CARLOS G MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91944	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
224352	Fee-for-Service	1689679300	1689679300	1	1	ROBISON, JAMES B DPM	1/9/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
224367	Fee-for-Service	1285011171	1285011171	1	1	RAYMOND, SAMUEL MD	5/8/2019	207R00000X	NA	Other	026	PHYSICIANS	157728	41	Internal Medicine	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
224388	Fee-for-Service	1821257569	1821257569	1	1	RHEE, SOPHIA LAC	6/19/2017	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1930 WILSHIRE BLVD	STE 206	LOS ANGELES	CA	90057	3612	19	06037	34.05720458	-118.2744084	Los Angeles County
224461	Fee-for-Service	1275638942	1275638942	1	1	REDDY, JAIPAL M MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62448	01	General Practice	0	In state provider	None	830 W OLIVE AVE	STE C	MERCED	CA	95348	2420	24	06047	37.31914899	-120.4828231	Merced County
224505	Fee-for-Service	1295201812	1295201812	1	1	RICHARDSON, VANESSA J LMFT	7/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14390 PARK AVE	None	VICTORVILLE	CA	92392	2310	36	06071	34.512453	-117.324936	San Bernardino County
224512	Fee-for-Service	1194968545	1194968545	1	1	RIGHT HEAR PALM SPRINGS LLC	11/9/2010	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1132 SAN MARINO DR	STE 104	SAN MARCOS	CA	92078	4641	37	06073	33.12486539	-117.2107986	San Diego County
224534	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
224543	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
224549	Fee-for-Service	1568520989	1568520989	1	1	RICHARDS, JAN	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
224553	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
224558	Fee-for-Service	1043869894	1043869894	1	1	ROBLES, NANCY NP	5/5/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
224576	Fee-for-Service	1689813420	1689813420	1	1	RAM DURABLE MEDICAL	8/28/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EQUIPMENT LLC	7909 SILVERTON AVE	#214	SAN DIEGO	CA	92126	6347	37	06073	32.8908535	-117.151821	San Diego County
224586	Fee-for-Service	1487704318	1487704318	1	1	REID, JULIE A MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89380	05	Anesthesiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93721	1365	10	06019	36.741663	-119.7841005	Fresno County
224599	Fee-for-Service	1710287297	1710287297	1	127	REGENTS UNIVERSITY OF CALIFO	7/14/2023	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
224614	Fee-for-Service	1023694973	1023694973	1	1	ROOS, JACKSON	2/27/2025	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
224620	Fee-for-Service	1710287297	1710287297	1	77	REGENTS UNIVERSITY OF CALIFO	10/24/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AS ONE LEGAL BUSINESS NA	25751 MCBEAN PKWY	210	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
224630	Fee-for-Service	1790900207	1790900207	1	1	ROBERT PATRICK MOODY PHD	1/17/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	303 DOWNEY AVE	None	MODESTO	CA	95354	1203	50	06099	37.64552848	-120.990087	Stanislaus County
224632	Fee-for-Service	1205047545	1205047545	1	1	RAMOS, CARLOS G MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91944	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
224664	Fee-for-Service	1992150205	1992150205	1	1	RAMAYYA, ASHWIN G MD	7/17/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	184508	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
224676	Fee-for-Service	1922028760	1922028760	1	1	REBELES, FIDEL C MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98075	30	Radiology	0	In state provider	None	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
224718	Fee-for-Service	1356420095	1356420095	1	1	RASKOFF, WILLIAM J MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20730	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 O'FARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
224742	Fee-for-Service	1528099439	1528099439	1	2	ROLFES, RICHARD A DPM	7/29/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	595 BUCKINGHAM WAY	SUITE 330	SAN FRANCISCO	CA	94132	1909	38	06075	37.73012679	-122.4767395	San Francisco County
224743	Fee-for-Service	1811379589	1811379589	1	1	ROBINSON, ANGELA NP	8/9/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
224762	Fee-for-Service	1073576005	1073576005	1	1	RAJAMANI, SRIDHAR MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53701	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224779	Fee-for-Service	1649303926	1649303926	1	1	ROSSER, JAMES R LCSW	10/10/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
224793	Fee-for-Service	1568481042	1568481042	1	1	RHEE, SHERMAN B MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130631	30	Radiology	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
224800	Fee-for-Service	1427443738	1427443738	1	1	RYAN, MARTHA E MD	11/25/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161841	18	Ophthalmology	0	In state provider	None	622 ABBOTT ST	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
224801	Fee-for-Service	1730135534	1730135534	1	1	REISCH, DONALD H MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
224810	Fee-for-Service	1154483899	1154483899	1	1	ROGADO, KENNETH C CRNA	2/23/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
224818	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
224820	Fee-for-Service	1679636112	1679636112	1	1	RAMOS, ALAN M NP	5/25/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
224830	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
224839	Fee-for-Service	1710287297	1710287297	1	32	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
224846	Fee-for-Service	1740273762	1740273762	1	1	REGENTS/UCDPBG/PED GASTR	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
224898	Fee-for-Service	1417995804	1417995804	1	1	RUBIO, CHRISTINA R MD	4/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89615	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
224916	Fee-for-Service	1972953230	1972953230	1	2	RIDGELINE EMERGENCY	3/10/2025	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S. CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
224931	Fee-for-Service	1457423329	1457423329	1	1	RIEGG-LUEDGE, JOHANNA F PHD	8/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	412 CEDAR STREET	SUITE A	SANTA CRUZ	CA	95060	4369	44	06087	36.97041854	-122.026546	Santa Cruz County
224932	Fee-for-Service	1700964376	1700964376	1	1	ROBINSON, CHARLAH A MD	12/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	84041	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
224939	Fee-for-Service	1790331502	1790331502	1	1	RONALD REAGAN CHARTER SCHOOL	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ALLIANCE	23151 PALOMAR ST	None	MURRIETA	CA	92562	9495	33	06065	33.58538812	-117.2465602	Riverside County
224944	Fee-for-Service	1093342917	1093342917	1	1	ROSENTHAL, JAIME A MD	8/29/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224965	Fee-for-Service	1851652689	1851652689	1	1	RILEY, KRISTIN L DO MD	2/28/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	13272	None	None	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
224978	Fee-for-Service	1356373229	1356373229	1	1	REN, XIUSHUI MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81101	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
224981	Fee-for-Service	1366709461	1366709461	1	1	REDWOOD COMMUNITY SERVICES,	10/8/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	154 S. MAIN	None	LAKEPORT	CA	95453	5017	17	06033	39.04152502	-122.9151344	Lake County
224989	Fee-for-Service	1891712436	1891712436	1	1	RODRIGUEZ, MICHAEL A MD	4/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68505	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
225032	Fee-for-Service	1336256114	1336256114	1	1	RAMPAL, ANGELIKA MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84907	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
225040	Fee-for-Service	1477015238	1477015238	1	1	RICHARD, CHASE E MD	12/19/2022	207P00000X	NA	Other	026	PHYSICIANS	181282	None	None	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
225051	Fee-for-Service	1073576005	1073576005	1	1	RAJAMANI, SRIDHAR MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53701	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
225052	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
225112	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
225114	Fee-for-Service	1003188061	1003188061	1	1	RAHIMI, SHEAVA LMFT	6/17/2022	225400000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
225118	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
225128	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
225150	Fee-for-Service	1598791600	1598791600	1	2	RANCHO FAMILY MEDICAL GROUP,	7/25/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	L ASSOCIATES	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
225172	Fee-for-Service	1184112385	1184112385	1	1	RANEY, JULIA H	10/4/2024	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	164180	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
225274	Fee-for-Service	1891712436	1891712436	1	1	RODRIGUEZ, MICHAEL A MD	4/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68505	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
225284	Fee-for-Service	1689775819	1689775819	1	1	REDDY, RAGHUNATH K MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	49255	08	Family Practice	0	In state provider	None	1805 N CALIFORNIA ST	STE 102	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
225298	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
225301	Fee-for-Service	1164809950	1164809950	1	1	RODRIGUEZ-MINETTE, JESSICA G	10/22/2020	207L00000X	NA	Other	026	PHYSICIANS	144599	05	Anesthesiology	0	In state provider	MD	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
225341	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	6/3/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
225344	Fee-for-Service	1265510929	1265510929	1	1	RICHARDSON, ANN C	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	63401	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
225353	Fee-for-Service	1720377880	1720377880	1	1	ROBINSON, COLIN L MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123689	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 420, 365, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
225383	Fee-for-Service	1427012806	1427012806	1	1	REBENTISH, ALKA P MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	901 RANCHO LN	STE 265	LAS VEGAS	NV	89106	3819	00	None	36.16025414	-115.1711566	Clark County
225399	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
225408	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	12/21/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
225417	Fee-for-Service	1710287297	1710287297	1	6	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	1260 15TH STREET	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
225421	Fee-for-Service	1841281292	1841281292	1	1	RUBENSTEIN, ISRAEL PHD	8/15/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
225433	Fee-for-Service	1306079181	1306079181	2	2	REYNALDO L. MAKABALI MD INC	6/14/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2426 W 8TH ST	STE 104	LOS ANGELES	CA	90057	3840	19	06037	34.05650917	-118.2815796	Los Angeles County
225434	Fee-for-Service	1881906006	1881906006	1	1	REZNIK, ROBERT S MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117573	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
225437	Fee-for-Service	1598791600	1598791600	1	2	RANCHO FAMILY MEDICAL GROUP,	12/11/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	L ASSOCIATES	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
225451	Fee-for-Service	1871536243	1871536243	1	1	RYAN M COLE	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7988 W MARIGOLD ST	STE 150	BOISE	ID	83714	5119	00	None	43.6593005	-116.2814085	Ada County
225453	Fee-for-Service	1659837375	1659837375	1	1	RIZO, DARLENE M LPCC	7/15/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 CANYON CREEK DR APT	None	COLFAX	CA	95713	9305	31	06061	39.07849814	-120.9564895	Placer County
225465	Fee-for-Service	1285742742	1285742742	1	2	RUSSELL, SCOTT K	7/1/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	312 W J ST	None	LOS BANOS	CA	93635	4069	24	06047	37.06221105	-120.8570564	Merced County
225469	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
225470	Fee-for-Service	1073838470	1073838470	1	1	ROSOW, LAURA K MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120376	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	ROOM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
225486	Fee-for-Service	1033195813	1033195813	1	1	RYSSO, JENNIFER H MD	7/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134485	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
225528	Fee-for-Service	1790835031	1790835031	1	1	RAI CARE CENTERS OF	6/1/2007	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	COLTON LLC	1275 W C ST	None	COLTON	CA	92324	1916	36	06071	34.07411951	-117.346491	San Bernardino County
225551	Fee-for-Service	1245625276	1245625276	1	1	RAPHAEL, EVA MD	5/1/2018	390200000X	NA	Other	026	PHYSICIANS	144476	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
225581	Fee-for-Service	1285168419	1285168419	1	1	RIVAS, BIANCA M MD	12/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159667	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
225582	Fee-for-Service	1063559110	1063559110	1	1	ROCKEY, MATTHEW G MD	8/27/2008	207L00000X	NA	Other	026	PHYSICIANS	95188	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
225586	Fee-for-Service	1710287297	1710287297	1	76	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
225622	Fee-for-Service	1952478893	1952478893	1	1	RILEY, GINGER H.	11/30/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	65819	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
225627	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	11/18/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
225640	Fee-for-Service	1720377880	1720377880	1	1	ROBINSON, COLIN L MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123689	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 420, 365, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
225644	Fee-for-Service	1407935547	1407935547	1	1	RUBIN, SANDRA G ,MD	5/10/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	58000	40	Pediatrics	0	In state provider	None	1112 9TH ST	None	CRESCENT CITY	CA	95531	2810	08	06015	41.75777595	-124.1988203	Del Norte County
225649	Fee-for-Service	1235224973	1235224973	1	1	RENDE, ROBERTO MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48593	None	None	0	In state provider	None	3300 E SOUTH ST	STE 105	LAKEWOOD	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
225683	Fee-for-Service	1710287297	1710287297	1	43	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
225692	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	6/6/2024	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
225720	Fee-for-Service	1881906006	1881906006	1	1	REZNIK, ROBERT S MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117573	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
225725	Fee-for-Service	1598791600	1598791600	1	2	RANCHO FAMILY MEDICAL GROUP,	8/22/2024	207Q00000X	NA	Adult Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	L ASSOCIATES	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
225753	Fee-for-Service	1780070896	1780070896	1	1	RAHIMI, NINA MD	5/6/2020	207ZP0102X	NA	Other	026	PHYSICIANS	159289	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
225757	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
225765	Fee-for-Service	1063770063	1063770063	1	1	RANADA, ENGELBERT T DO	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14081	41	Internal Medicine	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
225780	Fee-for-Service	1053347369	1053347369	1	1	REHABILITATION ASSOCIATES	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	MEDICAL GROUP	790 E WILLOW ST	SUITE 200	LONG BEACH	CA	90806	2771	19	06037	33.80426489	-118.1825796	Los Angeles County
225790	Fee-for-Service	1912485913	1912485913	1	1	REIS, ALEXANDRA E MD	1/2/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	320 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42954414	-119.7230551	Santa Barbara County
225800	Fee-for-Service	1124415609	1124415609	1	1	ROBERTSON SPECIALTY PHARMACY	8/12/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	4316	19	06037	34.04852492	-118.3855932	Los Angeles County
225815	Fee-for-Service	1710005640	1710005640	1	1	REINKE, ROBERT T MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17251	30	Radiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
225875	Fee-for-Service	1710287297	1710287297	1	76	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
225876	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
225892	Fee-for-Service	1720091697	1720091697	1	1	RATHBUN BRENT E MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54826	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
225907	Fee-for-Service	1265713267	1265713267	1	1	ROGERS, BRENDA A LCSW	3/8/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
225915	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
225947	Fee-for-Service	1306014071	1306014071	1	1	ROTHENBERG, MICHAEL E MD	11/23/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	96368	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
225965	Fee-for-Service	1689772071	1689772071	1	1	REDDY, BHASKARA G MD	1/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34089	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 205	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
225967	Fee-for-Service	1720056849	1720056849	1	2	ROY, BAKUL T MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	44318	41	Internal Medicine	0	In state provider	None	1196 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	6004	07	06013	37.77118252	-121.9732589	Contra Costa County
225980	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
225983	Fee-for-Service	1720391618	1720391618	1	1	ROSALES, AMALIA G CCC-SLP	1/17/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504962	-121.3858245	San Benito County
226009	Fee-for-Service	1881906006	1881906006	1	1	REZNIK, ROBERT S MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117573	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
226015	Fee-for-Service	1598791600	1598791600	1	2	RANCHO FAMILY MEDICAL GROUP,	7/25/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	L ASSOCIATES	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
226029	Fee-for-Service	1437179066	1437179066	1	1	RAMOS, VALENTE C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76225	41	Internal Medicine	0	In state provider	None	3621 MLK JR BLVD	STE 10	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
226040	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
226044	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
226056	Fee-for-Service	1598239857	1598239857	1	1	RAGSTER, JEREMY LMFT	8/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
226067	Fee-for-Service	1053347369	1053347369	1	1	REHABILITATION ASSOCIATES	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	MEDICAL GROUP	790 E WILLOW ST	SUITE 200	LONG BEACH	CA	90806	2771	19	06037	33.80426489	-118.1825796	Los Angeles County
226075	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
226081	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
226161	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
226164	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
226172	Fee-for-Service	1124439807	1124439807	1	7	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
226204	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	6/3/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
226210	Fee-for-Service	1982712592	1982712592	1	1	RIGGS, RICHARD V MD	12/31/1995	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	74069	25	Physical Medicine and Rehabilitation	0	In state provider	None	8635 W 3RD ST	STE 280W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
226218	Fee-for-Service	1932700101	1932700101	1	1	RYAN, BLAKE W PT	11/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26831 ALISO CREEK RD	#200	ALISO VIEJO	CA	92656	5341	30	06059	33.57507189	-117.7235623	Orange County
226238	Fee-for-Service	1023578101	1023578101	1	1	RIN, ERNEST JAMES MD	3/2/2023	207P00000X	NA	Other	026	PHYSICIANS	182811	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
226254	Fee-for-Service	1588790844	1588790844	1	1	RES-CARE CALIFORNIA, INC	3/17/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	499 RIVER OAKS DR	None	YUBA CITY	CA	95991	8223	51	06101	39.10317411	-121.6157146	Sutter County
226267	Fee-for-Service	1780622324	1780622324	1	1	RUSH SAMUEL BM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	17119	41	Internal Medicine	0	In state provider	None	684 MEDICAL CENTER DR E	STE 105	CLOVIS	CA	93611	6806	10	06019	36.840573	-119.658747	Fresno County
226269	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
226272	Fee-for-Service	1578162632	1578162632	1	1	REGENTS OF THE UNIVERSITY OF	10/27/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	618 5TH ST	None	MARYSVILLE	CA	95901	5612	58	06115	39.13999558	-121.5929238	Yuba County
226273	Fee-for-Service	1306425228	1306425228	1	1	RUH, RICHARD DO	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	22779	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
226275	Fee-for-Service	1992851877	1992851877	1	1	RABIZADEH, SHERVIN MD	3/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103737	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
226327	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
226332	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
226350	Fee-for-Service	1417414749	1417414749	1	1	RUDD, ANDREW S LMFT	11/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
226365	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
226370	Fee-for-Service	1518956499	1518956499	2	1	RAINWATER, JOEL MD	9/13/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1386 LEAD HILL BLVD	STE 160	ROSEVILLE	CA	95661	2936	31	06061	38.7489158	-121.2586337	Placer County
226372	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	8/1/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
226413	Fee-for-Service	1215914601	1215914601	1	1	RO, KYUNG M MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88570	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226418	Fee-for-Service	1790188928	1790188928	2	1	RYU PHYSICAL THERAPY, PC	3/8/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
226447	Fee-for-Service	1255444360	1255444360	1	2	ROTHSCHILD, MARTIN OD	2/23/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91913	1800	37	06073	32.62382113	-116.9960539	San Diego County
226448	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
226450	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
226453	Fee-for-Service	1568537314	1568537314	1	1	ROMERO, RAYMUNDO MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75748	02	General Surgery	0	In state provider	None	1505 WILSON TERRACE	SUITE 340	GLENDALE	CA	91206	4072	19	06037	34.14960934	-118.2313491	Los Angeles County
226462	Fee-for-Service	1124439807	1124439807	1	7	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
226484	Fee-for-Service	1386625986	1386625986	1	1	ROMANO, PATRICK S MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63583	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
226494	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
226495	Fee-for-Service	1205037181	1205037181	1	1	ROSING, DAVID K MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89674	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
226557	Fee-for-Service	1710287297	1710287297	1	97	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
226579	Fee-for-Service	1699154633	1699154633	1	1	RAMIREZ, MICHAEL MD	11/17/2017	207P00000X	NA	Other	026	PHYSICIANS	145093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
226584	Fee-for-Service	1033134630	1033134630	1	1	RALPHS GROCERY COMPANY	3/31/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #147	27760 MCBEAN PKWY	None	VALENCIA	CA	91354	1430	19	06037	34.44540143	-118.5532948	Los Angeles County
226592	Fee-for-Service	1760676464	1760676464	1	1	RAVINOVICH, SVETLANA G PSYD	8/1/2018	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
226616	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
226621	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
226626	Fee-for-Service	1881006948	1881006948	1	1	REYES ESTEVES, ARNALDO E MD	4/20/2023	207RC0200X	NA	Other	026	PHYSICIANS	176398	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	0000	43	06085	37.25111017	-121.9465891	Santa Clara County
226652	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
226656	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
226668	Fee-for-Service	1902978760	1902978760	1	1	RUSEV, STOYAN D MD	9/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	97255	36	Psychiatry	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
226673	Fee-for-Service	1619132198	1619132198	1	1	REYES, EUGENIO F	7/12/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3261 WEST SARGENT ROAD	None	LODI	CA	95242	9212	39	06077	38.13043236	-121.3556043	San Joaquin County
226700	Fee-for-Service	1518982560	1518982560	1	1	ROSS, BARBRA A MD	1/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53702	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
226704	Fee-for-Service	1790188928	1790188928	2	1	RYU PHYSICAL THERAPY, PC	3/8/2018	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
226737	Fee-for-Service	1710287297	1710287297	1	76	REGENTS UNIVERSITY OF CALIFO	5/20/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
226739	Fee-for-Service	1205198686	1205198686	1	1	RYAN, STEPHEN T MD	7/3/2017	208800000X	NA	Other	026	PHYSICIANS	147415	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
226740	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
226743	Fee-for-Service	1700918307	1700918307	1	1	RUSSELL, LAURA A LCSW	8/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
226747	Fee-for-Service	1124439807	1124439807	1	7	REGENTS UNIV OF CALIFORNIA U	1/9/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
226755	Fee-for-Service	1861792335	1861792335	1	1	RAUT, HRISHIKESH S MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125446	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
226778	Fee-for-Service	1710287297	1710287297	1	84	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
226779	Fee-for-Service	1558574491	1558574491	1	1	RIEDEL, BARTH B MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98328	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
226807	Fee-for-Service	1417572371	1417572371	1	1	REACH AIR MEDICAL SERVICES L	8/18/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	LC	8001 S INTERPORT BLVD	STE 150	ENGLEWOOD	CO	80112	6094	00	None	39.57042712	-104.8467784	Arapahoe County
226847	Fee-for-Service	1710287297	1710287297	1	33	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
226878	Fee-for-Service	1104277870	1104277870	1	1	RUELAS-RAMIREZ, MAYRA	5/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
226903	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
226909	Fee-for-Service	1710287297	1710287297	1	38	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	None	SANTA CLARITA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
226910	Fee-for-Service	1154371292	1154371292	1	1	RUSCH, MARIA T MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	51083	40	Pediatrics	0	In state provider	None	396 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3323	54	06107	36.06957469	-119.0259292	Tulare County
226919	Fee-for-Service	1275556607	1275556607	1	5	REDWOOD REGIONAL MEDICAL	3/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	GROUP, INC	625 STEELE LN	None	SANTA ROSA	CA	95403	3127	49	06097	38.460366	-122.7242565	Sonoma County
226929	Fee-for-Service	1619980455	1619980455	1	1	ROTHSTEIN, ANDREW R	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	DESERT PODIATRY GROUP	81709 DR CARREON BLVD	STE AB	INDIO	CA	92201	5509	33	06065	33.70733082	-116.2400326	Riverside County
226940	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
226952	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
226997	Fee-for-Service	1053651638	1053651638	1	1	RENN, LILY A MFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
227010	Fee-for-Service	1164493441	1164493441	1	1	RAVI, BARUGUR S MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53465	None	None	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
227023	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
227028	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
227036	Fee-for-Service	1124439807	1124439807	1	7	REGENTS UNIV OF CALIFORNIA U	11/1/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
227057	Fee-for-Service	1255489217	1255489217	1	1	RIAZ, NAVEED MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88111	08	Family Practice	0	In state provider	None	2704 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2436	19	06037	33.9598587	-118.3235034	Los Angeles County
227059	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	4/30/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
227065	Fee-for-Service	1609194497	1609194497	1	4	REGENTS OF THE UNIVERSITY OF	5/3/2019	2084N0400X	NA	Neurology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
227076	Fee-for-Service	1801812656	1801812656	1	1	RAMAMOORTHY, SONIA L MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65709	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
227119	Fee-for-Service	1841378304	1841378304	1	1	RITTER, JOSHUA T DC	4/14/2017	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1706 E BULLARD AVE	SUITE 107	FRESNO	CA	93710	5867	10	06019	36.82319512	-119.7561233	Fresno County
227153	Fee-for-Service	1235287145	1235287145	1	1	ROMIAS, JULIE F MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75118	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
227156	Fee-for-Service	1215096953	1215096953	1	1	ROMBERG, CHRISTOPHER D	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90928	41	Internal Medicine	0	In state provider	J MD	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
227167	Fee-for-Service	1568752400	1568752400	1	1	RHEE, JUNEWHA MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122021	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
227177	Fee-for-Service	1225319270	1225319270	1	1	ROJANAVONGSE, PATARA MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119096	40	Pediatrics	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
227196	Fee-for-Service	1710287297	1710287297	1	134	REGENTS UNIVERSITY OF CALIFO	4/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	RNIA	141 TRIUNFO CANYON RD	110	WESTLAKE VILLAGE	CA	91361	2525	56	06111	34.15961207	-118.8342816	Ventura County
227207	Fee-for-Service	1275556607	1275556607	1	5	REDWOOD REGIONAL MEDICAL	3/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GROUP, INC	625 STEELE LN	None	SANTA ROSA	CA	95403	3127	49	06097	38.460366	-122.7242565	Sonoma County
227229	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
227237	Fee-for-Service	1114543998	1114543998	1	1	RUSSELL, MELISSA DO	9/10/2023	207P00000X	NA	Other	026	PHYSICIANS	21171	None	None	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
227240	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
227282	Fee-for-Service	1508845702	1508845702	1	2	REDLANDS PROSTHETIC & ORTHOT	10/12/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	IC GROUP, INC	1849 W REDLANDS BLVD	STE 103	REDLANDS	CA	92373	3127	36	06071	34.06287354	-117.2162115	San Bernardino County
227289	Fee-for-Service	1710287297	1710287297	1	115	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	7345 MEDICAL CENTER DRIV	420	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
227291	Fee-for-Service	1801229463	1801229463	1	1	RAMANUJAM, NEELA MD	4/22/2021	207R00000X	NA	Other	026	PHYSICIANS	160043	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
227313	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	1/21/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
227315	Fee-for-Service	1710287297	1710287297	1	36	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
227318	Fee-for-Service	1942412747	1942412747	1	1	REGENTS OF UNIV OF CALIF	2/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	UCLA PERINATAL GROUP	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
227321	Fee-for-Service	1265501530	1265501530	1	1	RINKEVICH, DIANA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3303 SW BOND AVE	STE 9	PORTLAND	OR	97239	4501	00	None	45.49894088	-122.6708542	Multnomah County
227335	Fee-for-Service	1770992299	1770992299	1	1	RUGHANI, AMI A MD	12/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131373	01	General Practice	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
227337	Fee-for-Service	1467918573	1467918573	1	1	RICHARDSON, JOANNA K CCC-SLP	2/3/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
227345	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
227347	Fee-for-Service	1609194497	1609194497	1	4	REGENTS OF THE UNIVERSITY OF	12/24/2012	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
227389	Fee-for-Service	1366885840	1366885840	1	1	ROGERS, JASON E MD	10/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165429	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
227392	Fee-for-Service	1972123180	1972123180	1	1	RUBIO, SOFI	9/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
227438	Fee-for-Service	1689738783	1689738783	2	1	RAJU, MURALIDHARA R MD	4/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100400	14	Neurological Surgery	0	In state provider	None	11190 WARNER AVE	STE 305	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
227455	Fee-for-Service	1568752400	1568752400	1	1	RHEE, JUNEWHA MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122021	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
227458	Fee-for-Service	1831264068	1831264068	1	1	RILEY, ROBERT W MD	3/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37422	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
227478	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
227491	Fee-for-Service	1184095440	1184095440	1	1	RAMONES, M THERESA C MD INC	3/15/2016	208600000X	NA	General Surgery	026	PHYSICIANS	137645	02	General Surgery	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
227516	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
227526	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
227531	Fee-for-Service	1811372691	1811372691	1	1	ROMAIN, LISA PHD	2/25/2021	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	VICES	26395 JEFFERSON AVE	D	MURRIETA	CA	92562	6977	33	06065	33.53475568	-117.1791945	Riverside County
227576	Fee-for-Service	1710287297	1710287297	1	115	REGENTS UNIVERSITY OF CALIFO	12/15/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	7345 MEDICAL CENTER DRIV	420	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
227603	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
227604	Fee-for-Service	1659317915	1659317915	1	1	RUTLEDGE, FRANKLIN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60929	02	General Surgery	0	In state provider	None	780 W OLIVE AVE	STE 105	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
227608	Fee-for-Service	1891993762	1891993762	1	1	REESE, KERI A MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88233	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
227620	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
227631	Fee-for-Service	1609194497	1609194497	1	4	REGENTS OF THE UNIVERSITY OF	12/26/2017	2084N0400X	NA	Neurology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
227635	Fee-for-Service	1710287297	1710287297	1	113	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2825 SANTA MONICA BLVD	104	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
227651	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
227656	Fee-for-Service	1649626748	1649626748	1	1	RODRIGUEZ, DANIEL LMFT	7/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
227680	Fee-for-Service	1134369903	1134369903	1	1	ROOK, MICHELLE T MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	101371	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
227701	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
227731	Fee-for-Service	1124439807	1124439807	1	6	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4000 CIVIC CENTER DRIVE	206	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
227745	Fee-for-Service	1730723008	1730723008	1	1	RAMSAY, ROBYN R LPCC	6/23/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
227748	Fee-for-Service	1659670404	1659670404	1	1	REESE, LYNDSAY R PSYD	7/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
227768	Fee-for-Service	1710287297	1710287297	1	58	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
227803	Fee-for-Service	1710287297	1710287297	1	72	REGENTS UNIVERSITY OF CALIFO	5/22/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	EGAL BUSINESS NAME AS LI	18111 BROOKHURST ST	6400	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
227810	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
227812	Fee-for-Service	1710287297	1710287297	1	111	REGENTS UNIVERSITY OF CALIFO	11/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	191 BUENA VISTA ST	415	BURBANK	CA	91505	4541	19	06037	34.15872557	-118.3283863	Los Angeles County
227825	Fee-for-Service	1740226174	1740226174	1	1	ROSE, DONALD H MD	12/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35508	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
227859	Fee-for-Service	1831159870	1831159870	1	1	ROBERT GREENBAUM, M.D.	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
227865	Fee-for-Service	1710287297	1710287297	1	115	REGENTS UNIVERSITY OF CALIFO	12/15/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	7345 MEDICAL CENTER DRIV	420	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
227875	Fee-for-Service	1912919820	1912919820	1	1	REDER, MICHAEL S MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34552	04	Otology, Laryngology, Rhinology	0	In state provider	None	16500 VENTURA BLVD	STE 320	ENCINO	CA	91436	2016	19	06037	34.15756758	-118.4926374	Los Angeles County
227889	Fee-for-Service	1710287297	1710287297	1	98	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	800 S FAIRMOUNT AVE	415	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
227892	Fee-for-Service	1114114584	1114114584	1	1	ROSENBLUTH, EVAN MD	2/28/2018	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	119897	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
227895	Fee-for-Service	1548514961	1548514961	3	1	RANCHO HAVEN CARE LLC	10/9/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9170 HAVEN AVE	STE 122	RANCHO CUCAMONGA	CA	91730	0301	36	06071	34.087491	-117.5758895	San Bernardino County
227913	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
227925	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
227928	Fee-for-Service	1487745295	1487745295	1	1	ROSENBLUTH, GLENN MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85560	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
227933	Fee-for-Service	1629533500	1629533500	1	1	RIVERA, DAISY LCSW	7/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
227936	Fee-for-Service	1710987466	1710987466	1	1	REYNOLDS, HERBERT M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST MARYS HOSPITAL	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
227939	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
227955	Fee-for-Service	1366557928	1366557928	1	2	ROTH, JAMES B DO	12/17/2020	208600000X	NA	General Surgery	026	PHYSICIANS	4011	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
227969	Fee-for-Service	1831820554	1831820554	1	1	RENNINGER, LEVI	4/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
227977	Fee-for-Service	1528449071	1528449071	1	1	RISHEL, CHRISTOPHER A	5/30/2019	207L00000X	NA	Other	026	PHYSICIANS	144824	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
227989	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
228023	Fee-for-Service	1124439807	1124439807	1	6	REGENTS UNIV OF CALIFORNIA U	1/9/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4000 CIVIC CENTER DRIVE	206	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
228071	Fee-for-Service	1508824996	1508824996	1	1	RHOADS, WILLIAM P MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68761	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
228077	Fee-for-Service	1366896078	1366896078	1	1	RITFELD, GABY J MD	7/25/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
228098	Fee-for-Service	1710287297	1710287297	1	111	REGENTS UNIVERSITY OF CALIFO	11/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	191 BUENA VISTA ST	415	BURBANK	CA	91505	4541	19	06037	34.15872557	-118.3283863	Los Angeles County
228099	Fee-for-Service	1710287297	1710287297	1	22	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
228105	Fee-for-Service	1891942918	1891942918	1	1	RODRIGUEZ, VANESSA I LMFT	6/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
228109	Fee-for-Service	1841581857	1841581857	1	1	RYAN J BENDER M.D.	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
228138	Fee-for-Service	1679506208	1679506208	1	1	RUDER, MICHAEL A MD	7/1/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52891	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	770 WELCH RD	STE 100	PALO ALTO	CA	94304	1505	43	06085	37.43748087	-122.1759625	Santa Clara County
228151	Fee-for-Service	1427048768	1427048768	1	1	RODAS, ANA L MD	6/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40282	01	General Practice	0	In state provider	None	3705 GAGE AVE	STE A-B	BELL	CA	90201	1024	19	06037	33.97935067	-118.1993692	Los Angeles County
228153	Fee-for-Service	1710287297	1710287297	1	115	REGENTS UNIVERSITY OF CALIFO	12/15/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	7345 MEDICAL CENTER DRIV	420	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
228176	Fee-for-Service	1710287297	1710287297	1	76	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
228183	Fee-for-Service	1992746614	1992746614	1	1	RUIZ, RAUL MD	2/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
228213	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
228214	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	10/21/2020	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
228226	Fee-for-Service	1588689186	1588689186	1	1	RALPHS GROCERY COMPANY	5/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #293	1233 N LA BREA AVE	None	WEST HOLLYWOOD	CA	90038	1023	19	06037	34.09353	-118.3441185	Los Angeles County
228228	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
228234	Fee-for-Service	1508055765	1508055765	1	1	RUSHTON, JOHN M MD	12/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
228235	Fee-for-Service	1619053527	1619053527	1	1	RUSNAK, RIMA N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
228263	Fee-for-Service	1275074536	1275074536	1	1	ROSENBERG, ALEX M MD	8/16/2020	208M00000X	NA	Other	026	PHYSICIANS	157841	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
228264	Fee-for-Service	1275793739	1275793739	1	1	RIPPEY, KELLY MD	3/18/2022	208600000X	NA	General Surgery	026	PHYSICIANS	176613	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
228277	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
228295	Fee-for-Service	1184662256	1184662256	1	1	RAMSEY F HASAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
228312	Fee-for-Service	1124439807	1124439807	1	6	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4000 CIVIC CENTER DRIVE	206	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
228318	Fee-for-Service	1083232284	1083232284	1	1	ROSS, MICHAEL A LMFT	8/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
228340	Fee-for-Service	1831939883	1831939883	1	1	ROMO, ROXANNA M LMFT	3/13/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
228341	Fee-for-Service	1437701091	1437701091	1	1	RILLING, DUSTIN DPM	2/20/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1909 HILLHURST AVE	None	LOS ANGELES	CA	90027	2711	19	06037	34.105779	-118.287436	Los Angeles County
228364	Fee-for-Service	1427284843	1427284843	1	1	RSCR CALIFORNIA INC	2/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2130 E 8TH ST	None	NATIONAL CITY	CA	91950	2802	37	06073	32.68195964	-117.0849568	San Diego County
228373	Fee-for-Service	1265817001	1265817001	1	1	RUPARELIA, SUDEEP H MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154121	41	Internal Medicine	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
228387	Fee-for-Service	1710287297	1710287297	1	111	REGENTS UNIVERSITY OF CALIFO	11/17/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	191 BUENA VISTA ST	415	BURBANK	CA	91505	4541	19	06037	34.15872557	-118.3283863	Los Angeles County
228426	Fee-for-Service	1235147125	1235147125	1	1	RASI, ANNETTE J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84659	30	Radiology	0	In state provider	None	1685B COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1703	44	06087	36.9881044	-121.9813263	Santa Cruz County
228454	Fee-for-Service	1427386341	1427386341	1	1	RINGNES, JENNY MD	6/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176452	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
228456	Fee-for-Service	1366493546	1366493546	1	1	RETINA CONSULTANTS	2/28/1988	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SAN DIEGO, SUITE 200	9850 GENESEE AVE	STE 700	LA JOLLA	CA	92037	1218	37	06073	32.882913	-117.226341	San Diego County
228466	Fee-for-Service	1710287297	1710287297	1	76	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
228499	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	4/7/2022	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
228506	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
228515	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
228521	Fee-for-Service	1275556607	1275556607	1	10	REDWOOD REGIONAL MEDICAL	4/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	GROUP, INC	652 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
228536	Fee-for-Service	1790730992	1790730992	1	1	RAO, ANURADHA T MD	5/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129907	30	Radiology	0	In state provider	None	1001 POTRERO AVE	ROOM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
228558	Fee-for-Service	1619066651	1619066651	1	1	RIVERA-CRUZ, BERENICE RN	7/24/2003	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
228563	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
228589	Fee-for-Service	1235227778	1235227778	1	1	RICHARDS, JAMES M MD	10/23/1997	174400000X	NA	Other	026	PHYSICIANS	37794	41	Internal Medicine	0	In state provider	None	8610 S SEPULVEDA BLVD	STE 102	LOS ANGELES	CA	90045	4009	19	06037	33.959448	-118.396202	Los Angeles County
228597	Fee-for-Service	1124439807	1124439807	1	6	REGENTS UNIV OF CALIFORNIA U	10/12/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4000 CIVIC CENTER DRIVE	206	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
228629	Fee-for-Service	1174940019	1174940019	1	1	ROBERTSON, LEANNA-MARIE S MD	12/1/2020	207K00000X	NA	Other	026	PHYSICIANS	168045	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
228675	Fee-for-Service	1710287297	1710287297	1	111	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	191 BUENA VISTA ST	415	BURBANK	CA	91505	4541	19	06037	34.15872557	-118.3283863	Los Angeles County
228721	Fee-for-Service	1679887228	1679887228	1	1	RUVALCABA, STEPHANIE M S MFT	2/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96806	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
228773	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	8/9/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
228788	Fee-for-Service	1710287297	1710287297	1	113	REGENTS UNIVERSITY OF CALIFO	12/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	2825 SANTA MONICA BLVD	104	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
228791	Fee-for-Service	1265995328	1265995328	1	1	ROMAN, JORDAN M MD	8/16/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
228799	Fee-for-Service	1750775342	1750775342	1	1	RUBEN, DANA E DO	10/12/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	18902	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
228805	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
228809	Fee-for-Service	1275556607	1275556607	1	10	REDWOOD REGIONAL MEDICAL	4/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	GROUP, INC	652 PETALUMA AVE	STE B	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
228820	Fee-for-Service	1639889124	1639889124	1	1	REINA, MICHAEL A LMFT	8/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
228824	Fee-for-Service	1386762300	1386762300	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
228836	Fee-for-Service	1295111961	1295111961	1	1	RIZZO, BRITTANY LMFT	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
228852	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
228876	Fee-for-Service	1518126317	1518126317	1	1	RAIZADA, VARUN K MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94805	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
228903	Fee-for-Service	1265455471	1265455471	1	1	RAWSON, RICK MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	21883	02	General Surgery	0	In state provider	None	1617 N CALIFORNIA ST	# 1	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
228946	Fee-for-Service	1912907262	1912907262	1	1	RESCUE SERVICES	8/21/2007	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INTERNATIONAL, LTD.	12806 SCHABARUM AVE	STE A	IRWINDALE	CA	91706	6805	19	06037	34.08051204	-117.9945349	Los Angeles County
228970	Fee-for-Service	1164497830	1164497830	1	1	RANDOLPH, JOSEPH J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1406 6TH AVE N	None	SAINT CLOUD	MN	56303	1900	00	None	45.5746739	-94.17010435	Stearns County
228976	Fee-for-Service	1063586394	1063586394	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF I LLC	3115 W MARCH LN	None	STOCKTON	CA	95219	2372	39	06077	37.98421696	-121.3504148	San Joaquin County
228977	Fee-for-Service	1497786115	1497786115	1	1	RAFAEL SANTANA M.D.	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 JOHNSON FERRY RD	None	ATLANTA	GA	30342	1606	00	None	33.90791732	-84.3540509	Fulton County
229010	Fee-for-Service	1992286074	1992286074	1	1	RPRD DIAGNOSTICS LLC	1/31/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1225 DISCOVERY PARKWAY	STE 260	MILWAUKEE	WI	53226	1341	00	None	43.04695081	-88.03142189	Milwaukee County
229029	Fee-for-Service	1891741104	1891741104	1	1	ROSE, WILLIAM J MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	93626	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
229044	Fee-for-Service	1487101978	1487101978	1	1	ROMANA INTERNATIONAL INC.	5/28/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	N	3241 CHICAGO AVE.	None	RIVERSIDE	CA	92507	3426	33	06065	33.983586	-117.3484875	Riverside County
229061	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	3/2/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
229069	Fee-for-Service	1265995328	1265995328	1	1	ROMAN, JORDAN M MD	8/16/2024	207P00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
229077	Fee-for-Service	1710287297	1710287297	1	113	REGENTS UNIVERSITY OF CALIFO	12/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	2825 SANTA MONICA BLVD	104	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
229082	Fee-for-Service	1821442815	1821442815	1	1	RANA, NOREEN MD	2/23/2023	390200000X	NA	Other	026	PHYSICIANS	175914	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
229091	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
229111	Fee-for-Service	1386762300	1386762300	1	1	REGENTS OF THE UNIVERSITY OF	8/26/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
229139	Fee-for-Service	1407128275	1407128275	1	1	RANDHAWA, RUPINDER MD	4/26/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	140073	36	Psychiatry	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
229141	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
229153	Fee-for-Service	1649631821	1649631821	1	1	REYNOLDS, JASON R PSYD	6/7/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
229154	Fee-for-Service	1235799123	1235799123	1	1	RUBICON HOSPICE CARE	2/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 225	VAN NUYS	CA	91411	4719	19	06037	34.18570347	-118.450386	Los Angeles County
229157	Fee-for-Service	1306901152	1306901152	1	1	REYES, ALEJANDRO A LCSW	5/3/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73929 LARREA STREET	1B	PALM DESERT	CA	92260	4305	33	06065	33.71878454	-116.375094	Riverside County
229159	Fee-for-Service	1891003885	1891003885	1	1	RAI, SONYA K LCSW	9/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
229175	Fee-for-Service	1356479463	1356479463	1	1	RISKIN, DANIEL J MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88292	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
229191	Fee-for-Service	1518468487	1518468487	1	1	RENDAHL, CHELSEA E PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
229213	Fee-for-Service	1194769091	1194769091	1	1	RODRIGUEZ, ROBERT M MD	12/10/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70447	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
229244	Fee-for-Service	1265877336	1265877336	1	1	REEVES, MEGAN D MD	10/10/2017	390200000X	NA	Other	026	PHYSICIANS	135475	40	Pediatrics	0	In state provider	None	4000 CIVIC CENTER DR	STE 205	SAN RAFAEL	CA	94903	5233	21	06041	38.0041783	-122.538861	Marin County
229256	Fee-for-Service	1801906565	1801906565	1	1	RALEYS	5/4/1987	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	367 W MAIN ST	None	WOODLAND	CA	95695	3600	57	06113	38.67763626	-121.8011001	Yolo County
229258	Fee-for-Service	1649680026	1649680026	1	1	ROBERTS, BRANDY LCSW	5/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
229324	Fee-for-Service	1467588780	1467588780	1	1	ROMERO, MIRIAM MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95695	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
229339	Fee-for-Service	1518968353	1518968353	1	1	RHODES, DAVID E MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52968	None	None	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
229351	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
229361	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
229379	Fee-for-Service	1710287297	1710287297	1	69	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1255 15TH STREET	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
229395	Fee-for-Service	1821639675	1821639675	1	1	RODRIGUEZ, HANNAH LPCC	2/28/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
229399	Fee-for-Service	1871576363	1871576363	1	1	REISCH, PAUL A MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80478	30	Radiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
229419	Fee-for-Service	1487814299	1487814299	1	1	RUDDICK, BENJAMIN F MD	12/10/2019	207L00000X	NA	Other	026	PHYSICIANS	152316	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
229426	Fee-for-Service	1326107046	1326107046	1	1	RICH, KAREN R CRNA	5/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
229427	Fee-for-Service	1710287297	1710287297	1	23	REGENTS UNIVERSITY OF CALIFO	6/12/2020	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
229441	Fee-for-Service	1235799123	1235799123	1	1	RUBICON HOSPICE CARE	2/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 225	VAN NUYS	CA	91411	4719	19	06037	34.18570347	-118.450386	Los Angeles County
229450	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
229485	Fee-for-Service	1932370418	1932370418	1	1	RODRIGUEZ, SAMANTHA LMFT	12/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14393 PARK AVE STE 200	None	VICTORVILLE	CA	92392	3302	36	06071	34.5123	-117.3248825	San Bernardino County
229521	Fee-for-Service	1104889138	1104889138	1	2	REGENTS OF THE UNIV OF CA EM	9/17/2018	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ER MED	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
229573	Fee-for-Service	1972073104	1972073104	1	1	REYES, KELLY LMFT	3/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
229636	Fee-for-Service	1245203462	1245203462	1	1	REDDY, UDAY V MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52802	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
229646	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	10/6/2020	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
229651	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
229674	Fee-for-Service	1689752487	1689752487	1	1	RANTAPAA, AARON A MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67570	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
229688	Fee-for-Service	1255956520	1255956520	1	2	RABAH, WILLEED MD	7/27/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	185348	-	NOT APPLICABLE	0	In state provider	None	1889 W REDLANDS BLVD.	BLDG 9	REDLANDS	CA	92373	3119	36	06071	34.06288549	-117.21717	San Bernardino County
229698	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	11/18/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
229699	Fee-for-Service	1710132253	1710132253	1	1	RX CONSULTANTS GROUP INC	2/5/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FIRST STREET MEDICAL PLA	2010 E FIRST ST	#120	SANTA ANA	CA	92705	4079	30	06059	33.74554507	-117.8387522	Orange County
229726	Fee-for-Service	1164800538	1164800538	1	1	ROSELLI, MATTHEW A LCSW	2/6/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
229740	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
229783	Fee-for-Service	1477572683	1477572683	1	1	RECKTENWALD, MATTHEW R MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101306	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
229796	Fee-for-Service	1205909868	1205909868	1	1	ROSE, BARRY MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	56499	20	Orthopedic Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
229805	Fee-for-Service	1982084125	1982084125	1	1	RAHIMI INC	11/22/2019	193400000X	NA	Other	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	ILITATION	8201 NEWMAN AVE	#302	HUNTINGTON BEACH	CA	92647	7020	30	06059	33.7048475	-117.9855135	Orange County
229812	Fee-for-Service	1104889138	1104889138	1	2	REGENTS OF THE UNIV OF CA EM	9/17/2018	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ER MED	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
229854	Fee-for-Service	1598914772	1598914772	1	1	RUDOY, ELENA M MD	3/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107576	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
229858	Fee-for-Service	1477907715	1477907715	1	1	ROCK, ADAM G MD	7/13/2022	207RX0202X	NA	Oncology	026	PHYSICIANS	162794	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
229860	Fee-for-Service	1649607581	1649607581	1	1	REEDER, SHARON K	11/12/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
229882	Fee-for-Service	1023147501	1023147501	1	1	RESENDEZ, LUIS F LMFT	8/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3610 CENTRAL AVE	#400	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
229924	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
229940	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	8/11/2022	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
229948	Fee-for-Service	1306079181	1306079181	2	1	REYNALDO L. MAKABALI MD INC	10/18/2013	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2500 W 8TH ST.	202	LOS ANGELES	CA	90057	3860	19	06037	34.05685316	-118.2823508	Los Angeles County
229987	Fee-for-Service	1588026322	1588026322	1	1	RANGEL, JULIO C MD	10/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153075	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
229988	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
230001	Fee-for-Service	1346304417	1346304417	1	1	RABKIN, ANGELA F MD	8/1/2000	207R00000X	NA	Other	026	PHYSICIANS	30514	41	Internal Medicine	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
230027	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
230029	Fee-for-Service	1215032404	1215032404	1	1	RENAL TREATMENT CENTERS	5/30/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	1075 E PACIFIC COAST HWY	None	LONG BEACH	CA	90806	5089	19	06037	33.78988935	-118.1787752	Los Angeles County
230050	Fee-for-Service	1255590642	1255590642	1	1	RIESENBERG, TYSON R MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98746	05	Anesthesiology	0	In state provider	None	25470 MEDICAL CTR DR	STE 206	MURRIETA	CA	92562	4901	33	06065	33.55723646	-117.1859554	Riverside County
230067	Fee-for-Service	1053997742	1053997742	1	1	REDDY, ARCHANA M MD	4/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191979	08	Family Practice	0	In state provider	None	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
230080	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
230093	Fee-for-Service	1184205668	1184205668	1	1	RYAN, RHIANNON	7/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22746	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
230113	Fee-for-Service	1124330170	1124330170	1	1	RORY MURPHY MD NEURSURGICAL	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19829 N 27TH AVE	None	PHOENIX	AZ	85027	4001	00	None	33.665616	-112.116267	Maricopa County
230164	Fee-for-Service	1770154528	1770154528	1	1	RICHARDSON, JULIA C OD	7/14/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	342 F STREET	None	CHULA VISTA	CA	91910	2625	37	06073	32.64073026	-117.0815293	San Diego County
230184	Fee-for-Service	1417054461	1417054461	1	2	RETTINGER, HERBERT I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25017	01	General Practice	0	In state provider	None	1211 W LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2855	30	06059	33.84718298	-117.933758	Orange County
230218	Fee-for-Service	1710287297	1710287297	1	62	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
230228	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	4/22/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
230258	Fee-for-Service	1467289694	1467289694	1	1	RILEY, CAITLIN NP	11/12/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
230264	Fee-for-Service	1720707367	1720707367	1	1	RAMY SABA O.D. CORPORATION	9/19/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12721 MORENO BEACH DR	None	MORENO VALLEY	CA	92555	4411	33	06065	33.935742	-117.1819035	Riverside County
230274	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
230289	Fee-for-Service	1013941962	1013941962	1	1	RASKIN, BERNARD I MD	5/4/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	34720	None	None	0	In state provider	None	23861 MCBEAN PKWY	STE E14	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
230302	Fee-for-Service	1699720789	1699720789	1	1	ROBERT BARRALI, M.D.	8/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
230316	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
230365	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
230391	Fee-for-Service	1255498689	1255498689	1	1	RAINES, JAMES A JR PHD	3/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
230409	Fee-for-Service	1104831569	1104831569	1	1	RUBIN, RICK A MD INC	5/2/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	36791	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
230455	Fee-for-Service	1245533231	1245533231	1	1	RELEKAR, KIRAN V MD	2/10/2021	207R00000X	NA	Other	026	PHYSICIANS	171354	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
230456	Fee-for-Service	1245276450	1245276450	1	1	REYNOLDS, JOAN MD	1/31/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46213	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
230474	Fee-for-Service	1417054461	1417054461	1	2	RETTINGER, HERBERT I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25017	67	Endocrinology	0	In state provider	None	1211 W LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2855	30	06059	33.84718298	-117.933758	Orange County
230495	Fee-for-Service	1457398471	1457398471	1	1	REYNOLDS, THOMAS F MD	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43190	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
230517	Fee-for-Service	1710287297	1710287297	1	113	REGENTS UNIVERSITY OF CALIFO	12/1/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	2825 SANTA MONICA BLVD	104	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
230523	Fee-for-Service	1013043678	1013043678	1	2	RAYMOND, JENNIFER K MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144825	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
230554	Fee-for-Service	1518032150	1518032150	1	1	RED BLUFF HEALTH CARE,	6/1/2006	310400000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	555 LUTHER RD	None	RED BLUFF	CA	96080	4256	52	06103	40.16083295	-122.2320158	Tehama County
230562	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
230572	Fee-for-Service	1013435916	1013435916	1	1	RODRIGUEZ, BRIANA C PSYD	4/2/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
230603	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
230633	Fee-for-Service	1821365040	1821365040	1	1	ROSEMEL HLTH CARE SERV INC	5/1/2012	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	INC	27850 VILLA CANYON RD	None	CASTAIC	CA	91384	3732	19	06037	34.47332392	-118.6221451	Los Angeles County
230644	Fee-for-Service	1265673511	1265673511	1	1	ROSENTHAL, ELAN H MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107149	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
230654	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
230760	Fee-for-Service	1275556607	1275556607	1	13	REDWOOD REGIONAL MEDICAL	1/27/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	5150 HILL RD E	STE F	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
230781	Fee-for-Service	1457398471	1457398471	1	1	REYNOLDS, THOMAS F MD	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43190	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
230804	Fee-for-Service	1710287297	1710287297	1	119	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
230813	Fee-for-Service	1962563080	1962563080	1	2	RAJ PRASAD MD INC	2/23/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8711 VENICE BLVD	None	LOS ANGELES	CA	90034	3216	19	06037	34.03259874	-118.3827656	Los Angeles County
230814	Fee-for-Service	1770509606	1770509606	1	1	RICHARD, BRAD A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	40557	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
230825	Fee-for-Service	1790026375	1790026375	1	1	ROMERO, FRANCES E LMFT	5/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
230849	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	5/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
230890	Fee-for-Service	1710287297	1710287297	1	49	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
230908	Fee-for-Service	1467588822	1467588822	1	1	RCSR CALIFORNIA, INC	2/26/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1414 E ELM ST	None	ANAHEIM	CA	92805	4232	30	06059	33.83590949	-117.8982892	Orange County
230925	Fee-for-Service	1861783870	1861783870	1	1	RABI, SEPIDEH L MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129376	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
230942	Fee-for-Service	1720112634	1720112634	1	1	REDDI, ANITHA MD	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92404	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
230943	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
230947	Fee-for-Service	1144635483	1144635483	1	1	ROBINSON, HANNAH S DO	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14645	41	Internal Medicine	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
230965	Fee-for-Service	1003577958	1003577958	1	1	RAINCROSS FAMILY COUNSELING,	12/9/2022	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC.	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
230966	Fee-for-Service	1336846617	1336846617	1	1	RX GROUP, INC	4/14/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	227 W JANSS RD	STE. 120	THOUSAND OAKS	CA	91360	1855	56	06111	34.20611691	-118.883861	Ventura County
230973	Fee-for-Service	1114318854	1114318854	1	1	RESIDENCE AT ROYAL	5/18/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	BELLINGHAM INC	12229 CHANDLER BLVD	None	VALLEY VILLAGE	CA	91607	4395	19	06037	34.16867453	-118.3995765	Los Angeles County
230978	Fee-for-Service	1538716170	1538716170	1	1	RUIZ, MICHAEL K	2/3/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50-225 CESAR CHAVEZ ST.	SUITE 103	COACHELLA	CA	92253	7243	33	06065	33.67309459	-116.181558	Riverside County
230995	Fee-for-Service	1568598480	1568598480	1	1	RES-CARE CALIFORNIA	3/17/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1805 WHITE OAK DR	None	YUBA CITY	CA	95991	8217	51	06101	39.10283333	-121.613415	Sutter County
231014	Fee-for-Service	1912071663	1912071663	1	1	REISER, BIBIANA J MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81507	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231032	Fee-for-Service	1669415881	1669415881	1	1	RIGGS,RYAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 WEST 9000 SOUTH	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
231036	Fee-for-Service	1659356137	1659356137	1	1	RAFFO, WILLIAM R MD	6/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80608	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
231048	Fee-for-Service	1275556607	1275556607	1	13	REDWOOD REGIONAL MEDICAL	9/16/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	5150 HILL RD E	STE F	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
231058	Fee-for-Service	1912042375	1912042375	1	1	ROBERTS, TANYA M LCSW	8/14/2018	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	404 W PINE ST	STE 1	LODI	CA	95240	2048	39	06077	38.13437954	-121.2780387	San Joaquin County
231070	Fee-for-Service	1013195296	1013195296	1	1	REAM, SARA M MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
231071	Fee-for-Service	1477294601	1477294601	1	1	REIM, PETER R MD	11/23/2024	207P00000X	NA	Other	026	PHYSICIANS	190540	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
231096	Fee-for-Service	1063454510	1063454510	1	1	RAZEGHI, SEYYED M MD	10/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94467	41	Internal Medicine	0	In state provider	None	777 FLOWER ST	STE A	GLENDALE	CA	91201	3000	19	06037	34.15802552	-118.2812712	Los Angeles County
231133	Fee-for-Service	1184803827	1184803827	1	1	RYAN R BELL	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1325 N 600 E	STE 101	LOGAN	UT	84341	6743	00	None	41.75604221	-111.8191191	Cache County
231137	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
231150	Fee-for-Service	1083317879	1083317879	1	1	RAMIREZ, BRENDA C	4/27/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1764 ORANGE TREE LN	None	REDLANDS	CA	92374	2856	36	06071	34.06785052	-117.2146365	San Bernardino County
231222	Fee-for-Service	1407286719	1407286719	1	1	RODRIGUEZ, MARIBEL LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
231234	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
231254	Fee-for-Service	1003577958	1003577958	1	1	RAINCROSS FAMILY COUNSELING,	2/9/2022	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
231261	Fee-for-Service	1780608661	1780608661	1	1	ROLLINS, DAWN A LCSW	5/25/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5910 CLARK RD	SUITE M	PARADISE	CA	95969	4859	04	06007	39.75749014	-121.6070408	Butte County
231269	Fee-for-Service	1760918650	1760918650	1	1	RADCLIFFE, COLLIN B CRNA	5/11/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
231271	Fee-for-Service	1891873378	1891873378	1	1	ROYLE, KENNETH M MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	43958	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
231322	Fee-for-Service	1669093589	1669093589	1	1	RABINE, RHIANNON J PSYD	11/29/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
231336	Fee-for-Service	1275556607	1275556607	1	13	REDWOOD REGIONAL MEDICAL	1/27/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	5150 HILL RD E	STE F	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
231355	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
231356	Fee-for-Service	1477294601	1477294601	1	1	REIM, PETER R MD	11/23/2024	207P00000X	NA	Other	026	PHYSICIANS	190540	70	Clinic (mixed specialty)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
231359	Fee-for-Service	1720244536	1720244536	1	1	ROUHANI, AMIR A MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104142	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
231392	Fee-for-Service	1255687489	1255687489	1	1	RX ADVISORS INC	10/15/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 HERNDON AVE	STE 102	CLOVIS	CA	93611	6300	10	06019	36.83754673	-119.6771619	Fresno County
231425	Fee-for-Service	1710287297	1710287297	1	66	REGENTS UNIVERSITY OF CALIFO	5/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	25775 MCBEAN PKWY	115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
231431	Fee-for-Service	1134371412	1134371412	1	1	RODRIGUEZ, VERONICA MD	7/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105087	08	Family Practice	0	In state provider	None	4733 W. SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
231481	Fee-for-Service	1033529508	1033529508	1	1	RATANAPRASATPORN, LISA MD	7/19/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	192021	30	Radiology	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
231517	Fee-for-Service	1679708028	1679708028	1	1	RSCR CALIFORNIA INC	3/1/2009	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1384 FRAULINE DRIVE	None	SAN DIEGO	CA	92154	2922	37	06073	32.571072	-117.0908855	San Diego County
231519	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
231520	Fee-for-Service	1144889817	1144889817	1	1	RUSHAKOFF, JOSHUA A MD	6/9/2022	207R00000X	NA	Other	026	PHYSICIANS	177084	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
231524	Fee-for-Service	1497375299	1497375299	1	1	RAZOOK, WISAM DO	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	20866	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
231547	Fee-for-Service	1124008727	1124008727	1	1	REGENTS OF THE UNIV CA	11/1/1996	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	3200 BELL RD	None	AUBURN	CA	95603	9244	31	06061	38.94193574	-121.103139	Placer County
231575	Fee-for-Service	1780641712	1780641712	1	1	REITER, SCOTT D MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
231635	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
231645	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
231646	Fee-for-Service	1184658973	1184658973	1	1	REN, XING-JIAN MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54295	38	Geriatrics	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
231648	Fee-for-Service	1033306717	1033306717	1	1	RAJAGOPAL, SHEILA MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92034	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	SUITE 270	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
231709	Fee-for-Service	1508864000	1508864000	1	1	RADIATION MEDICAL GROUP	6/14/1994	174400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6699 ALVARADO RD	STE 2109	SAN DIEGO	CA	92120	5253	37	06073	32.77665383	-117.0540279	San Diego County
231743	Fee-for-Service	1730897174	1730897174	1	1	ROSENTHAL, GABRIELLA R NP	11/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
231806	Fee-for-Service	1710287297	1710287297	1	13	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
231816	Fee-for-Service	1831833797	1831833797	1	1	RAHMAN, HANNA DO	1/22/2025	207P00000X	NA	Other	026	PHYSICIANS	22124	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
231842	Fee-for-Service	1740382993	1740382993	1	1	REGENTS OF THE UNIVERSITY OF	4/5/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
231843	Fee-for-Service	1609061548	1609061548	1	1	RAIMONDO, MARCELLA M PHD	7/27/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
231862	Fee-for-Service	1780641712	1780641712	1	1	REITER, SCOTT D MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42150	41	Internal Medicine	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
231882	Fee-for-Service	1205260114	1205260114	1	1	RAYMOND, REBECCA MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133206	01	General Practice	0	In state provider	None	219 N SANBORN RD	None	SALINAS	CA	93905	2218	27	06053	36.67720965	-121.6266381	Monterey County
231908	Fee-for-Service	1669870242	1669870242	1	1	RH HOME HEALTH SERVICES INC	5/21/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	229 N CENTRAL AVE	SUITE 610	GLENDALE	CA	91203	3533	19	06037	34.14910181	-118.2579537	Los Angeles County
231920	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
231934	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
232030	Fee-for-Service	1881744654	1881744654	1	1	ROSALES-WYMAN, CAROLINA LCSW	8/12/2010	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1904 FRANKLIN ST.	SUITE 703	OAKLAND	CA	94612	2906	01	06001	37.8074326	-122.2676693	Alameda County
232062	Fee-for-Service	1902121429	1902121429	1	1	REYNOLDS, APRIL DO	4/6/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14006	25	Physical Medicine and Rehabilitation	0	In state provider	None	39180 FARWELL DRIVE	SUITE 110	FREMONT	CA	94538	1015	01	06001	37.53211262	-121.9981587	Alameda County
232078	Fee-for-Service	1568966687	1568966687	1	1	RAMEY, JESSICA LPCC	4/17/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARDS RD	240	CERRITOS	CA	90703	2465	19	06037	33.87401441	-118.0344613	Los Angeles County
232079	Fee-for-Service	1528146255	1528146255	1	1	RATHBUN, KRISTEN T MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76249	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
232088	Fee-for-Service	1124439807	1124439807	1	26	REGENTS UNIV OF CALIFORNIA U	2/27/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1100 SOUTH ELISEO DR	STE 2A	GREENBRAE	CA	94904	2017	21	06041	37.94358265	-122.5345035	Marin County
232129	Fee-for-Service	1740382993	1740382993	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
232130	Fee-for-Service	1508255498	1508255498	1	1	RUSSAK, DAVID A	3/13/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
232143	Fee-for-Service	1366772154	1366772154	1	1	RASMUSSEN, AMY C MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119539	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
232183	Fee-for-Service	1144046905	1144046905	1	1	REIS, DAVID NP	3/11/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1701 CESAR E CHAVEZ AVE	SUITE 535	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
232189	Fee-for-Service	1639308588	1639308588	1	1	RHODES, SUZANNE	8/19/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1200 N. BEAVER STREET	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
232209	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	2/23/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
232217	Fee-for-Service	1255761664	1255761664	1	1	RMX MONITORING LLC.	6/7/2021	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	5000 ATRIUM WAY	SUITE 1	MOUNT LAUREL	NJ	08054	3915	00	None	39.91564583	-74.95547354	Burlington County
232220	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	5/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
232237	Fee-for-Service	1932141488	1932141488	1	1	REN, WENDY MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75429	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
232287	Fee-for-Service	1144416348	1144416348	1	1	RUBIN, JACK MD	9/25/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	1045 ATLANTIC AVENUE	SUITE 915	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
232333	Fee-for-Service	1437976032	1437976032	1	1	RESILIENT AGENCY	12/10/2024	251S00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	1925 W TEMPLE ST	STE 206	LOS ANGELES	CA	90026	4972	19	06037	34.06964168	-118.2660274	Los Angeles County
232356	Fee-for-Service	1962793695	1962793695	1	1	RL DOYAN MD INC	5/13/2011	193200000X	NA	Other	026	PHYSICIANS	50937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1241 S GLENDALE AVE	SUITE 201	GLENDALE	CA	91205	3385	19	06037	34.13065269	-118.2524619	Los Angeles County
232386	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	5/14/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
232416	Fee-for-Service	1659620854	1659620854	1	1	REDDY, SAMATHHA R MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120797	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	#450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
232418	Fee-for-Service	1124439807	1124439807	1	18	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
232460	Fee-for-Service	1598727166	1598727166	1	1	RICHARD G LOVATO, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	711 ENCINO PL NE	None	ALBUQUERQUE	NM	87102	2619	00	None	35.08750695	-106.632624	Bernalillo County
232478	Fee-for-Service	1821699620	1821699620	1	1	REEDLEY COMMUNITY HOSPITAL	5/4/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	398 S CHURCH RD	None	EARLIMART	CA	93219	0000	54	06107	35.88213895	-119.2680999	Tulare County
232479	Fee-for-Service	1073776191	1073776191	1	1	RAMOS, NEILL D MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	104711	41	Internal Medicine	0	In state provider	None	1043 ELM AVE	STE 402	LONG BEACH	CA	90813	3296	19	06037	33.779655	-118.1880065	Los Angeles County
232497	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
232505	Fee-for-Service	1083600126	1083600126	1	1	ROTUNDA, EDWARD S MD	9/19/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76575	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
232508	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
232521	Fee-for-Service	1760792717	1760792717	1	1	ROTEN, RYAN DO	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
232546	Fee-for-Service	1023179546	1023179546	1	1	RODRIGUEZ, MARIA E MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43620	None	None	0	In state provider	INC	2417 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1355	19	06037	34.03408745	-118.2150183	Los Angeles County
232578	Fee-for-Service	1144416348	1144416348	1	1	RUBIN, JACK MD	9/25/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	A PROFESSIONAL CORP	1045 ATLANTIC AVENUE	SUITE 915	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
232591	Fee-for-Service	1043715949	1043715949	1	1	RIVAS, MARILYN LCSW	10/29/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
232604	Fee-for-Service	1902101348	1902101348	1	1	RAZINIA, TANNAZ MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134508	01	General Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232617	Fee-for-Service	1811949449	1811949449	1	2	ROSADO-COSME, RAFAEL A	7/6/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75995	08	Family Practice	0	In state provider	None	407 POTTER ST	STE G	FALLBROOK	CA	92028	3086	37	06073	33.3790266	-117.2428111	San Diego County
232619	Fee-for-Service	1033677190	1033677190	1	1	ROBERTS, DE EDRA NP	1/8/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
232633	Fee-for-Service	1952873291	1952873291	1	1	RIVARD, JUSTIN J NP	7/19/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
232646	Fee-for-Service	1962793695	1962793695	1	1	RL DOYAN MD INC	5/13/2011	193200000X	NA	Other	026	PHYSICIANS	50937	08	Family Practice	0	In state provider	None	1241 S GLENDALE AVE	SUITE 201	GLENDALE	CA	91205	3385	19	06037	34.13065269	-118.2524619	Los Angeles County
232656	Fee-for-Service	1922004662	1922004662	1	1	RIFF, DENNIS S MD	7/1/1981	174400000X	NA	Other	026	PHYSICIANS	22807	10	Gastroenterology (M.D. only)	0	In state provider	None	377 E CHAPMAN AVE	STE 240	PLACENTIA	CA	92870	5091	30	06059	33.87122847	-117.8635161	Orange County
232660	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	10/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
232677	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
232691	Fee-for-Service	1780741330	1780741330	1	1	REYES, GEORGE D MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76226	30	Radiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
232705	Fee-for-Service	1124439807	1124439807	1	18	REGENTS UNIV OF CALIFORNIA U	6/29/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
232733	Fee-for-Service	1104889138	1104889138	1	1	REGENTS OF THE UNIV OF CA EM	4/1/1995	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ER MED	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
232744	Fee-for-Service	1477998862	1477998862	1	1	RUDISAILE, DAREN G MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138660	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
232746	Fee-for-Service	1033456793	1033456793	1	1	RUSHTON, LISA R PT	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
232766	Fee-for-Service	1821699620	1821699620	1	1	REEDLEY COMMUNITY HOSPITAL	5/4/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	398 S CHURCH RD	None	EARLIMART	CA	93219	0000	54	06107	35.88213895	-119.2680999	Tulare County
232784	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	2/23/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
232791	Fee-for-Service	1053930156	1053930156	1	1	RIBEIRO, ANATEVKA S MD	7/23/2024	390200000X	NA	Other	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
232794	Fee-for-Service	1710287297	1710287297	1	65	REGENTS UNIVERSITY OF CALIFO	5/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
232829	Fee-for-Service	1811024185	1811024185	1	1	ROCKCREEK INC	5/19/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7312 TEAK WAY	None	RANCHO CUCAMONGA	CA	91730	1529	36	06071	34.12151605	-117.5873735	San Bernardino County
232833	Fee-for-Service	1457744534	1457744534	1	1	RETINA INSTITUTE OF CALIFORN	3/31/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9500 STOCKDALE HIGHWAY	108	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
232865	Fee-for-Service	1144416348	1144416348	1	1	RUBIN, JACK MD	9/25/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	A PROFESSIONAL CORP	1045 ATLANTIC AVENUE	SUITE 915	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
232879	Fee-for-Service	1417066242	1417066242	1	1	ROSENTHAL, PHILIP MD	10/8/1991	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	36254	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
232943	Fee-for-Service	1922004662	1922004662	1	1	RIFF, DENNIS S MD	7/1/1981	174400000X	NA	Other	026	PHYSICIANS	22807	41	Internal Medicine	0	In state provider	None	377 E CHAPMAN AVE	STE 240	PLACENTIA	CA	92870	5091	30	06059	33.87122847	-117.8635161	Orange County
232947	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	10/1/2020	207Q00000X	NA	Adult Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
232948	Fee-for-Service	1033280409	1033280409	1	1	RIVERSIDE PHARMACY	2/2/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE PHARMACY	9448 MAGNOLIA AVE	STE B	RIVERSIDE	CA	92503	3746	33	06065	33.92080525	-117.4455963	Riverside County
232964	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
232984	Fee-for-Service	1124123765	1124123765	1	1	ROSEN, MICHAEL S MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
232991	Fee-for-Service	1720159767	1720159767	1	1	ROSSI, KEVIN J MD	7/2/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52825	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
232994	Fee-for-Service	1124439807	1124439807	1	18	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
233052	Fee-for-Service	1730566613	1730566613	1	1	ROYER, CHRISTINE A MD	8/24/2020	207K00000X	NA	Other	026	PHYSICIANS	169502	03	Allergy	0	In state provider	None	130 STONY POINT RD	SUITE E	SANTA ROSA	CA	95401	4120	49	06097	38.44143	-122.7452805	Sonoma County
233067	Fee-for-Service	1760494116	1760494116	1	1	REID, THOMAS T MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114505	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233073	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
233074	Fee-for-Service	1730271685	1730271685	1	1	ROUZROCH, SIMIAK MD INC	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72525	41	Internal Medicine	0	In state provider	None	1703 TERMINO AVE	STE 107	LONG BEACH	CA	90804	2126	19	06037	33.7883073	-118.1459488	Los Angeles County
233107	Fee-for-Service	1033203005	1033203005	1	1	REED, LISA L DO	12/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8675	40	Pediatrics	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 138	TEMECULA	CA	92591	5211	33	06065	33.50627123	-117.1431728	Riverside County
233119	Fee-for-Service	1013912674	1013912674	1	1	RECTO, MICHAEL R MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55642	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	455 S MAIN STREET	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
233122	Fee-for-Service	1457744534	1457744534	1	1	RETINA INSTITUTE OF CALIFORN	9/15/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9500 STOCKDALE HIGHWAY	108	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
233139	Fee-for-Service	1962477067	1962477067	1	2	RODRIGUEZ, HECTOR MD	11/1/2022	207L00000X	NA	Other	026	PHYSICIANS	92346	05	Anesthesiology	0	In state provider	None	1145 WEST REDONDO BEACH	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
233152	Fee-for-Service	1528018785	1528018785	1	1	RAHIMIFAR, MAJID MD	4/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41492	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
233158	Fee-for-Service	1124439807	1124439807	1	5	REGENTS UNIV OF CALIFORNIA U	10/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	104 LYNCH CREEK WAY	10	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
233186	Fee-for-Service	1134451438	1134451438	1	1	RYUJIN, LISA T MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110675	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
233197	Fee-for-Service	1629173935	1629173935	1	1	RIGDON, MICHAEL R MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73571	30	Radiology	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
233221	Fee-for-Service	1376298539	1376298539	1	1	RYAN, MADELAINE NP	5/9/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
233234	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	11/16/2018	207Q00000X	NA	Adult Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
233241	Fee-for-Service	1598863722	1598863722	1	1	REYNOLDS, LYNNE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 SEVENTH AVE	None	FORT WORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
233250	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
233281	Fee-for-Service	1720159767	1720159767	1	1	ROSSI, KEVIN J MD	7/2/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52825	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
233308	Fee-for-Service	1972600310	1972600310	1	1	RICHMOND, GLENN H MD	9/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46498	36	Psychiatry	0	In state provider	None	8201 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7020	30	06059	33.7048475	-117.9855135	Orange County
233348	Fee-for-Service	1528135423	1528135423	1	1	RAVDEN, MARSHALL IVAN MD	4/22/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42864	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233349	Fee-for-Service	1619526522	1619526522	1	1	RECOVERY INNOVATIONS, INC.	9/7/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	82380 MILES AVE	None	INDIO	CA	92201	2608	33	06065	33.72120813	-116.2273994	Riverside County
233357	Fee-for-Service	1215564265	1215564265	1	1	RUSSELL, SAMUEL MD	7/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186031	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
233361	Fee-for-Service	1710287297	1710287297	1	9	REGENTS UNIVERSITY OF CALIFO	2/23/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1250 16TH STREET	STE 1501, 1502	LOS ANGELES	CA	90404	1135	19	06037	34.02749142	-118.486063	Los Angeles
233416	Fee-for-Service	1639241706	1639241706	1	2	ROMINES, PETER DPM	10/18/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 W. HAMMER LANE	7B	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
233419	Fee-for-Service	1942875448	1942875448	1	1	RAMOS, KIMBERLY CCC-SLP	12/27/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
233440	Fee-for-Service	1912085697	1912085697	1	1	RUSSELL, ANTHONY W MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85115	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
233441	Fee-for-Service	1528018785	1528018785	1	1	RAHIMIFAR, MAJID MD	4/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41492	14	Neurological Surgery	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
233445	Fee-for-Service	1194838292	1194838292	1	1	RAJANI, KRISHNAKUMAR MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32537	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
233447	Fee-for-Service	1124439807	1124439807	1	5	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	104 LYNCH CREEK WAY	10	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
233453	Fee-for-Service	1134153505	1134153505	1	1	RYU, STEPHEN I MD	8/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72659	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
233499	Fee-for-Service	1609261692	1609261692	1	1	ROWELL, ELIZABETH A LMFT	6/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	670 PLACERVILLE DR	SUITE 2	PLACERVILLE	CA	95667	8828	09	06017	38.73161765	-120.8213885	El Dorado County
233510	Fee-for-Service	1003800368	1003800368	1	1	RIZKALLAH, JEAN A MD	9/18/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93296	08	Family Practice	0	In state provider	None	450 FOURTH AVE	STE 407	CHULA VISTA	CA	91910	3883	37	06073	32.63513513	-117.0820663	San Diego County
233521	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	8/12/2024	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
233541	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
233542	Fee-for-Service	1538693718	1538693718	1	1	ROSS, JENNIFER L A MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134506	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
233560	Fee-for-Service	1154631943	1154631943	1	1	RANCHO MIRAGE PAIN	10/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61216	05	Anesthesiology	0	In state provider	MANAGEMENT INC	608 G STREET	SUITE 1-A	BRAWLEY	CA	92227	2567	13	06025	32.97749255	-115.5318435	Imperial County
233583	Fee-for-Service	1053376806	1053376806	1	1	RICHARD E BUTIN MD	2/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
233596	Fee-for-Service	1619590684	1619590684	1	1	RAZBANNIA, NATHAN M MD	8/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187022	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
233623	Fee-for-Service	1720087141	1720087141	1	1	ROSENFIELD, MICHAEL MD	2/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14721	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
233643	Fee-for-Service	1124439807	1124439807	1	19	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1100 LARKSPUR LANDING CI	STE 10	LARKSPUR	CA	94939	1827	21	06041	37.94817177	-122.5100062	Marin County
233673	Fee-for-Service	1831209592	1831209592	1	1	RALEY'S	11/5/1980	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7847 LICHEN DR	None	CITRUS HEIGHTS	CA	95621	1074	34	06067	38.709576	-121.3132545	Sacramento County
233679	Fee-for-Service	1083785976	1083785976	1	1	ROGERS, MICHAEL SETH MD	11/15/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	92406	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
233680	Fee-for-Service	1588036610	1588036610	1	1	REYES, JORDAN M	1/20/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	840 WILLOW ST	STE 300	SAN JOSE	CA	95125	2377	43	06085	37.31069335	-121.8963251	Santa Clara County
233686	Fee-for-Service	1790190411	1790190411	1	1	RANAT, MALINI MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150170	01	General Practice	0	In state provider	None	3865 JACKSON STREET	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
233711	Fee-for-Service	1275556607	1275556607	1	6	REDWOOD REGIONAL MEDICAL	4/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP, INC	3540 MENDOCINO AVE	STE 100	SANTA ROSA	CA	95403	2276	49	06097	38.473938	-122.7258495	Sonoma County
233726	Fee-for-Service	1851362552	1851362552	1	1	RACEK, ERWARD L MD	7/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	34996	02	General Surgery	0	In state provider	None	750 MEDICAL CENTER CT	STE 5	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
233733	Fee-for-Service	1194838292	1194838292	1	1	RAJANI, KRISHNAKUMAR MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
233734	Fee-for-Service	1124439807	1124439807	1	5	REGENTS UNIV OF CALIFORNIA U	10/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	104 LYNCH CREEK WAY	10	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
233755	Fee-for-Service	1023064771	1023064771	1	1	ROBERTS, JOHN F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MEDICAL CENTER OF AURORA	1501 S POTOMAC	None	AURORA	CO	80012	0000	00	None	39.689343	-104.832198	Arapahoe County
233772	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
233774	Fee-for-Service	1518524321	1518524321	1	1	REYNOLDS, LAURA A MD	10/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184488	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
233803	Fee-for-Service	1093181075	1093181075	1	1	ROSS, ALESSANDRA AMY	6/15/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	128009	20	Orthopedic Surgery	0	In state provider	ELIZABETH MD INC	3770 JANES RD	None	ARCATA	CA	95521	4474	12	06023	40.89583739	-124.0932916	Humboldt County
233812	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	5/18/2021	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
233827	Fee-for-Service	1710287297	1710287297	1	68	REGENTS UNIVERSITY OF CALIFO	5/14/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	201 S BUENA VISTA ST	200	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
233836	Fee-for-Service	1417163494	1417163494	1	1	REACH PROJECT	12/31/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1915 D STREET	None	ANTIOCH	CA	94509	2571	07	06013	38.0038299	-121.8099949	Contra Costa County
233842	Fee-for-Service	1336562289	1336562289	1	1	RX STAFFING & HOME CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4640 MARCONI AVE	SUITE 5	SACRAMENTO	CA	95821	4352	34	06067	38.617164	-121.3560405	Sacramento County
233916	Fee-for-Service	1811296429	1811296429	1	1	RANADE, MONA MD	10/23/2020	2085R0204X	NA	Other	026	PHYSICIANS	170242	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
233931	Fee-for-Service	1124439807	1124439807	1	19	REGENTS UNIV OF CALIFORNIA U	4/1/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1100 LARKSPUR LANDING CI	STE 10	LARKSPUR	CA	94939	1827	21	06041	37.94817177	-122.5100062	Marin County
234060	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
234077	Fee-for-Service	1033139894	1033139894	1	1	RAMPULLA, JOHN E MD	10/17/1987	207P00000X	NA	Other	026	PHYSICIANS	38531	41	Internal Medicine	0	In state provider	None	709 UNION ST	None	SAN FRANCISCO	CA	94133	2720	38	06075	37.80018057	-122.4110679	San Francisco County
234098	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	1/23/2019	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
234129	Fee-for-Service	1336562289	1336562289	1	1	RX STAFFING & HOME CARE INC	5/19/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4640 MARCONI AVE	SUITE 5	SACRAMENTO	CA	95821	4352	34	06067	38.617164	-121.3560405	Sacramento County
234132	Fee-for-Service	1255956520	1255956520	1	1	RABAH, WILLEED A MD	7/27/2023	207P00000X	NA	Other	026	PHYSICIANS	185348	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
234185	Fee-for-Service	1770083990	1770083990	1	1	ROYAL VISTA CARE CENTER	1/11/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	909 W SANTA ANITA AVE	None	SAN GABRIEL	CA	91776	1018	19	06037	34.09479383	-118.1121525	Los Angeles County
234211	Fee-for-Service	1760126247	1760126247	1	1	REBUILDING FAMILY THERAPY	11/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9220 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
234217	Fee-for-Service	1124439807	1124439807	1	19	REGENTS UNIV OF CALIFORNIA U	9/27/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1100 LARKSPUR LANDING CI	STE 10	LARKSPUR	CA	94939	1827	21	06041	37.94817177	-122.5100062	Marin County
234281	Fee-for-Service	1164044574	1164044574	1	1	REPOSA, RACHELLE LCSW	12/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
234285	Fee-for-Service	1679805402	1679805402	1	1	REHMAN, ZEHRA MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109476	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
234294	Fee-for-Service	1366566556	1366566556	1	1	RUSS, JONNIE LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
234300	Fee-for-Service	1972814184	1972814184	1	1	RODRIGUEZ, OMAR MD	3/9/2020	2080P0203X	NA	Other	026	PHYSICIANS	167757	40	Pediatrics	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
234347	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
234358	Fee-for-Service	1639669567	1639669567	1	1	ROY, NERVIK DO	8/1/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
234369	Fee-for-Service	1235593245	1235593245	1	1	RASMUSSEN, BEN G DO	12/3/2019	207R00000X	NA	Other	026	PHYSICIANS	15974	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
234376	Fee-for-Service	1851463723	1851463723	1	3	REGENTS OF THE UNIVERSITY OF	6/28/2019	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	UP	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
234386	Fee-for-Service	1124439807	1124439807	1	1	REGENTS UNIV OF CALIFORNIA U	10/5/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
234478	Fee-for-Service	1295984318	1295984318	1	1	RICHARD L FORGEY LORI L	5/10/2006	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MATSUNO PARTNERSHIP	210 S GRAND AVE	STE 115	GLENDORA	CA	91741	4263	19	06037	34.133859	-117.872523	Los Angeles County
234482	Fee-for-Service	1871667170	1871667170	1	1	RITTERMAN, JEFFREY B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45228	01	General Practice	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
234489	Fee-for-Service	1821458860	1821458860	1	1	ROGERS, TIFFANY N LMFT	3/16/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122564	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
234497	Fee-for-Service	1972189777	1972189777	1	1	RHEE, RACHEL MD	2/19/2024	207R00000X	NA	Other	026	PHYSICIANS	184050	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
234532	Fee-for-Service	1386092914	1386092914	1	1	ROSS, CORDELIA Y MD	9/9/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	173525	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
234539	Fee-for-Service	1780624544	1780624544	1	1	ROGOFF, REBECCA SUSAN	7/1/1996	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	13132 STUDEBAKER RD	STE 9	NORWALK	CA	90650	2575	19	06037	33.911874	-118.099151	Los Angeles County
234549	Fee-for-Service	1356415509	1356415509	1	1	RAI CARE CENTERS OF NORTHERN	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA II, LLC	1800 HAIGHT ST	None	SAN FRANCISCO	CA	94117	2712	38	06075	37.76932071	-122.4523826	San Francisco County
234559	Fee-for-Service	1518394501	1518394501	1	1	RUIZ, LOREDANA F CNM	4/4/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	46900 MONROE ST	SUITE E	INDIO	CA	92201	4827	33	06065	33.707718	-116.233843	Riverside County
234617	Fee-for-Service	1295214468	1295214468	1	1	REIKES, EMILY C LCSW	5/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
234630	Fee-for-Service	1003142985	1003142985	1	1	ROOSEVELT, MATTHEW J MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114981	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
234633	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	4/30/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
234694	Fee-for-Service	1225173735	1225173735	1	1	REYES, HILARY	10/1/2007	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
234739	Fee-for-Service	1295105435	1295105435	1	1	RAYMOND, BENJAMIN L CNP	8/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
234744	Fee-for-Service	1114594884	1114594884	1	1	ROGERS, CORY L CNM	3/25/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
234798	Fee-for-Service	1104889138	1104889138	1	3	REGENTS OF THE UNIV OF CA EM	8/30/2019	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ER MED	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
234807	Fee-for-Service	1124439807	1124439807	1	21	REGENTS UNIV OF CALIFORNIA U	2/6/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7100 REDWOOD BLVD	SUITE 100	NOVATO	CA	94945	4110	21	06041	38.10057107	-122.5678339	Marin County
234817	Fee-for-Service	1699814350	1699814350	1	1	ROTH, DANIEL E MD	6/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51337	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	6TH FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
234855	Fee-for-Service	1427078690	1427078690	1	1	REUBEN, DAVID B MD	3/1/1993	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	66427	None	None	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
234922	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	11/1/2022	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
234954	Fee-for-Service	1881913614	1881913614	1	1	RIVERA, VERONICA LMFT	1/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
234963	Fee-for-Service	1174925960	1174925960	1	1	ROBLES, RENE CCC-SLP	2/24/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22365 BARTON RD	None	GRAND TERRACE	CA	92313	5015	36	06071	34.03387854	-117.316818	San Bernardino County
234973	Fee-for-Service	1649603713	1649603713	1	1	REDDING SURGERY CENTER LLC	10/1/2013	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1238 WEST ST	None	REDDING	CA	96001	0415	45	06089	40.58551548	-122.3983748	Shasta County
234985	Fee-for-Service	1093100836	1093100836	1	1	ROSEN, BROOKE H MD	6/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143829	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
234999	Fee-for-Service	1851451934	1851451934	1	1	REED, JAMES H MD	11/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55633	41	Internal Medicine	0	In state provider	None	450 SUTTER ST	RM 1203	SAN FRANCISCO	CA	94108	4001	38	06075	37.78934929	-122.4077786	San Francisco County
235012	Fee-for-Service	1841201183	1841201183	1	1	RENSLO, RICHARD MD	1/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	60083	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
235015	Fee-for-Service	1033141585	1033141585	1	1	RANDAL BENSEN M.D.	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6468	00	None	47.8799292	-122.2332137	Snohomish County
235017	Fee-for-Service	1932109972	1932109972	1	1	ROSS VALLEY PARAMEDIC	12/1/1998	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	777 SAN ANSELMO AVE	None	SAN ANSELMO	CA	94960	2045	21	06041	37.97664096	-122.5639149	Marin County
235058	Fee-for-Service	1619179454	1619179454	1	1	RABBANI, NIMA DO	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9740	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	#502	SHERMAN OAKS	CA	91403	1817	19	06037	34.160805	-118.4487295	Los Angeles County
235073	Fee-for-Service	1396074373	1396074373	1	1	RINK, NICOLE MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110269	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
235095	Fee-for-Service	1124439807	1124439807	1	21	REGENTS UNIV OF CALIFORNIA U	9/6/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	7100 REDWOOD BLVD	SUITE 100	NOVATO	CA	94945	4110	21	06041	38.10057107	-122.5678339	Marin County
235104	Fee-for-Service	1609834266	1609834266	1	1	ROARK, JOHN W JR MD	8/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	38581	10	Gastroenterology (M.D. only)	0	In state provider	None	3300 WEBSTER ST	STE 312	OAKLAND	CA	94609	3118	01	06001	37.82132826	-122.2621843	Alameda County
235109	Fee-for-Service	1790102879	1790102879	1	1	ROBINSON, NANCY M NP	8/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5319 W HILLSDALE AVE	None	VISALIA	CA	93291	5118	54	06107	36.329139	-119.3500755	Tulare County
235148	Fee-for-Service	1194962266	1194962266	1	1	ROSS MCCORMICK, CAROL NP	10/13/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
235160	Fee-for-Service	1639464928	1639464928	1	1	ROMERO, KATHLEEN E MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124682	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
235210	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
235214	Fee-for-Service	1487103990	1487103990	1	1	RODRIGUEZ, MARIANA LMFT	1/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
235260	Fee-for-Service	1659506012	1659506012	1	1	RSCR CALIFORNIA INC	3/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2757 SULA WAY	None	SAN DIEGO	CA	92139	3839	37	06073	32.67382833	-117.0449114	San Diego County
235267	Fee-for-Service	1366590242	1366590242	1	1	RADKE, JUDITH L MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74068	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
235284	Fee-for-Service	1851451934	1851451934	1	1	REED, JAMES H MD	11/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55633	10	Gastroenterology (M.D. only)	0	In state provider	None	450 SUTTER ST	RM 1203	SAN FRANCISCO	CA	94108	4001	38	06075	37.78934929	-122.4077786	San Francisco County
235293	Fee-for-Service	1407404411	1407404411	1	1	RESTREPO, AURA LCSW	1/21/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	214 E WALNUT ST	None	SANTA ANA	CA	92701	5896	30	06059	33.74436237	-117.8656067	Orange County
235298	Fee-for-Service	1841201183	1841201183	1	1	RENSLO, RICHARD MD	1/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	60083	30	Radiology	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
235308	Fee-for-Service	1518459197	1518459197	1	1	ROBERTSON, KRISTI L LMFT	6/27/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
235344	Fee-for-Service	1639375777	1639375777	1	1	RODRIGUEZ, YVONNE G LCSW	12/16/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 LAMART DR	100B3	RIVERSIDE	CA	92507	8902	33	06065	33.959493	-117.3322255	Riverside County
235373	Fee-for-Service	1669621033	1669621033	1	1	REYNOLDS, ABIGAIL S	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
235375	Fee-for-Service	1568756922	1568756922	2	1	ROBSAG INC	12/17/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1760 N FAIR OAKS AVE	None	PASADENA	CA	91103	1617	19	06037	34.175997	-118.1507145	Los Angeles County
235382	Fee-for-Service	1124439807	1124439807	1	21	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7100 REDWOOD BLVD	SUITE 100	NOVATO	CA	94945	4110	21	06041	38.10057107	-122.5678339	Marin County
235436	Fee-for-Service	1710287297	1710287297	1	133	REGENTS UNIVERSITY OF CALIFO	2/6/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	150 ORANGE GROVE BLVD	1100, 1200, 1300, 1400	PASADENA	CA	91103	3534	19	06037	34.14815178	-118.1610562	Los Angeles County
235457	Fee-for-Service	1285708503	1285708503	1	1	RUIZ, FRANK MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57310	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
235473	Fee-for-Service	1033780499	1033780499	1	1	RABBANI, RAYMOND LMFT	7/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
235476	Fee-for-Service	1730263716	1730263716	1	1	RICH, STEPHEN M MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40922	01	General Practice	0	In state provider	None	95 MONTGOMERY DR	None	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
235499	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
235526	Fee-for-Service	1962759480	1962759480	1	1	RANCHO NEUROLOGY AND SLEEP	4/16/2013	193200000X	NA	Other	026	PHYSICIANS	62324	13	Neurology (M.D. only)	0	In state provider	None	16776 BERNARDO CENTER DR	STE 209	SAN DIEGO	CA	92128	2669	37	06073	33.01805061	-117.0757327	San Diego County
235553	Fee-for-Service	1184722779	1184722779	1	1	REGENTS OF THE UNIV CA	7/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER-SAN DIEGO	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
235555	Fee-for-Service	1366590242	1366590242	1	1	RADKE, JUDITH L MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74068	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
235577	Fee-for-Service	1003873605	1003873605	2	1	RAPOZA, RUSSELL P MD	9/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71959	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11190 WARNER AVE	SUITE 410	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.714	-117.9333585	Orange County
235605	Fee-for-Service	1568524429	1568524429	1	1	REDJAIAN, ALI PSYD	4/1/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	861 S OAK PARK DR	STE 6	COVINA	CA	91724	3624	19	06037	34.07365369	-117.8640742	Los Angeles County
235671	Fee-for-Service	1124439807	1124439807	1	21	REGENTS UNIV OF CALIFORNIA U	9/6/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7100 REDWOOD BLVD	SUITE 100	NOVATO	CA	94945	4110	21	06041	38.10057107	-122.5678339	Marin County
235687	Fee-for-Service	1356399703	1356399703	1	1	REGENTS OF THE UNIVERSITY OF	11/16/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	E	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
235714	Fee-for-Service	1689648305	1689648305	1	1	ROBERTS, GAYLE A MD	8/13/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	53213	68	Hematology	0	In state provider	None	44151 15TH ST WEST	STE 409	LANCASTER	CA	93534	5504	19	06037	34.68551775	-118.1568686	Los Angeles County
235723	Fee-for-Service	1710287297	1710287297	1	133	REGENTS UNIVERSITY OF CALIFO	2/6/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	150 ORANGE GROVE BLVD	1100, 1200, 1300, 1400	PASADENA	CA	91103	3534	19	06037	34.14815178	-118.1610562	Los Angeles County
235786	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
235806	Fee-for-Service	1174601744	1174601744	1	1	RAPOSA, TERRY E JR DO	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6992	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
235808	Fee-for-Service	1700882479	1700882479	1	1	RUBIN, JACK MD INC	9/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70182	45	Nephrology (Renal-Kidney)	0	In state provider	None	10941 BLOOMFIELD ST	STE A	LOS ALAMITOS	CA	90720	6702	30	06059	33.804234	-118.0632055	Orange County
235812	Fee-for-Service	1962759480	1962759480	1	1	RANCHO NEUROLOGY AND SLEEP	4/16/2013	193200000X	NA	Other	026	PHYSICIANS	62324	01	General Practice	0	In state provider	None	16776 BERNARDO CENTER DR	STE 209	SAN DIEGO	CA	92128	2669	37	06073	33.01805061	-117.0757327	San Diego County
235852	Fee-for-Service	1558683920	1558683920	1	1	RAMIREZ, EDWIN R MD	2/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101638	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 N ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
235856	Fee-for-Service	1033102934	1033102934	1	1	REGENTS/UCDPBG/EPIDEMIOL	5/1/1983	2083X0100X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
235884	Fee-for-Service	1538402987	1538402987	1	1	RADULESCU, VLAD A MD	2/12/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
235904	Fee-for-Service	1871503433	1871503433	1	1	ROBINSON, MAGDA L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	52460	01	General Practice	0	In state provider	None	1738 N WATERMAN AVE	STE 7	SAN BERNARDINO	CA	92404	5131	36	06071	34.13076398	-117.2788051	San Bernardino County
235990	Fee-for-Service	1518280288	1518280288	1	1	RODRIGUEZ, TONANTZIN E MD	7/14/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139055	08	Family Practice	0	In state provider	None	4341 GOLDEN CENTER DRIVE	SUITE B	PLACERVILLE	CA	95667	6260	09	06017	38.70594583	-120.8270239	El Dorado County
236000	Fee-for-Service	1689648305	1689648305	1	1	ROBERTS, GAYLE A MD	8/13/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	53213	41	Internal Medicine	0	In state provider	None	44151 15TH ST WEST	STE 409	LANCASTER	CA	93534	5504	19	06037	34.68551775	-118.1568686	Los Angeles County
236009	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	5/18/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
236063	Fee-for-Service	1528270063	1528270063	1	1	ROSALES, GUSTAVO A MD	3/3/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	5385 FRANKLIN BLVD	STE K	SACRAMENTO	CA	95820	4717	34	06067	38.526282	-121.471398	Sacramento County
236073	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	1/3/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
236087	Fee-for-Service	1083235204	1083235204	1	1	REYES, REBECA	6/11/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
236092	Fee-for-Service	1487959995	1487959995	1	1	RIDERS CHOICE NON EMERGENCY	5/13/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION, LLC	8862 BOREAL WAY	None	ELK GROVE	CA	95758	6020	34	06067	38.433375	-121.4473635	Sacramento County
236111	Fee-for-Service	1295731784	1295731784	1	1	RALEIGH CARDIOLOGY ASSOC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 NEW BERN AVE	SUITE 1200	RALEIGH	NC	27610	0000	00	None	35.784927	-78.5876895	Wake County
236132	Fee-for-Service	1538685078	1538685078	1	1	REDDY PATEL, SHIVANJALI PT	8/3/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8800 STOCKDALE HWY	150	BAKERSFIELD	CA	93311	1012	15	06029	35.35448783	-119.0995578	Kern County
236150	Fee-for-Service	1043768229	1043768229	1	1	ROEBEN, AMANDA M LCSW	7/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	422 N. REDINGTON ST.	None	HANFORD	CA	93230	4479	16	06031	36.329085	-119.649366	Kings County
236194	Fee-for-Service	1871503433	1871503433	1	1	ROBINSON, MAGDA L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	52460	08	Family Practice	0	In state provider	None	1738 N WATERMAN AVE	STE 7	SAN BERNARDINO	CA	92404	5131	36	06071	34.13076398	-117.2788051	San Bernardino County
236214	Fee-for-Service	1811912256	1811912256	1	1	REICHE, ANDREA J MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50973	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	6815 NOBLE AVE	STE 408	VAN NUYS	CA	91405	3794	19	06037	34.19440435	-118.461871	Los Angeles County
236247	Fee-for-Service	1912936865	1912936865	1	1	REHAB MEDICAL OF SALT LAKE,	10/19/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	3690 S 500 W	SUITE 104	SALT LAKE CITY	UT	84115	4249	00	None	40.69147173	-111.9055182	Salt Lake County
236270	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	9/7/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
236274	Fee-for-Service	1184186264	1184186264	1	1	RANDHAWA, MANDY K MD	2/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180193	None	None	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
236295	Fee-for-Service	1184881559	1184881559	1	1	RODRIGUEZ, MICHAEL PHD	11/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	674 COUNTY SQUARE DR	STE 106	VENTURA	CA	93003	0439	56	06111	34.26954195	-119.2148249	Ventura County
236298	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	9/4/2020	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
236306	Fee-for-Service	1750906954	1750906954	1	1	RANCHO BERNARDO HEALTHCARE	10/1/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	3750 CONVOY STREET	SUITE 220	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
236351	Fee-for-Service	1528270063	1528270063	1	1	ROSALES, GUSTAVO A MD	3/3/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	5385 FRANKLIN BLVD	STE K	SACRAMENTO	CA	95820	4717	34	06067	38.526282	-121.471398	Sacramento County
236362	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
236371	Fee-for-Service	1346491552	1346491552	1	1	ROOSTAEIAN, JASON MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103442	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
236396	Fee-for-Service	1528456050	1528456050	1	1	REYES, TONI M NP	3/18/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
236411	Fee-for-Service	1003813700	1003813700	1	1	ROSEN, RICHARD B MD	7/26/2024	207R00000X	NA	Other	026	PHYSICIANS	59148	38	Geriatrics	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
236419	Fee-for-Service	1568973071	1568973071	1	1	REALOPTIONS	1/8/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	12 N WHITE RD	STE 1	SAN JOSE	CA	95127	1932	43	06085	37.36623544	-121.8283726	Santa Clara County
236428	Fee-for-Service	1831401546	1831401546	1	1	RUTTENBERG, TODD M DO	2/13/2022	207P00000X	NA	Other	026	PHYSICIANS	11991	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
236444	Fee-for-Service	1689694523	1689694523	1	1	RICHARD GREENE JOHNSON	11/30/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	415 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4208	19	06037	34.13420945	-117.870876	Los Angeles County
236458	Fee-for-Service	1063944049	1063944049	1	1	ROWE, LAURA P DPM	7/13/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
236495	Fee-for-Service	1063477891	1063477891	1	1	REDDY, MICHELLE MD	2/26/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	65661	None	None	0	In state provider	None	1250 BELLFLOWER BLVD	None	LONG BEACH	CA	90840	0201	19	06037	33.783174	-118.119528	Los Angeles County
236497	Fee-for-Service	1598806259	1598806259	1	1	RGJ INC	7/30/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	150 N. ROBERTSON BLVD.	SUITE 211	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
236508	Fee-for-Service	1770517047	1770517047	1	1	RUDA, JOHN M DC	10/1/1995	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	130 S HALCYON RD	STE B	ARROYO GRANDE	CA	93420	3116	40	06079	35.117721	-120.591607	San Luis Obispo County
236524	Fee-for-Service	1063146041	1063146041	1	1	REHAN MUTTALIB MD INC APMC	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	23639 HAWTHORNE BLVD	102	TORRANCE	CA	90505	5985	19	06037	33.810543	-118.351257	Los Angeles County
236545	Fee-for-Service	1861008534	1861008534	1	1	RSAG HOSPICE INC	12/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	402 W BROADWAY	STE 400	SAN DIEGO	CA	92101	3554	37	06073	32.71578647	-117.166941	San Diego County
236551	Fee-for-Service	1366228785	1366228785	1	1	RADI, OSMAN O MD	2/26/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	183623	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
236560	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	2/1/2022	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
236563	Fee-for-Service	1790780658	1790780658	1	1	RAINWATER, HAROLD G MD	11/1/2006	208800000X	NA	Other	026	PHYSICIANS	42718	34	Urology and Urological Surgery	0	In state provider	VALLEY UROLOGY INE	6113 N FRESNO ST	# 101	FRESNO	CA	93710	5207	10	06019	36.82539	-119.7814385	Fresno County
236586	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
236595	Fee-for-Service	1992743413	1992743413	1	1	ROGERS, JULIA L PSYD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
236605	Fee-for-Service	1609505023	1609505023	1	1	REDD, ANDREA LPCC	2/27/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
236645	Fee-for-Service	1588731475	1588731475	1	1	RASIN, LEV	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40886	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
236649	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	10/21/2020	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
236700	Fee-for-Service	1003813700	1003813700	1	1	ROSEN, RICHARD B MD	7/26/2024	207R00000X	NA	Other	026	PHYSICIANS	59148	41	Internal Medicine	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
236709	Fee-for-Service	1306306857	1306306857	1	1	RAMIREZ HARO, CHRISTIAN J MD	3/12/2024	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	179256	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
236734	Fee-for-Service	1689694523	1689694523	1	1	RICHARD GREENE JOHNSON	11/30/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	415 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4208	19	06037	34.13420945	-117.870876	Los Angeles County
236787	Fee-for-Service	1851463723	1851463723	1	8	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	UP	1245 16TH ST	105	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
236793	Fee-for-Service	1083813737	1083813737	1	1	RANSBARGER, DARRON M MD	1/14/2016	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	105223	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	135 MISSION RANCH BLVD	STE 100	CHICO	CA	95926	2175	04	06007	39.75330715	-121.8611016	Butte County
236797	Fee-for-Service	1275556607	1275556607	1	12	REDWOOD REGIONAL MEDICAL	8/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3555 ROUND BARN CIR	STE 100	SANTA ROSA	CA	95403	1763	49	06097	38.478717	-122.729715	Sonoma County
236803	Fee-for-Service	1467514372	1467514372	1	1	RAMSEY, JOAN M LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	419 SPRING ST	STE C4	NEVADA CITY	CA	95959	2422	29	06057	39.26252155	-121.0210988	Nevada County
236812	Fee-for-Service	1255765657	1255765657	1	1	RACKOFF, CHRISTOPHER J MD	11/1/2019	207P00000X	NA	Other	026	PHYSICIANS	162375	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
236835	Fee-for-Service	1861008534	1861008534	1	1	RSAG HOSPICE INC	12/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	402 W BROADWAY	STE 400	SAN DIEGO	CA	92101	3554	37	06073	32.71578647	-117.166941	San Diego County
236850	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	5/26/2022	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
236863	Fee-for-Service	1710287297	1710287297	1	120	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	2428 SANTA MONICA BLVD	200	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
236875	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
236877	Fee-for-Service	1396816864	1396816864	1	1	ROSENBLUM, ALAN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	19352	78	Neoplastic Diseases/Oncology	0	In state provider	None	2415 BATH ST	None	SANTA BARBARA	CA	93105	4324	42	06083	34.43190764	-119.7238799	Santa Barbara County
236913	Fee-for-Service	1073710083	1073710083	1	1	RAMSINGH, GIRIDHARAN MD	12/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122506	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
236922	Fee-for-Service	1073016036	1073016036	1	1	RANGEL, NOEMI	1/6/2025	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
236933	Fee-for-Service	1588731475	1588731475	1	1	RASIN, LEV	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40886	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
236936	Fee-for-Service	1710287297	1710287297	1	14	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
236953	Fee-for-Service	1821001496	1821001496	2	1	RATINER, BORIS D MD	9/1/2013	207RR0500X	NA	Other	026	PHYSICIANS	60202	None	None	0	In state provider	None	18376 CLARK ST	None	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
236956	Fee-for-Service	1295750891	1295750891	1	1	RALPHS GROCERY COMPANY	2/4/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #123	101 G ST	None	SAN DIEGO	CA	92101	6833	37	06073	32.71253549	-117.1633447	San Diego County
236961	Fee-for-Service	1548517329	1548517329	1	1	RAMOS PEREZ, JORGE M MD	8/1/2024	208M00000X	NA	Other	026	PHYSICIANS	173040	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
236977	Fee-for-Service	1437185279	1437185279	1	1	RUBENSTEIN,ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2512 WHEATON WAY	None	BREMERTON	WA	98310	3399	00	None	47.58211219	-122.6268828	Kitsap County
236997	Fee-for-Service	1164433017	1164433017	1	1	RUSS, ISI J MD INC	3/1/2004	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	EMER ASSOCIATES INC	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
237005	Fee-for-Service	1285228494	1285228494	1	1	ROCCO TUTELA JR M D INC	6/10/2021	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	11100 WARNER AVE.	258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
237006	Fee-for-Service	1295703262	1295703262	1	1	ROSADO, MAYRA MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68926	40	Pediatrics	0	In state provider	None	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
237045	Fee-for-Service	1831620582	1831620582	1	1	RAINONE, MICHAEL R MD	2/10/2021	207R00000X	NA	Other	026	PHYSICIANS	169980	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
237056	Fee-for-Service	1366461220	1366461220	1	1	ROITMAN, JAY S DO	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	5805	01	General Practice	0	In state provider	None	2480 SONOMA ST	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
237061	Fee-for-Service	1700800992	1700800992	1	1	ROTHSTEIN, DRAKE J MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
237086	Fee-for-Service	1851423073	1851423073	1	1	ROGERS, DORIS M LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
237137	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	5/12/2022	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
237149	Fee-for-Service	1710287297	1710287297	1	120	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	2428 SANTA MONICA BLVD	200	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
237162	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
237164	Fee-for-Service	1396816864	1396816864	1	1	ROSENBLUM, ALAN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	19352	41	Internal Medicine	0	In state provider	None	2415 BATH ST	None	SANTA BARBARA	CA	93105	4324	42	06083	34.43190764	-119.7238799	Santa Barbara County
237167	Fee-for-Service	1255994646	1255994646	1	1	RUSHING, ANNTOINETTE	5/23/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4434 HARDING AVENUE	None	LOS ANGELES	CA	90066	6123	19	06037	33.99345856	-118.4253359	Los Angeles County
237203	Fee-for-Service	1073710083	1073710083	1	1	RAMSINGH, GIRIDHARAN MD	12/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122506	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
237216	Fee-for-Service	1104221548	1104221548	1	1	ROSCHE, NINA E CNP	5/29/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
237222	Fee-for-Service	1235486135	1235486135	1	2	ROMITO, LEAH S MD	2/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122441	01	General Practice	0	In state provider	None	595 CENTER AVENUE	SUITE 300	MARTINEZ	CA	94553	4634	07	06013	37.99313048	-122.1189497	Contra Costa County
237320	Fee-for-Service	1659387686	1659387686	1	1	REDDY, MADHULATA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
237346	Fee-for-Service	1154346757	1154346757	1	1	RALPHS GROCERY COMPANY	6/16/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #099	26751 PORTOLA PKWY	None	FOOTHILL RANCH	CA	92610	1713	30	06059	33.67969256	-117.6640436	Orange County
237356	Fee-for-Service	1568797660	1568797660	1	1	RICHARDS, KIM LMFT	5/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1333 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	3313	40	06079	35.28178701	-120.6547771	San Luis Obispo County
237391	Fee-for-Service	1851458103	1851458103	1	1	RANDLE, MARGARET L	12/13/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
237416	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
237425	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	9/7/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
237439	Fee-for-Service	1710287297	1710287297	1	120	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	2428 SANTA MONICA BLVD	200	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
237450	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
237453	Fee-for-Service	1255994646	1255994646	1	1	RUSHING, ANNTOINETTE	5/23/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4434 HARDING AVENUE	None	LOS ANGELES	CA	90066	6123	19	06037	33.99345856	-118.4253359	Los Angeles County
237458	Fee-for-Service	1265858203	1265858203	1	1	RAGHUNAND, SHRAVYA LCSW	3/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
237478	Fee-for-Service	1588955728	1588955728	1	1	RANDHAWA, GURPREET S MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130193	01	General Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
237485	Fee-for-Service	1730193681	1730193681	1	1	RUOCCO, DRUCILLA A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2423 CAMINO DEL RIO S	STE 205	SAN DIEGO	CA	92108	3735	37	06073	32.76759179	-117.1387533	San Diego County
237555	Fee-for-Service	1013316694	1013316694	1	1	RAI, ANITA MD	1/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143663	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
237577	Fee-for-Service	1417980947	1417980947	1	1	RATERMAN, LEONIDS MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	28929	02	General Surgery	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
237592	Fee-for-Service	1518146851	1518146851	1	1	RAMOS GONZALO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	403 E DALLAS ST	None	CLEVELAND	TX	77327	4518	00	None	30.33834938	-95.0866145	Liberty County
237610	Fee-for-Service	1124439807	1124439807	1	2	REGENTS UNIV OF CALIFORNIA U	6/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1701 4TH ST	120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
237614	Fee-for-Service	1366547747	1366547747	1	1	RIVERSIDE HOSPITAL INC	10/6/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	500 J CLYDE MORRIS BLVD	None	NEWPORT NEWS	VA	23601	1929	00	None	37.064304	-76.4830395	Newport News City
237620	Fee-for-Service	1689601502	1689601502	1	1	RETHY, MICHAEL MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	103809	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
237629	Fee-for-Service	1275840878	1275840878	2	1	RAO, SUCHET MD	4/9/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172363	None	None	0	In state provider	None	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
237636	Fee-for-Service	1508810763	1508810763	1	1	RYDFORS, JAN T MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65169	01	General Practice	0	In state provider	None	401 WARREN ST	STE 300	REDWOOD CITY	CA	94063	1536	41	06081	37.48729928	-122.2318924	San Mateo County
237641	Fee-for-Service	1235224973	1235224973	1	2	RENDE, ROBERTO MD	4/7/2021	261QM2500X	NA	Other	026	PHYSICIANS	48593	None	None	0	In state provider	None	8520 WESTERN AVE	None	ANAHEIM	CA	90620	3927	30	06059	33.83877679	-118.0022795	Orange County
237706	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	9/12/2023	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
237712	Fee-for-Service	1710287297	1710287297	1	107	REGENTS UNIVERSITY OF CALIFO	9/7/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
237726	Fee-for-Service	1710287297	1710287297	1	120	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2428 SANTA MONICA BLVD	200	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
237740	Fee-for-Service	1710287297	1710287297	1	133	REGENTS UNIVERSITY OF CALIFO	2/6/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	150 ORANGE GROVE BLVD	1100, 1200, 1300, 1400	PASADENA	CA	91103	3534	19	06037	34.14815178	-118.1610562	Los Angeles County
237749	Fee-for-Service	1104876002	1104876002	1	1	RASHTIAN, MAYER Y MD	7/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66273	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
237803	Fee-for-Service	1124439807	1124439807	1	16	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1341 S ELISEO DR	None	GREENBRAE	CA	94904	2000	21	06041	37.9449045	-122.537105	Marin County
237840	Fee-for-Service	1689852865	1689852865	1	1	ROSENBERG PLASTIC SURGERY, P	2/8/2021	208200000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	.C.	145 N ROBERTSON	None	BEVERLY HILLS	CA	90211	2103	19	06037	34.06812719	-118.3837687	Los Angeles County
237854	Fee-for-Service	1124613401	1124613401	1	1	RANDLE, MONICA D LPCC	11/22/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
237891	Fee-for-Service	1124439807	1124439807	1	2	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1701 4TH ST	120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
237901	Fee-for-Service	1366547747	1366547747	1	1	RIVERSIDE HOSPITAL INC	10/6/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	500 J CLYDE MORRIS BLVD	None	NEWPORT NEWS	VA	23601	1929	00	None	37.064304	-76.4830395	Newport News City
237902	Fee-for-Service	1225260862	1225260862	1	1	REINSTADLER, DAVID R MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109185	04	Otology, Laryngology, Rhinology	0	In state provider	None	12462 PUTNAM	SUITE 303	WHITTIER	CA	90606	2502	19	06037	33.96800626	-118.044153	Los Angeles County
237928	Fee-for-Service	1508810763	1508810763	1	1	RYDFORS, JAN T MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65169	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 WARREN ST	STE 300	REDWOOD CITY	CA	94063	1536	41	06081	37.48729928	-122.2318924	San Mateo County
237938	Fee-for-Service	1427445055	1427445055	1	1	RICHARDS, BRIAN J DO	9/12/2019	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
237953	Fee-for-Service	1104189067	1104189067	1	1	ROBERTS, JOHN E MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 SOUTH GRAND AVENUE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
237959	Fee-for-Service	1376737874	1376737874	1	1	REYNOLDS, TYLER S MD	12/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101986	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
237981	Fee-for-Service	1740607019	1740607019	1	1	ROBERTS, KATHERINE R MD	3/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154272	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
237992	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	4/22/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
237995	Fee-for-Service	1124005368	1124005368	1	1	RP ZUCKER MD A MEDICAL	9/1/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	CORPORATION	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
238010	Fee-for-Service	1841368636	1841368636	1	1	RAO NARSING M.D.	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 SW 1ST AVE	None	OCALA	FL	34471	6504	00	None	29.174976	-82.138905	Marion County
238026	Fee-for-Service	1710287297	1710287297	1	74	REGENTS UNIVERSITY OF CALIFO	5/18/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
238039	Fee-for-Service	1104876002	1104876002	1	1	RASHTIAN, MAYER Y MD	7/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66273	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
238042	Fee-for-Service	1689340432	1689340432	1	1	RORDEN, NICOLE LMFT	11/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1439 E CHAPMAN AVE	None	ORANGE	CA	92866	2228	30	06059	33.78784945	-117.8381205	Orange County
238076	Fee-for-Service	1851865158	1851865158	1	1	ROQUE, CHRISTINE M NP	10/4/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
238079	Fee-for-Service	1861610529	1861610529	1	1	ROCHELLE-LEVY, PAULETTE LMFT	2/11/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2215 OAK STREET	SUITE 201	SANTA MONICA	CA	90405	5040	19	06037	34.01432245	-118.4615983	Los Angeles County
238085	Fee-for-Service	1316005614	1316005614	1	1	RICHARD JOSEPH BUCKLEY, JR.,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 MAPLE ROAD	None	AMHERST	NY	14226	1039	00	None	42.990354	-78.806979	Erie County
238088	Fee-for-Service	1124439807	1124439807	1	16	REGENTS UNIV OF CALIFORNIA U	5/1/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1341 S ELISEO DR	None	GREENBRAE	CA	94904	2000	21	06041	37.9449045	-122.537105	Marin County
238112	Fee-for-Service	1760599252	1760599252	1	1	RHODES, ADAM C MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96784	08	Family Practice	0	In state provider	None	278 TOWN CENTER PKWY	STE 105	SANTEE	CA	92071	5809	37	06073	32.8429885	-116.984583	San Diego County
238127	Fee-for-Service	1841832706	1841832706	1	1	ROJAS, BRICIA	9/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
238151	Fee-for-Service	1710947858	1710947858	1	1	REDDY, SIVAKUMAR MD	1/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77642	02	General Surgery	0	In state provider	None	2 MEDICAL PLAZA DR	STE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
238178	Fee-for-Service	1124439807	1124439807	1	2	REGENTS UNIV OF CALIFORNIA U	10/27/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1701 4TH ST	120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
238183	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
238190	Fee-for-Service	1164526448	1164526448	1	1	ROSENTHAL, JOSEPH MD	8/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52229	68	Hematology	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
238191	Fee-for-Service	1912553231	1912553231	2	1	ROBERTSON, RHONDA LMFT	7/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1421 GUERNEVILLE RD	200	SANTA ROSA	CA	95403	7220	49	06097	38.458233	-122.7349305	Sonoma County
238280	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
238294	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
238300	Fee-for-Service	1619040227	1619040227	1	1	RIORDAN, JOHN W MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	52155	None	None	0	In state provider	UCSF MEDICAL CTR #0532	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238326	Fee-for-Service	1073581914	1073581914	1	1	REILLY, IAN H MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76423	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
238340	Fee-for-Service	1316034333	1316034333	1	1	RITE TIME PHARMACEUTICALS	10/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	56555 HWY 371	None	ANZA	CA	92539	0415	33	06065	33.55505553	-116.673939	Riverside County
238349	Fee-for-Service	1891785143	1891785143	1	1	R FELLEN INC	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2939 S PEACH AVE	None	FRESNO	CA	93725	9302	10	06019	36.69444204	-119.7183156	Fresno County
238380	Fee-for-Service	1124439807	1124439807	1	16	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1341 S ELISEO DR	None	GREENBRAE	CA	94904	2000	21	06041	37.9449045	-122.537105	Marin County
238409	Fee-for-Service	1689334674	1689334674	1	1	ROSALES, MATTHEW S CRNA	3/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
238415	Fee-for-Service	1134173750	1134173750	1	1	REINHERZ, LANCE S MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86823	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25405 HANCOCK AVE	STE 216	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
238432	Fee-for-Service	1851463723	1851463723	1	2	REGENTS OF THE UNIVERSITY OF	6/28/2019	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	UP	1250 16TH ST.	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
238443	Fee-for-Service	1811523509	1811523509	1	1	RUBIO, JENNIFER L LCSW	3/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
238446	Fee-for-Service	1174633820	1174633820	1	1	RALEYS	1/8/2003	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10430 TWIN CITIES RD	None	GALT	CA	95632	9032	34	06067	38.289933	-121.3075485	Sacramento County
238457	Fee-for-Service	1205146453	1205146453	1	1	RAHAL, SIMRITA MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60128	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
238466	Fee-for-Service	1124439807	1124439807	1	2	REGENTS UNIV OF CALIFORNIA U	1/21/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1701 4TH ST	120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
238471	Fee-for-Service	1164526448	1164526448	1	1	ROSENTHAL, JOSEPH MD	8/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52229	78	Neoplastic Diseases/Oncology	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
238472	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
238473	Fee-for-Service	1871618496	1871618496	1	2	RAMIREZ-VASQUEZ, CORA LMFT	8/23/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47818	-	NOT APPLICABLE	0	In state provider	None	405 W. MANCHESTER BLVD	SUITE A & 4	INGLEWOOD	CA	90301	1196	19	06037	33.96175122	-118.3621356	Los Angeles County
238522	Fee-for-Service	1356459952	1356459952	1	1	RIEKER, CAROLE S	4/1/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
238531	Fee-for-Service	1255451498	1255451498	1	1	RICHER, PENNY	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 LOS GATOS SARATOGA	STE B	LOS GATOS	CA	95030	5327	43	06085	37.23068619	-121.983597	Santa Clara County
238540	Fee-for-Service	1114901469	1114901469	1	1	ROSE, MARY A MD	6/14/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	43111	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
238570	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	6/27/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
238580	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	2/21/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
238586	Fee-for-Service	1558449652	1558449652	1	1	RAMIREZ-CACERES, M MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73370	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
238605	Fee-for-Service	1811925985	1811925985	1	1	ROYCE, JONATHAN M	9/14/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1528 PLUMAS CT	STE 200	YUBA CITY	CA	95991	2973	51	06101	39.15297032	-121.6186294	Sutter County
238654	Fee-for-Service	1144457078	1144457078	1	2	RX BIOTECH PHARMACY LLC	6/19/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2514 N ONTARIO ST	SUITE 102	BURBANK	CA	91504	2512	19	06037	34.19758512	-118.3444644	Los Angeles County
238700	Fee-for-Service	1851463723	1851463723	1	12	REGENTS OF THE UNIVERSITY OF	3/16/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	UP	100 MOODY CT	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
238712	Fee-for-Service	1316987084	1316987084	1	1	RHODES, BRETT C LCSW	8/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
238734	Fee-for-Service	1750433587	1750433587	1	1	RUIZ-DURANT, MONICA MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	64187	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
238756	Fee-for-Service	1124439807	1124439807	1	2	REGENTS UNIV OF CALIFORNIA U	6/10/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 4TH ST	120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
238760	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
238761	Fee-for-Service	1164526448	1164526448	1	1	ROSENTHAL, JOSEPH MD	8/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52229	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
238797	Fee-for-Service	1245911429	1245911429	1	1	ROSCHEK, WALTER T	10/10/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
238827	Fee-for-Service	1114901469	1114901469	1	1	ROSE, MARY A MD	6/14/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	43111	78	Neoplastic Diseases/Oncology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
238842	Fee-for-Service	1144220781	1144220781	1	1	RATNASABAPATHY,	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	RAMALINGAM MD	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
238859	Fee-for-Service	1861437360	1861437360	1	1	RIDDLE, PHILLIP C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86016	05	Anesthesiology	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
238860	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	7/2/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
238867	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
238891	Fee-for-Service	1336290295	1336290295	1	1	ROSEN, NEIL B OD	1/1/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238917	Fee-for-Service	1417998113	1417998113	2	1	RICHARD MORAN	1/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 N MAYFAIR RD	None	WAUWATOSA	WI	53226	4216	00	None	43.03206488	-88.04735576	Milwaukee County
238947	Fee-for-Service	1972001980	1972001980	1	1	RODRIGUEZ, LUIS LCSW	2/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
238974	Fee-for-Service	1568913044	1568913044	1	1	RUSSELL, SAMANTHA S	12/9/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
238984	Fee-for-Service	1376899369	1376899369	1	1	RAMIREZ, LUZ G MD INC	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69267	05	Anesthesiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
239049	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
239125	Fee-for-Service	1144220781	1144220781	1	1	RATNASABAPATHY,	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	RAMALINGAM MD	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
239145	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
239155	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
239158	Fee-for-Service	1780777474	1780777474	1	1	REES STEPHENS INC	8/27/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17742 BEACH BLVD	STE 360	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
239200	Fee-for-Service	1174548770	1174548770	1	1	RALPHS GROCERY COMPANY	9/18/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #295	8626 FIRESTONE BLVD	None	DOWNEY	CA	90241	5243	19	06037	33.93671382	-118.1265089	Los Angeles County
239216	Fee-for-Service	1205926748	1205926748	1	1	RANDY G DELCORE M.D.	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1335 NORTHFIELD RD	STE 200	CEDAR CITY	UT	84721	9489	00	None	37.70157005	-113.0682821	Iron County
239237	Fee-for-Service	1316214091	1316214091	1	1	RATINER, YANA	1/13/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18376 CLARK STREET	None	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
239264	Fee-for-Service	1891237798	1891237798	1	1	ROBILLOS, LEAH LISA R	4/27/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
239282	Fee-for-Service	1487631842	1487631842	1	1	ROGER T WILLIAMS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	118 S MOUNTAIN AVE	None	SPRINGERVILLE	AZ	85938	5104	00	None	34.131384	-109.2854205	Apache County
239317	Fee-for-Service	1659431971	1659431971	1	1	RIOS, ENA G MSW LCSW	4/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	140 MAYHEW WAY	300	PLEASANT HILL	CA	94523	4398	07	06013	37.93664097	-122.0572179	Contra Costa County
239336	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
239345	Fee-for-Service	1043594294	1043594294	1	1	RADABAUGH, SARA L	1/18/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
239368	Fee-for-Service	1366854325	1366854325	1	1	RUSNAK, WILLIAM J MD	1/3/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162010	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
239435	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	4/22/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
239445	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	6/10/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
239465	Fee-for-Service	1710287297	1710287297	1	104	REGENTS UNIVERSITY OF CALIFO	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
239472	Fee-for-Service	1639265101	1639265101	1	1	RAWLINSON, ADRIAN J MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66237	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
239524	Fee-for-Service	1124423082	1124423082	1	1	RORISON, EVE B NP	11/26/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
239562	Fee-for-Service	1457302887	1457302887	1	2	ROGALSKI, ROGER P MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	1520 VIRGINIA RANCH RD	None	GARDNERVILLE	NV	89410	5731	00	None	38.91994556	-119.7196198	Douglas County
239602	Fee-for-Service	1003805029	1003805029	1	1	REED, RICHARD A MD	2/28/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	56692	30	Radiology	0	In state provider	None	323 N PRAIRIE AVE	STE 160	INGLEWOOD	CA	90301	4503	19	06037	33.966333	-118.3439975	Los Angeles County
239623	Fee-for-Service	1073553681	1073553681	1	1	ROJANY, MICHA MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77007	10	Gastroenterology (M.D. only)	0	In state provider	None	2241 WANKEL WAY	STE A	OXNARD	CA	93030	0191	56	06111	34.21679844	-119.1467863	Ventura County
239625	Fee-for-Service	1710287297	1710287297	1	71	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
239635	Fee-for-Service	1700066149	1700066149	1	1	RAHIMI, MARYAM DO	11/22/2019	2081S0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	10143	25	Physical Medicine and Rehabilitation	0	In state provider	None	8201 NEWMAN AVE	#302	HUNTINGTON BEACH	CA	92647	7020	30	06059	33.7048475	-117.9855135	Orange County
239662	Fee-for-Service	1578253159	1578253159	1	1	RITCEY, HAILEE CRNA	7/21/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
239697	Fee-for-Service	1740273762	1740273762	1	2	REGENTS/UCDPBG/PED GASTR	5/1/1999	2080P0206X	NA	Gastroenterology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
239706	Fee-for-Service	1598892648	1598892648	1	1	RESCARE INC	10/1/1999	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	RCCA SERVICES	60 BRENTFORD CIR	None	SACRAMENTO	CA	95823	5364	34	06067	38.462526	-121.4287785	Sacramento County
239720	Fee-for-Service	1710287297	1710287297	1	51	REGENTS UNIVERSITY OF CALIFO	2/25/2021	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
239727	Fee-for-Service	1841488814	1841488814	1	1	ROWE, ECHO D MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83827	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
239734	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	12/7/2021	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
239754	Fee-for-Service	1710287297	1710287297	1	104	REGENTS UNIVERSITY OF CALIFO	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
239760	Fee-for-Service	1639265101	1639265101	1	1	RAWLINSON, ADRIAN J MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66237	08	Family Practice	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
239777	Fee-for-Service	1528097839	1528097839	1	1	RICHARD J PATTERSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
239812	Fee-for-Service	1356641062	1356641062	1	1	RAMIREZ, RENE F MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115170	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 WEST MINERAL KING	BLVD	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
239821	Fee-for-Service	1508418666	1508418666	1	1	RAMOS, ALISIA	10/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
239834	Fee-for-Service	1164447769	1164447769	1	1	RALPH'S GROCERY COMPANY	7/2/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMCAY #213	22915 VICTORY BLVD	None	CANOGA PARK	CA	91307	3533	19	06037	34.18647446	-118.626363	Los Angeles County
239845	Fee-for-Service	1477844017	1477844017	1	1	REA, BRENDA L MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122437	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
239870	Fee-for-Service	1912234618	1912234618	1	1	RICHARD BERNERT MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9060 E VIA LINDA	STE 150	SCOTTSDALE	AZ	85258	5422	00	None	33.570531	-111.8845845	Maricopa County
239911	Fee-for-Service	1073553681	1073553681	1	1	ROJANY, MICHA MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77007	41	Internal Medicine	0	In state provider	None	2241 WANKEL WAY	STE A	OXNARD	CA	93030	0191	56	06111	34.21679844	-119.1467863	Ventura County
239919	Fee-for-Service	1154631943	1154631943	1	2	RANCHO MIRAGE PAIN	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61216	05	Anesthesiology	0	In state provider	None	71780 SAN JACINTO DRIVE	SUITE B3	RANCHO MIRAGE	CA	92270	5517	33	06065	33.74325198	-116.411769	Riverside County
239949	Fee-for-Service	1124169768	1124169768	1	1	REGACHO, CONCEPCION A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39919	05	Anesthesiology	0	In state provider	None	28 BUTTERCUP CT	None	ALAMO	CA	94507	1357	07	06013	37.87146078	-122.0254674	Contra Costa County
239983	Fee-for-Service	1740273762	1740273762	1	2	REGENTS/UCDPBG/PED GASTR	10/1/2020	2080P0206X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
239990	Fee-for-Service	1427156173	1427156173	1	1	REDDY, VEDHIRE S	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46202	None	None	0	In state provider	None	505 N TUSTIN AVE	STE 206	SANTA ANA	CA	92705	3735	30	06059	33.74962094	-117.8341227	Orange County
240000	Fee-for-Service	1073581237	1073581237	1	1	RUSSELL, SCOTT A MD	11/5/2018	207R00000X	NA	Other	026	PHYSICIANS	12138	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
240003	Fee-for-Service	1912606534	1912606534	1	1	RICHARD, ARIEL S PT	5/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24021 ALESSANDRO	109-112A	MORENO VALLEY	CA	92553	6707	33	06065	33.9171415	-117.2423475	Riverside County
240020	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
240031	Fee-for-Service	1538191150	1538191150	1	1	RICH, STEFFANI PT	7/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	860 SEQUOIA AVE	STE A	LINDSAY	CA	93247	1425	54	06107	36.21418314	-119.096029	Tulare County
240041	Fee-for-Service	1710287297	1710287297	1	104	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
240055	Fee-for-Service	1285056481	1285056481	1	1	RAJAEI, SHEEVA M MD	5/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130220	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
240086	Fee-for-Service	1730381799	1730381799	1	1	RATHI, DEEPA K MD	1/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106155	41	Internal Medicine	0	In state provider	None	9400 NO NAME UNO RD	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
240088	Fee-for-Service	1790129492	1790129492	1	1	REGENT HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 103	CONOGA PARK	CA	91303	3001	19	06037	34.20099048	-118.60776	Los Angeles County
240125	Fee-for-Service	1497169502	1497169502	1	1	RHEE, JOICE H MD	3/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148722	01	General Practice	0	In state provider	None	3838 SAN DIMAS ST	SUITE B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
240200	Fee-for-Service	1447258868	1447258868	1	1	RASNER, VALERIE L OD	2/1/1997	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19530 VAN BUREN BLVD	STE G8	RIVERSIDE	CA	92508	9456	33	06065	33.88904444	-117.321547	Riverside County
240202	Fee-for-Service	1245645076	1245645076	1	1	ROJAS, SARAH A MD	5/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139169	None	None	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
240214	Fee-for-Service	1508241720	1508241720	1	1	RANCHO PACIFIC HOME CARE INC	3/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4416 SAN JOAQUIN ST	None	OCEANSIDE	CA	92057	6021	37	06073	33.24324224	-117.3218871	San Diego County
240224	Fee-for-Service	1295792034	1295792034	1	1	ROME, RICHARD MD	3/12/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175115	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
240257	Fee-for-Service	1780835447	1780835447	1	1	REDDY, SRIDHAR K MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118770	45	Nephrology (Renal-Kidney)	0	In state provider	None	12665 GARDEN GROVE BLVD	#211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
240267	Fee-for-Service	1508814914	1508814914	1	1	ROBBINS, SHIRA L MD	3/29/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78486	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
240288	Fee-for-Service	1235138363	1235138363	1	1	RIOS, JAVIER R MD INC	8/4/1999	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MAGNOLIA CLINICA MEDICA	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
240294	Fee-for-Service	1811457625	1811457625	1	1	RODRIGUEZ-AMENERO, KEVIN MD	9/16/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	316 S STRATFORD AVE	None	SANTA MARIA	CA	93454	0001	42	06083	34.95019447	-120.4147816	Santa Barbara County
240299	Fee-for-Service	1801222732	1801222732	1	1	RAHMAN, KAZI S DPM	9/9/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	820 S AKERS	STE 220	VISALIA	CA	93277	8309	54	06107	36.323757	-119.3491755	Tulare County
240309	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	2/21/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
240328	Fee-for-Service	1710287297	1710287297	1	104	REGENTS UNIVERSITY OF CALIFO	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
240378	Fee-for-Service	1790129492	1790129492	1	1	REGENT HOSPICE INC	5/2/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 103	CONOGA PARK	CA	91303	3001	19	06037	34.20099048	-118.60776	Los Angeles County
240407	Fee-for-Service	1134261944	1134261944	1	1	ROBERTSON, VALERIE J MD	8/2/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54466	30	Radiology	0	In state provider	None	10861 CHERRY ST	STE 200	LONG BEACH	CA	90806	2768	19	06037	33.80465174	-118.0680053	Orange County
240421	Fee-for-Service	1720061112	1720061112	1	1	REEN, AMIKJIT S MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91581	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
240428	Fee-for-Service	1528424371	1528424371	1	1	ROSENTHAL, LESLIE A MD	9/28/2023	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	135613	None	None	0	In state provider	None	5000 W SUNSET BLVD	FL 4	LOS ANGELES	CA	90027	5861	19	06037	34.0981066	-118.2986382	Los Angeles County
240449	Fee-for-Service	1710996384	1710996384	2	1	REDDY, REDDIWANDLA SEENU MD	6/1/2013	193200000X	NA	Other	026	PHYSICIANS	38098	41	Internal Medicine	0	In state provider	None	8881 FLETCHER PKWY	STE 240	LA MESA	CA	91942	3190	37	06073	32.78442148	-117.0073814	San Diego County
240480	Fee-for-Service	1083650782	1083650782	1	1	RUDO, NEIL MD	4/11/2009	208600000X	NA	General Surgery	026	PHYSICIANS	32385	02	General Surgery	0	In state provider	None	236 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
240513	Fee-for-Service	1861887150	1861887150	1	1	RYAN, WESTON PT	3/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
240514	Fee-for-Service	1508303819	1508303819	1	1	RORTY, PATRICIA LCSW	1/22/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	2510	42	06083	34.4257705	-119.7087933	Santa Barbara County
240548	Fee-for-Service	1073736427	1073736427	1	1	RAZAVI CORPORATION	7/1/1990	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER	7979 LA MESA BLVD	None	LA MESA	CA	91942	5565	37	06073	32.76430507	-117.0257799	San Diego County
240576	Fee-for-Service	1235138363	1235138363	1	1	RIOS, JAVIER R MD INC	8/4/1999	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MAGNOLIA CLINICA MEDICA	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
240595	Fee-for-Service	1710287297	1710287297	1	19	REGENTS UNIVERSITY OF CALIFO	2/21/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
240598	Fee-for-Service	1922532712	1922532712	1	1	ROSENBAUM, HERBERT B MD	10/11/2021	390200000X	NA	Other	026	PHYSICIANS	169694	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
240620	Fee-for-Service	1710287297	1710287297	1	104	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
240643	Fee-for-Service	1376816249	1376816249	1	1	RAOWAS, ANAS MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127374	None	None	0	In state provider	None	4500 BROCKTON AVE	SUITE 107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
240661	Fee-for-Service	1003072620	1003072620	1	1	RUIZ, EDWARD A MD PC	6/7/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104554	None	None	0	In state provider	None	47-110 WASHINGTON STREET	SUITE #203	LA QUINTA	CA	92253	2186	33	06065	33.70299458	-116.2948052	Riverside County
240675	Fee-for-Service	1821609975	1821609975	1	1	RESULTAY, ALLYSA M OT	10/4/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
240686	Fee-for-Service	1548365273	1548365273	1	1	RICHEY, DUANE C MD	11/21/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	32549	30	Radiology	0	In state provider	None	1240 D ST	None	MERCED	CA	95340	6248	24	06047	37.29196045	-120.4742796	Merced County
240705	Fee-for-Service	1023192234	1023192234	1	1	RICKETTS, RANDALL V DO	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	4956	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
240711	Fee-for-Service	1386649713	1386649713	1	1	ROMAN, LYNDA D MD	1/1/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72001	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
240737	Fee-for-Service	1710996384	1710996384	2	1	REDDY, REDDIWANDLA SEENU MD	6/1/2013	193200000X	NA	Other	026	PHYSICIANS	38098	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8881 FLETCHER PKWY	STE 240	LA MESA	CA	91942	3190	37	06073	32.78442148	-117.0073814	San Diego County
240787	Fee-for-Service	1629488366	1629488366	3	1	RHEAULT, NATHAN A	9/28/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	740 FRONT STREET	STE 345B	SANTA CRUZ	CA	95060	4561	44	06087	36.97547419	-122.0254852	Santa Cruz County
240805	Fee-for-Service	1538517768	1538517768	1	1	RAMIREZ, HILARIO M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136496	05	Anesthesiology	0	In state provider	None	1441 CONSTITUTUION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
240817	Fee-for-Service	1871604108	1871604108	1	1	RANA, MANASI MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84193	26	Psychiatry (child)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
240848	Fee-for-Service	1043411374	1043411374	1	1	RYALL, KRISTINE M NP	5/7/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
240852	Fee-for-Service	1063567394	1063567394	1	1	RANDOLPH, JOHN F MD INC	9/30/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
240868	Fee-for-Service	1265456776	1265456776	1	1	RENCKEN, INGO O MD	7/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56477	None	None	0	In state provider	None	240 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
240879	Fee-for-Service	1750382024	1750382024	1	1	RECKERT, MARLA A MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54426	36	Psychiatry	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
240900	Fee-for-Service	1265857759	1265857759	1	1	RADIOLOGY MEDICAL GROUP OF	5/9/2014	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SANTA CRUZ COUNTY INC	1661 SOQUEL DR	BLDG G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
240912	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
240952	Fee-for-Service	1649298670	1649298670	1	1	RETINA CONSULTANTS	3/22/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	OF LOS ANGELES INC	850 S ATLANTIC BLVD	STE 105	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
240999	Fee-for-Service	1295836138	1295836138	1	1	RODRIGUEZ-REIMANN, DOLOR	7/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PROF & PERS EXC INT	3530 CAMINO DEL RIO NORT	STE 103	SAN DIEGO	CA	92108	1744	37	06073	32.7786731	-117.1181297	San Diego County
241015	Fee-for-Service	1124085220	1124085220	1	3	RUNTE, ERIC M MD	11/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73139	08	Family Practice	0	In state provider	None	137 S SHEPHERD ST	None	SONORA	CA	95370	4736	55	06109	37.98406603	-120.3812326	Tuolumne County
241025	Fee-for-Service	1093752305	1093752305	1	1	ROSENQUIST, CARL J MD	4/1/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	23598	30	Radiology	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
241072	Fee-for-Service	1194920983	1194920983	1	1	REY, JOSE M LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
241073	Fee-for-Service	1629488366	1629488366	3	1	RHEAULT, NATHAN A	9/28/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	740 FRONT STREET	STE 345B	SANTA CRUZ	CA	95060	4561	44	06087	36.97547419	-122.0254852	Santa Cruz County
241096	Fee-for-Service	1164470126	1164470126	1	1	ROSENZWEIG, MICHAEL A MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118217	68	Hematology	0	In state provider	None	1500 DUARTE RD	BLDG 149	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
241114	Fee-for-Service	1184987513	1184987513	1	1	RAPPLEYE, JEFFREY W MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156857	30	Radiology	0	In state provider	None	2336 SANTA MONICA BLVD	STE 206	SANTA MONICA	CA	90404	2938	19	06037	34.03136627	-118.4766854	Los Angeles County
241140	Fee-for-Service	1730267634	1730267634	1	1	ROZEN, IRINA MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72527	41	Internal Medicine	0	In state provider	None	957 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12822258	-122.248362	Solano County
241184	Fee-for-Service	1831395532	1831395532	1	1	RHODES, CONNIE R LCSW	2/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
241187	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
241189	Fee-for-Service	1497466767	1497466767	1	1	RSF OPHTHALMOLOGY, PC	4/18/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	100 N RANCHO SANTA FE RD	127	SAN MARCOS	CA	92069	1294	37	06073	33.15125491	-117.197854	San Diego County
241203	Fee-for-Service	1316929565	1316929565	1	1	RODRIGUEZ, ANNE O MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84678	78	Neoplastic Diseases/Oncology	0	In state provider	None	2900 LOMA VISTA ROAD	SUITE 205	VENTURA	CA	93003	2907	56	06111	34.27545839	-119.2569382	Ventura County
241214	Fee-for-Service	1366517716	1366517716	1	1	ROBLES, JORGE F MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52681	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1501 OCOTILLO DR	STE C	EL CENTRO	CA	92243	4217	13	06025	32.7771555	-115.570368	Imperial County
241238	Fee-for-Service	1023109899	1023109899	1	1	RAY SAWAQED, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8687 CONNECTICUT STREET	STE F	MERRILLVILLE	IN	46410	5549	00	None	41.46093	-87.331302	Lake County
241246	Fee-for-Service	1922453356	1922453356	1	1	RIOS, JUAN R MD	6/20/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158401	08	Family Practice	0	In state provider	None	1570 E HERNDON AVE	None	FRESNO	CA	93720	3303	10	06019	36.83756046	-119.759841	Fresno County
241295	Fee-for-Service	1144201609	1144201609	1	1	REDWINE, JONATHON T MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93113	02	General Surgery	0	In state provider	None	280 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
241302	Fee-for-Service	1104904093	1104904093	1	1	REDLIN, HILLARY G MD	10/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70776	20	Orthopedic Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
241381	Fee-for-Service	1164470126	1164470126	1	1	ROSENZWEIG, MICHAEL A MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118217	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	BLDG 149	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
241422	Fee-for-Service	1902880115	1902880115	1	1	ROWE, DARRELL G OT	3/26/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
241462	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	7/10/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
241473	Fee-for-Service	1417464009	1417464009	1	1	REYES, CAROLINA	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241490	Fee-for-Service	1316929565	1316929565	1	1	RODRIGUEZ, ANNE O MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84678	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2900 LOMA VISTA ROAD	SUITE 205	VENTURA	CA	93003	2907	56	06111	34.27545839	-119.2569382	Ventura County
241492	Fee-for-Service	1326002064	1326002064	1	1	RATCLIFF, JAMES W	8/6/1992	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2460 SAMARITAN DR	None	SAN JOSE	CA	95124	3907	43	06085	37.25105952	-121.948542	Santa Clara County
241495	Fee-for-Service	1306874987	1306874987	1	1	RAINSFORD, KEVIN JOHN MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60487	41	Internal Medicine	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
241504	Fee-for-Service	1366517716	1366517716	1	1	ROBLES, JORGE F MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52681	08	Family Practice	0	In state provider	None	1501 OCOTILLO DR	STE C	EL CENTRO	CA	92243	4217	13	06025	32.7771555	-115.570368	Imperial County
241529	Fee-for-Service	1881253813	1881253813	1	1	RAY, ROBERT DO	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	21173	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
241567	Fee-for-Service	1346530995	1346530995	1	1	REDDY, PRANAV K MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131711	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241590	Fee-for-Service	1871849091	1871849091	1	1	ROOTMAN, DANIEL B MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122223	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
241625	Fee-for-Service	1710287297	1710287297	1	73	REGENTS UNIVERSITY OF CALIFO	5/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
241628	Fee-for-Service	1851463723	1851463723	1	6	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	1245 16TH ST	100	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
241630	Fee-for-Service	1811047921	1811047921	1	1	RAPHA PHYSICAL THERAPY, INC	2/8/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	SUITE 109C	MONTCLAIR	CA	91763	2331	36	06071	34.08129954	-117.6966135	San Bernardino County
241639	Fee-for-Service	1841216926	1841216926	1	1	ROUSE, GLENN A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	36255	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
241648	Fee-for-Service	1255612685	1255612685	1	1	ROSSER, REBECCA L	7/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
241668	Fee-for-Service	1285720292	1285720292	1	1	ROSSER, TENA L MD	2/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88668	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
241680	Fee-for-Service	1033418785	1033418785	1	1	RIOS, DR JAVIER A MEDICAL	7/16/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CORPORATION	141 NORTH MAIN STREET	None	LAKE ELSINORE	CA	92530	4118	33	06065	33.66881794	-117.3273839	Riverside County
241736	Fee-for-Service	1316035363	1316035363	1	1	RANDHAWA, INDERPAL S MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80644	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
241751	Fee-for-Service	1215015805	1215015805	1	1	REIFF, RUSSELL H MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49217	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
241752	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
241767	Fee-for-Service	1871797118	1871797118	1	1	ROW, DAVID MD	11/1/2023	208C00000X	NA	General Surgery	026	PHYSICIANS	120226	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
241770	Fee-for-Service	1598791600	1598791600	1	1	RANCHO FAMILY MEDICAL GROUP,	9/17/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
241783	Fee-for-Service	1669865192	1669865192	1	1	ROSANA G MEAD	1/30/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7655 PRINCE ST	None	CITRUS HEIGHTS	CA	95610	3820	34	06067	38.693007	-121.283064	Sacramento County
241805	Fee-for-Service	1730125410	1730125410	1	1	RODRIGUEZ-MARTINEZ, MARIBEL	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4677	19	06037	34.22145548	-118.4566005	Los Angeles County
241835	Fee-for-Service	1467607119	1467607119	1	1	RAI, RANVINDER K MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111969	26	Psychiatry (child)	0	In state provider	None	801 TRAEGER AVE	SUITE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
241855	Fee-for-Service	1861859928	1861859928	1	1	REY, JENNIFER CO	2/24/2016	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2575 EAST BIDWELL	SUITE 200	FOLSOM	CA	95630	6444	34	06067	38.658888	-121.1303835	Sacramento County
241897	Fee-for-Service	1326794355	1326794355	1	1	ROSEVILLE FOOT AND ANKLE PC	2/10/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	906 CIRBY WAY	SUITE 100	ROSEVILLE	CA	95661	4475	31	06061	38.72946148	-121.2762825	Placer County
241912	Fee-for-Service	1710287297	1710287297	1	73	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
241937	Fee-for-Service	1124439807	1124439807	1	13	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	23 REED BLVD	STE 120	MILL VALLEY	CA	94941	2334	21	06041	37.9011569	-122.5149215	Marin County
241966	Fee-for-Service	1033418785	1033418785	1	1	RIOS, DR JAVIER A MEDICAL	7/16/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CORPORATION	141 NORTH MAIN STREET	None	LAKE ELSINORE	CA	92530	4118	33	06065	33.66881794	-117.3273839	Riverside County
241971	Fee-for-Service	1871512400	1871512400	1	1	REDDY, ANNAPURNA	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32452	None	None	0	In state provider	None	700 W OLIVE AVE	STE H	MERCED	CA	95348	2435	24	06047	37.31918006	-120.480202	Merced County
241978	Fee-for-Service	1891011144	1891011144	1	1	RAJKOMAR, ALVIN R MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119040	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
241981	Fee-for-Service	1003107152	1003107152	1	1	RENIGUNTALA, SHARATH E MD	9/18/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151331	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241984	Fee-for-Service	1558435396	1558435396	1	1	RASHID, ASHRAF O MD	7/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129301	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241999	Fee-for-Service	1407199813	1407199813	1	1	RAVIKUMAR, SANDHYA MD	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135960	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
242015	Fee-for-Service	1720352685	1720352685	1	1	RIDGECREST REGIONAL HOSPITAL	12/2/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	82820 TRONA ROAD	None	TRONA	CA	93562	1929	36	06071	35.75769665	-117.3778648	San Bernardino County
242028	Fee-for-Service	1780055582	1780055582	1	1	REES, JAIME R NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
242055	Fee-for-Service	1063004281	1063004281	1	1	RAUDA, MARCEL E NP	4/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
242058	Fee-for-Service	1598791600	1598791600	1	1	RANCHO FAMILY MEDICAL GROUP,	9/17/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
242062	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	6/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
242090	Fee-for-Service	1710175559	1710175559	1	1	RUSSELL, RYAN A CP	3/7/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	8540 RESEDA BLVD	#200	NORTHRIDGE	CA	91324	4628	19	06037	34.22579296	-118.5360435	Los Angeles County
242105	Fee-for-Service	1053993808	1053993808	1	1	RAMIREZ-MAMDANI, HAYDEE M NP	9/14/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
242134	Fee-for-Service	1487658936	1487658936	1	1	REDA, ZACHARIA Y MD FAAP	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47947	40	Pediatrics	0	In state provider	None	17692 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	6810	30	06059	33.705462	-117.9890701	Orange County
242179	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
242194	Fee-for-Service	1184063901	1184063901	1	1	REYNOLDS, KARA L DO	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
242202	Fee-for-Service	1710287297	1710287297	1	73	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
242214	Fee-for-Service	1811190937	1811190937	1	1	RAMSEY, HOMER L MD	4/17/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	31240	26	Psychiatry (child)	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
242225	Fee-for-Service	1124439807	1124439807	1	13	REGENTS UNIV OF CALIFORNIA U	4/27/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	23 REED BLVD	STE 120	MILL VALLEY	CA	94941	2334	21	06041	37.9011569	-122.5149215	Marin County
242271	Fee-for-Service	1467918680	1467918680	1	1	RICCOBONO, JANE CNM	2/25/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	57	06113	38.56371578	-121.7691963	Yolo County
242290	Fee-for-Service	1598893398	1598893398	1	1	RAZ, DAN J MD	1/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86093	33	Thoracic Surgery	0	In state provider	None	1500 DUARTE RD	BLDG 149	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
242300	Fee-for-Service	1720352685	1720352685	1	1	RIDGECREST REGIONAL HOSPITAL	12/2/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	82820 TRONA ROAD	None	TRONA	CA	93562	1929	36	06071	35.75769665	-117.3778648	San Bernardino County
242306	Fee-for-Service	1346477338	1346477338	1	1	RIVERA, MANUEL C MD APC	6/30/1990	193400000X	NA	Other	026	PHYSICIANS	37676	08	Family Practice	0	In state provider	None	2983 CHINO AVE	STE A2	CHINO HILLS	CA	91709	3576	36	06071	34.01069672	-117.7407233	San Bernardino County
242317	Fee-for-Service	1275556607	1275556607	1	7	REDWOOD REGIONAL MEDICAL	4/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP, INC	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
242327	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
242340	Fee-for-Service	1780751503	1780751503	1	1	ROSEN, ROMINA S MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75432	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
242346	Fee-for-Service	1598791600	1598791600	1	1	RANCHO FAMILY MEDICAL GROUP,	9/17/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP INC	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
242361	Fee-for-Service	1508989377	1508989377	1	1	ROBINOWITZ, DAVID L MD	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74822	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0648	38	06075	37.7634502	-122.4579779	San Francisco County
242388	Fee-for-Service	1528170768	1528170768	1	1	ROSENTHAL, ALAN J MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27451	36	Psychiatry	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94538	2227	01	06001	37.54662058	-121.9736002	Alameda County
242389	Fee-for-Service	1871712752	1871712752	3	1	RANJINI RAINA ROY	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
242416	Fee-for-Service	1144408832	1144408832	1	1	RITTER, DAVID J MD	7/6/2009	208M00000X	NA	Other	026	PHYSICIANS	100904	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	#480	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
242423	Fee-for-Service	1487658936	1487658936	1	1	REDA, ZACHARIA Y MD FAAP	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47947	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17692 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	6810	30	06059	33.705462	-117.9890701	Orange County
242468	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
242469	Fee-for-Service	1184617102	1184617102	1	2	REGENTS/UCDPBG/DERMATOLO	2/16/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
242481	Fee-for-Service	1124252317	1124252317	1	1	RAMANATH, MADHURI MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 EAST LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
242488	Fee-for-Service	1710287297	1710287297	1	73	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
242490	Fee-for-Service	1568076347	1568076347	1	1	ROSENTHAL, ALLEN PHD	2/22/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
242491	Fee-for-Service	1962885632	1962885632	1	1	RICHARDSON, TIMOTHY MD	7/29/2019	207P00000X	NA	Other	026	PHYSICIANS	161195	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
242501	Fee-for-Service	1811190937	1811190937	1	1	RAMSEY, HOMER L MD	4/17/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	31240	36	Psychiatry	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
242505	Fee-for-Service	1386214989	1386214989	1	1	ROZSITS, KATHERINE L NP	7/29/2021	363LP0222X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
242511	Fee-for-Service	1124439807	1124439807	1	13	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	23 REED BLVD	STE 120	MILL VALLEY	CA	94941	2334	21	06041	37.9011569	-122.5149215	Marin County
242547	Fee-for-Service	1437358967	1437358967	1	1	ROSS, ELIZABETH O MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119731	10	Gastroenterology (M.D. only)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
242556	Fee-for-Service	1992239792	1992239792	1	1	RAFIZADEH, SASSAN MD	2/15/2023	207L00000X	NA	Other	026	PHYSICIANS	159882	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
242565	Fee-for-Service	1801924667	1801924667	1	1	ROLDAN, MARCELA LCSW	11/22/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
242581	Fee-for-Service	1104568922	1104568922	1	1	ROH, SEAN MD	11/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191992	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
242592	Fee-for-Service	1922582485	1922582485	1	1	RAINE, DANIEL MD	5/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	174504	08	Family Practice	0	In state provider	None	10458 CULVER BLVD	None	CULVER CITY	CA	90232	3469	19	06037	34.01560282	-118.4009328	Los Angeles County
242618	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
242648	Fee-for-Service	1508989377	1508989377	1	1	ROBINOWITZ, DAVID L MD	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74822	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0648	38	06075	37.7634502	-122.4579779	San Francisco County
242653	Fee-for-Service	1376503839	1376503839	1	1	RUSHTON, ROBERT B MD INC	6/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47055	08	Family Practice	0	In state provider	None	844 S DORA ST	None	UKIAH	CA	95482	5711	23	06045	39.14040107	-123.2102865	Mendocino County
242671	Fee-for-Service	1427100965	1427100965	1	1	RENAULT, CYBELE ANNE	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86690	77	Infectious Disease	0	In state provider	MD	3700 EDISON ST	None	SAN MATEO	CA	94403	4462	41	06081	37.53169972	-122.2983207	San Mateo County
242672	Fee-for-Service	1073062527	1073062527	1	1	REGEN HOSPICE INC	9/3/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	560 N ARROWHEAD AVE	SUITE 9A	SAN BERNARDINO	CA	92401	1219	36	06071	34.109496	-117.289667	San Bernardino County
242704	Fee-for-Service	1972184950	1972184950	1	1	REYNAGA, ANDY MD	9/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7223 CHURCH ST	STE C	HIGHLAND	CA	92346	5816	36	06071	34.122888	-117.1737945	San Bernardino County
242709	Fee-for-Service	1225557853	1225557853	1	1	RAMIREZ, CLAUDIA LCSW	12/20/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
242755	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
242757	Fee-for-Service	1184617102	1184617102	1	2	REGENTS/UCDPBG/DERMATOLO	5/1/1999	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
242776	Fee-for-Service	1710287297	1710287297	1	73	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2910	19	06037	33.893289	-118.395933	Los Angeles County
242783	Fee-for-Service	1386721561	1386721561	1	1	RAUCH, JEFFREY B MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91579	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
242789	Fee-for-Service	1811190937	1811190937	1	1	RAMSEY, HOMER L MD	4/17/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	31240	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
242804	Fee-for-Service	1215185566	1215185566	1	1	RIZEA, CHRISTIAN	8/2/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
242811	Fee-for-Service	1841256633	1841256633	1	1	RINE, KEVIN E MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57924	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 30TH ST	STE 205	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
242829	Fee-for-Service	1144308974	1144308974	1	1	RABEY, GEORGE A MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50554	30	Radiology	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
242857	Fee-for-Service	1922327683	1922327683	1	1	ROSEDALE UNION ELEMENTARY	7/19/2009	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	2553 OLD FARM RD	None	BAKERSFIELD	CA	93312	3531	15	06029	35.38321439	-119.1367185	Kern County
242902	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
242908	Fee-for-Service	1346929411	1346929411	1	1	RODRIGUEZ, ANGEE POSTPARTUM	8/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
242941	Fee-for-Service	1679103873	1679103873	1	1	RADY CHILDREN'S HOSPITAL RES	5/11/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	R GENOMIC MEDICINE	7910 FROST ST	STE. 240	SAN DIEGO	CA	92123	2781	37	06073	32.80027449	-117.153846	San Diego County
242944	Fee-for-Service	1356473664	1356473664	1	1	RODRIGUEZ, JOSEPHINA LMFT	3/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	937 COFFEE RD	500	MODESTO	CA	95355	4240	50	06099	37.65636629	-120.9756356	Stanislaus County
242962	Fee-for-Service	1073062527	1073062527	1	1	REGEN HOSPICE INC	9/3/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	560 N ARROWHEAD AVE	SUITE 9A	SAN BERNARDINO	CA	92401	1219	36	06071	34.109496	-117.289667	San Bernardino County
242977	Fee-for-Service	1003878539	1003878539	1	2	REGENTS OF THE UNIVERSITY OF	7/2/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	H SYSTEM	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
243043	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243091	Fee-for-Service	1205139581	1205139581	1	1	RANKINS, MARGO M	6/17/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124031	-	NOT APPLICABLE	0	In state provider	None	831 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09030767	-117.7353578	Los Angeles County
243097	Fee-for-Service	1811157308	1811157308	1	1	ROBINSON, CELINE G MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14455	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
243134	Fee-for-Service	1154645505	1154645505	1	1	ROWE, MELANIE S CRNA	11/5/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
243135	Fee-for-Service	1689624538	1689624538	1	1	REEVES, DONALD S MD	2/1/1994	207L00000X	NA	Other	026	PHYSICIANS	53391	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
243142	Fee-for-Service	1407201916	1407201916	1	1	RITCHIE, DAVID MD	8/11/2021	2085D0003X	NA	MRI Provider	026	PHYSICIANS	153366	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
243152	Fee-for-Service	1194257386	1194257386	1	1	RUELAS, ROBERTO H MD	2/3/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	170141	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
243153	Fee-for-Service	1033682604	1033682604	1	1	ROOKER, THOMAS LCSW	3/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
243156	Fee-for-Service	1720058027	1720058027	1	1	RENOWN SOUTH MEADOWS	2/3/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	MEDICAL CENTER	10101 DOUBLE R BLVD	None	RENO	NV	89521	5931	00	None	39.43617476	-119.758524	Washoe County
243168	Fee-for-Service	1487637351	1487637351	1	1	ROXAS, ARNOLD G DPM	5/1/2010	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	940 E DOMINGUEZ ST	STE D	CARSON	CA	90746	7205	19	06037	33.84040849	-118.2582045	Los Angeles County
243184	Fee-for-Service	1053599936	1053599936	1	1	RORABECK, JEANNE M MD	8/24/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	86994	44	Public Health	0	In state provider	None	606 E MILL ST	None	SAN BERNARDINO	CA	92415	0620	36	06071	34.09217051	-117.271935	San Bernardino County
243192	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
243203	Fee-for-Service	1881172518	1881172518	1	1	RAMOS, ROBERT S RCP	10/17/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
243269	Fee-for-Service	1003878539	1003878539	1	2	REGENTS OF THE UNIVERSITY OF	7/2/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	H SYSTEM	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
243274	Fee-for-Service	1568787851	1568787851	1	1	RBDE PROFESSIONAL MEDICAL	9/9/2010	193400000X	NA	Other	026	PHYSICIANS	68178	67	Endocrinology	0	In state provider	CORPORATION	1868 PACIFIC AVE	None	LONG BEACH	CA	90806	6113	19	06037	33.791391	-118.193652	Los Angeles County
243330	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243336	Fee-for-Service	1710287297	1710287297	1	131	REGENTS UNIVERSITY OF CALIFO	4/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	111 EAST VICTORIA ST	None	SANTA BARBARA	CA	93101	2018	42	06083	34.42584014	-119.7041442	Santa Barbara County
243404	Fee-for-Service	1205811106	1205811106	1	1	REILE, DALE A CRNA	12/1/1982	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
243424	Fee-for-Service	1689624538	1689624538	1	1	REEVES, DONALD S MD	2/1/1994	207L00000X	NA	Other	026	PHYSICIANS	53391	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
243442	Fee-for-Service	1720058027	1720058027	1	1	RENOWN SOUTH MEADOWS	2/3/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	MEDICAL CENTER	10101 DOUBLE R BLVD	None	RENO	NV	89521	5931	00	None	39.43617476	-119.758524	Washoe County
243472	Fee-for-Service	1053599936	1053599936	1	1	RORABECK, JEANNE M MD	8/24/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	86994	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	606 E MILL ST	None	SAN BERNARDINO	CA	92415	0620	36	06071	34.09217051	-117.271935	San Bernardino County
243474	Fee-for-Service	1104889138	1104889138	1	4	REGENTS OF THE UNIV OF CA EM	5/3/2021	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ER MED	200 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
243480	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
243489	Fee-for-Service	1649740499	1649740499	1	1	RHEA, COURTNEY LMFT	9/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
243498	Fee-for-Service	1538459870	1538459870	1	1	RUBIN, ASHLEY G MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120960	07	Dermatology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
243517	Fee-for-Service	1629507231	1629507231	1	1	ROBINSON, JENNIFER S LMFT	1/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
243547	Fee-for-Service	1437129350	1437129350	1	1	ROBERTS, STEVEN G MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76879	34	Urology and Urological Surgery	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
243564	Fee-for-Service	1841280989	1841280989	1	1	REDMAN, DAVID M OD	3/1/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1039 EL MONTE AVE	SUITE K	MOUNTAIN VIEW	CA	94040	2371	43	06085	37.39058176	-122.0958518	Santa Clara County
243607	Fee-for-Service	1003017997	1003017997	1	1	RICE, JACQUELINE A	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
243619	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243623	Fee-for-Service	1710287297	1710287297	1	131	REGENTS UNIVERSITY OF CALIFO	4/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	111 EAST VICTORIA ST	None	SANTA BARBARA	CA	93101	2018	42	06083	34.42584014	-119.7041442	Santa Barbara County
243646	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
243655	Fee-for-Service	1710287297	1710287297	1	132	REGENTS UNIVERSITY OF CALIFO	3/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	141 TRIUNFO CANYON RD	120	WESTLAKE VILLAGE	CA	91361	2525	56	06111	34.15961207	-118.8342816	Ventura County
243662	Fee-for-Service	1790345940	1790345940	1	1	RUSSELL, JAREL	6/16/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
243712	Fee-for-Service	1962896498	1962896498	1	1	ROMERO, SAMANTHA MSW LCSW	4/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
243739	Fee-for-Service	1639398225	1639398225	1	1	ROBERT D TONKS MD INC	6/5/1989	2086S0127X	NA	General Surgery	026	PHYSICIANS	46158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8010 FROST ST	STE 604	SAN DIEGO	CA	92123	4204	37	06073	32.80026879	-117.1520059	San Diego County
243761	Fee-for-Service	1740873694	1740873694	1	1	REDWOOD BAKERSFIELD LLC	8/10/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	810 S UNION AVE	None	BAKERSFIELD	CA	93307	3638	15	06029	35.346231	-119.002904	Kern County
243764	Fee-for-Service	1104889138	1104889138	1	4	REGENTS OF THE UNIV OF CA EM	5/3/2021	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ER MED	200 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
243765	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
243771	Fee-for-Service	1275556607	1275556607	1	3	REDWOOD REGIONAL MEDICAL	6/2/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3555 ROUND BARN CIR	STE 100	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
243792	Fee-for-Service	1346335585	1346335585	1	1	RICH, PRESTON B MD	11/22/2021	2086S0127X	NA	General Surgery	026	PHYSICIANS	175296	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
243822	Fee-for-Service	1275556607	1275556607	1	8	REDWOOD REGIONAL MEDICAL	12/20/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	110 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2337	49	06097	38.25171165	-122.6351052	Sonoma County
243823	Fee-for-Service	1992761951	1992761951	1	1	ROEFS, JAMES A MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	72199	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
243826	Fee-for-Service	1154679462	1154679462	1	1	RAGLAND, TANISHA R NP	3/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
243908	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243914	Fee-for-Service	1073924684	1073924684	1	1	RAMOS-MONTELONGO, FLOR E LCS	2/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
243919	Fee-for-Service	1710287297	1710287297	1	131	REGENTS UNIVERSITY OF CALIFO	4/4/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	111 EAST VICTORIA ST	None	SANTA BARBARA	CA	93101	2018	42	06083	34.42584014	-119.7041442	Santa Barbara County
243921	Fee-for-Service	1225208606	1225208606	1	1	RHEUMATOLOGY ASSOCIATES	2/23/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	12660 RIVERSIDE DRIVE	SUITE 200	VALLEY VILLAGE	CA	91607	3430	19	06037	34.1575795	-118.409499	Los Angeles County
243932	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
243943	Fee-for-Service	1710287297	1710287297	1	132	REGENTS UNIVERSITY OF CALIFO	3/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	141 TRIUNFO CANYON RD	120	WESTLAKE VILLAGE	CA	91361	2525	56	06111	34.15961207	-118.8342816	Ventura County
243959	Fee-for-Service	1144458944	1144458944	1	1	RAJPUT, IRSHAN A MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
243974	Fee-for-Service	1699093104	1699093104	1	1	RAZFAR, ALI MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118700	04	Otology, Laryngology, Rhinology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
243985	Fee-for-Service	1487654844	1487654844	1	1	ROTHENBERG, RONALD N MD	9/28/1994	207P00000X	NA	Other	026	PHYSICIANS	21379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
243994	Fee-for-Service	1801874375	1801874375	1	1	RODRIGUEZ, JORGE E MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54429	41	Internal Medicine	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
244017	Fee-for-Service	1457826919	1457826919	1	1	RUSSELL, BRIDGET K LCSW	4/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
244022	Fee-for-Service	1942517701	1942517701	1	1	RYAN, SARAH C MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111476	36	Psychiatry	0	In state provider	None	2340 CLAY ST 7TH FLOOR	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
244028	Fee-for-Service	1639398225	1639398225	1	1	ROBERT D TONKS MD INC	6/5/1989	2086S0127X	NA	General Surgery	026	PHYSICIANS	46158	20	Orthopedic Surgery	0	In state provider	None	8010 FROST ST	STE 604	SAN DIEGO	CA	92123	4204	37	06073	32.80026879	-117.1520059	San Diego County
244059	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	4/29/2022	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
244070	Fee-for-Service	1821201351	1821201351	1	1	RATHOD, RAJIV MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120894	18	Ophthalmology	0	In state provider	None	1200 N TUSTIN AVE	STE 140	SANTA ANA	CA	92705	3501	30	06059	33.75564579	-117.8342574	Orange County
244079	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
244080	Fee-for-Service	1609857788	1609857788	1	1	RAZAVI, MEHRDAD MD	1/3/2020	2084S0012X	NA	Neurology	026	PHYSICIANS	53033	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1505 VICTOR AVE	None	REDDING	CA	96003	4031	45	06089	40.58541565	-122.3388174	Shasta County
244112	Fee-for-Service	1477507911	1477507911	1	1	RAINE, TINA MD	12/1/2003	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84337	None	None	0	In state provider	None	625 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2116	38	06075	37.76149739	-122.4071512	San Francisco County
244165	Fee-for-Service	1174584619	1174584619	1	1	REINBERG, YURI E MD	3/21/2023	2088P0231X	NA	Other	026	PHYSICIANS	51722	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
244195	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	12/16/2021	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
244196	Fee-for-Service	1376556027	1376556027	1	1	RICHARD I TORBAN A PROFESSIO	3/14/2020	261QM1300X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	S	44-530 SAN PABLO AVE	SUITE 201	PALM DESERT	CA	92260	3596	33	06065	33.72807112	-116.3825504	Riverside County
244198	Fee-for-Service	1235302373	1235302373	1	1	RICHARDSON, BERONIE V MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103394	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244223	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
244233	Fee-for-Service	1710287297	1710287297	1	132	REGENTS UNIVERSITY OF CALIFO	3/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	141 TRIUNFO CANYON RD	120	WESTLAKE VILLAGE	CA	91361	2525	56	06111	34.15961207	-118.8342816	Ventura County
244251	Fee-for-Service	1144458944	1144458944	1	1	RAJPUT, IRSHAN A MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
244259	Fee-for-Service	1174138556	1174138556	1	1	ROLLING HILLS GUEST HOME INC	7/13/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1000 ROLLING HILLS DRIVE	None	FULLERTON	CA	92835	3210	30	06059	33.90305481	-117.9105816	Orange County
244273	Fee-for-Service	1487654844	1487654844	1	1	ROTHENBERG, RONALD N MD	9/28/1994	207P00000X	NA	Other	026	PHYSICIANS	21379	01	General Practice	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
244284	Fee-for-Service	1801874375	1801874375	1	1	RODRIGUEZ, JORGE E MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54429	10	Gastroenterology (M.D. only)	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
244326	Fee-for-Service	1528683745	1528683745	1	1	RAHM, LISA M NP	3/15/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
244331	Fee-for-Service	1003971888	1003971888	1	1	REDDY, SURABHI C MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137131	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
244350	Fee-for-Service	1093785123	1093785123	1	1	ROSEN, ROBERT S MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34129	18	Ophthalmology	0	In state provider	None	10737 CAMINO RUIZ	STE 143	SAN DIEGO	CA	92126	2361	37	06073	32.91416051	-117.1437943	San Diego County
244357	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
244364	Fee-for-Service	1518086578	1518086578	1	1	REDDY, NIRUPA MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94933	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
244367	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
244401	Fee-for-Service	1376573808	1376573808	1	1	RUSSELL WONG M.D.	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	321 N KUAKINI ST	STE 811	HONOLULU	HI	96817	2362	00	None	21.32171328	-157.8557577	Honolulu County
244405	Fee-for-Service	1881677292	1881677292	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1212 HANNA AVENUE	None	CORCORAN	CA	93212	2334	16	06031	36.09974853	-119.56293	Kings County
244482	Fee-for-Service	1710287297	1710287297	1	24	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
244483	Fee-for-Service	1376556027	1376556027	1	1	RICHARD I TORBAN A PROFESSIO	3/14/2020	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S	44-530 SAN PABLO AVE	SUITE 201	PALM DESERT	CA	92260	3596	33	06065	33.72807112	-116.3825504	Riverside County
244485	Fee-for-Service	1306349907	1306349907	1	1	ROSE MARIE DELFIN ENRIQUEZ	3/21/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	22011 HIAWATHA ST	UNIT 5	CHATSWORTH	CA	91311	2080	19	06037	34.25907845	-118.606734	Los Angeles County
244499	Fee-for-Service	1922026897	1922026897	1	1	ROOHIPOUR, HALEH MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84198	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244501	Fee-for-Service	1972939494	1972939494	1	3	ROOTS, INC.	2/21/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	SUITE 102	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
244508	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
244513	Fee-for-Service	1629149687	1629149687	1	1	ROSENBERG, GARY A MD	12/1/1998	204D00000X	NA	Other	026	PHYSICIANS	84643	20	Orthopedic Surgery	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
244520	Fee-for-Service	1609339878	1609339878	1	1	ROMANU, JOSHUA T MD	6/2/2022	207P00000X	NA	Other	026	PHYSICIANS	176680	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
244532	Fee-for-Service	1356501449	1356501449	1	1	RAMOS, SUSANNE L MD INC	4/1/1998	193400000X	NA	Other	026	PHYSICIANS	55641	None	None	0	In state provider	None	2323 OAK PARK LANE	STE 101	SANTA BARBARA	CA	93105	4276	42	06083	34.42888554	-119.7249243	Santa Barbara County
244552	Fee-for-Service	1447347273	1447347273	1	1	RODRIGUEZ, JANET R MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2510 DOUGLAS BLVD	STE 300	ROSEVILLE	CA	95661	3302	31	06061	38.74412472	-121.2400335	Placer County
244564	Fee-for-Service	1013155175	1013155175	1	1	ROVERAN, GIORGIO MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106675	41	Internal Medicine	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
244565	Fee-for-Service	1023120318	1023120318	1	1	RAMIREZ, RANDALL A CSW	6/25/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY ROAD	SUITE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
244589	Fee-for-Service	1437340940	1437340940	1	1	RANDALL, BRIAN P MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140743	01	General Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
244597	Fee-for-Service	1033861935	1033861935	1	1	RIVERSIDE CLINICAL LABORATOR	7/18/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	Y INC	7177 BROCKTON AVE	STE 338	RIVERSIDE	CA	92506	2634	33	06065	33.94289496	-117.3943941	Riverside County
244610	Fee-for-Service	1629394036	1629394036	1	1	RIBEIRA, RYAN J MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139010	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244626	Fee-for-Service	1346317211	1346317211	1	1	RUSHEEN, LARRY M MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57925	13	Neurology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
244629	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
244630	Fee-for-Service	1578722070	1578722070	1	1	RICHARDS, IRINA N MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114580	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
244655	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
244662	Fee-for-Service	1750471231	1750471231	1	1	ROBERT H. HOPKINS, JR., MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	None	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
244663	Fee-for-Service	1780466102	1780466102	1	1	RAK, PAULINA AU	11/1/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
244672	Fee-for-Service	1356858567	1356858567	1	1	REYES SANTANA, YOLANDA	8/9/2021	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3920 GRAND	SUITE E	CHINO	CA	91710	5484	36	06071	33.99859228	-117.7190491	San Bernardino County
244694	Fee-for-Service	1881677292	1881677292	2	1	REEDLEY COMMUNITY HOSPITAL	12/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1212 HANNA AVENUE	None	CORCORAN	CA	93212	2334	16	06031	36.09974853	-119.56293	Kings County
244720	Fee-for-Service	1114363066	1114363066	1	1	RAKKAR, GEORGE J MD	10/19/2020	207LP2900X	NA	Other	026	PHYSICIANS	155423	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
244735	Fee-for-Service	1942020672	1942020672	1	1	RIPPLE IN KIND CARE SERVICES	10/17/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	333 GELLERT BLVD	128	DALY CITY	CA	94015	2694	41	06081	37.66672018	-122.4685948	San Mateo County
244748	Fee-for-Service	1689816589	1689816589	1	1	ROZEN, YULIA MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121711	05	Anesthesiology	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
244773	Fee-for-Service	1306349907	1306349907	1	1	ROSE MARIE DELFIN ENRIQUEZ	3/21/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	22011 HIAWATHA ST	UNIT 5	CHATSWORTH	CA	91311	2080	19	06037	34.25907845	-118.606734	Los Angeles County
244796	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
244817	Fee-for-Service	1285614222	1285614222	1	1	RIDINGS, JANE W MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
244874	Fee-for-Service	1447707351	1447707351	1	1	ROOME, KRISTINA M LMFT	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107272	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
244917	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
244918	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
244944	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
244960	Fee-for-Service	1063640555	1063640555	1	1	ROSS, CURTIS P DO	1/23/2018	208800000X	NA	Other	026	PHYSICIANS	14109	34	Urology and Urological Surgery	0	In state provider	None	909 HYDE ST	STE 222	SAN FRANCISCO	CA	94109	4845	38	06075	37.78939387	-122.4170945	San Francisco County
244962	Fee-for-Service	1558383828	1558383828	1	1	RICHARD T KRUG M.D.	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3610 ENSIGN RD NE	None	OLYMPIA	WA	98506	5025	00	None	47.05104341	-122.843941	Thurston County
244983	Fee-for-Service	1881677292	1881677292	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1212 HANNA AVENUE	None	CORCORAN	CA	93212	2334	16	06031	36.09974853	-119.56293	Kings County
245023	Fee-for-Service	1942020672	1942020672	1	1	RIPPLE IN KIND CARE SERVICES	10/17/2024	103TC0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	333 GELLERT BLVD	128	DALY CITY	CA	94015	2694	41	06081	37.66672018	-122.4685948	San Mateo County
245040	Fee-for-Service	1376625582	1376625582	1	1	ROSE, HEIDI A	1/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	34	06067	38.599524	-121.437738	Sacramento County
245068	Fee-for-Service	1629395546	1629395546	1	1	RAD, HELEYA PSYD	1/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	SUITE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
245086	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
245113	Fee-for-Service	1821131632	1821131632	1	1	RASTEGAR, JACOB MD	10/1/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	78955	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500-30 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
245152	Fee-for-Service	1831289115	1831289115	1	1	RANA, VIPULKUMAR MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146438	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
245156	Fee-for-Service	1083647523	1083647523	2	1	REINGANUM, SARA J MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70642	02	General Surgery	0	In state provider	None	13847 E 14TH STREET	STE 109	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
245204	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
245208	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	3/13/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
245233	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
245236	Fee-for-Service	1235323106	1235323106	1	1	RICHARDS, SUMMER D LMFT	1/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18245 HWY 18	STE 6	APPLE VALLEY	CA	92307	2217	36	06071	34.54026632	-117.2656302	San Bernardino County
245237	Fee-for-Service	1942225545	1942225545	1	1	RALPHS GROCERY COMPANY	3/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #210	11727 W OLYMPIC BLVD	# D	LOS ANGELES	CA	90064	1202	19	06037	34.03394098	-118.4483898	Los Angeles County
245251	Fee-for-Service	1306139183	1306139183	1	1	REYHAN, ANNE PSYCHOTHERAPIST	7/31/2018	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	14708 PIPELINE AVE	STE B	CHINO HILLS	CA	91709	0000	36	06071	33.985719	-117.7152575	San Bernardino County
245253	Fee-for-Service	1659376689	1659376689	1	1	REZNICK,JAMES W DO	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6509	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3055 W ORANGE AVE	STE 202	ANAHEIM	CA	92804	3154	30	06059	33.8247435	-117.99621	Orange County
245269	Fee-for-Service	1881677292	1881677292	2	1	REEDLEY COMMUNITY HOSPITAL	12/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1212 HANNA AVENUE	None	CORCORAN	CA	93212	2334	16	06031	36.09974853	-119.56293	Kings County
245295	Fee-for-Service	1710106737	1710106737	1	1	RAOUFI, FARZANEH NP	3/21/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245323	Fee-for-Service	1063918910	1063918910	1	1	ROLFES, MARY C MD	6/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	164389	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
245345	Fee-for-Service	1811424559	1811424559	1	1	ROY, VARUN Y MD	10/18/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	157636	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
245372	Fee-for-Service	1275631236	1275631236	1	1	REYES, ELIZABETH R MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	67305	40	Pediatrics	0	In state provider	None	100 E VALENCIA MESA DR	STE 100	FULLERTON	CA	92835	3816	30	06059	33.89343304	-117.9279349	Orange County
245375	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
245377	Fee-for-Service	1255726485	1255726485	1	1	RAPHAEL, OREN S MD	11/6/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	152831	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
245398	Fee-for-Service	1457747099	1457747099	1	1	RICE, CAMERON M MD	7/1/2019	207L00000X	NA	Other	026	PHYSICIANS	146110	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
245404	Fee-for-Service	1124439807	1124439807	1	24	REGENTS UNIV OF CALIFORNIA U	12/23/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	7100 REDWOOD BLVD	STE 200	NOVATO	CA	94945	4110	21	06041	38.10057107	-122.5678339	Marin County
245412	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
245423	Fee-for-Service	1508870403	1508870403	1	1	RUDIN, GEORGE H MD	7/31/1991	2086S0122X	NA	General Surgery	026	PHYSICIANS	73237	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
245428	Fee-for-Service	1780762377	1780762377	1	1	ROSOFF, JOHN MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83020	05	Anesthesiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
245438	Fee-for-Service	1669612347	1669612347	1	1	ROUTT DIALYSIS, LLC	1/25/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	3310 GONI RD	BLDG H, STE 171	CARSON CITY	NV	89706	7917	00	None	39.188448	-119.748069	Consolidated Municipality of Carson City
245446	Fee-for-Service	1043576796	1043576796	1	1	RAOUFI, RAHIM A MD, INC	1/22/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	94293	10	Gastroenterology (M.D. only)	0	In state provider	None	228 SOUTH D STREET	SUITE B	LOMPOC	CA	93436	7308	42	06083	34.63619744	-120.4528292	Santa Barbara County
245461	Fee-for-Service	1326719592	1326719592	1	1	RAFIQUE, RABAB OD	11/4/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
245477	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
245478	Fee-for-Service	1821103730	1821103730	1	1	REYES, RAYMOND M MD	10/26/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50200	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
245490	Fee-for-Service	1225375900	1225375900	1	1	ROGERS, DOROTHY M BIRTH DOUL	4/8/2024	176B00000X	NA	Licensed Midwife	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
245493	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
245495	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	5/21/2021	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
245498	Fee-for-Service	1831109651	1831109651	1	1	RAMIRA, MARIA L CNP	7/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
245503	Fee-for-Service	1669497939	1669497939	1	1	ROSENBLUM, ELIZABETH MD	1/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52654	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
245518	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
245521	Fee-for-Service	1265761811	1265761811	1	2	REHOBOTH DRUG AND ALCOHOLPRE	5/30/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	568 COMPTON BLVD	None	COMPTON	CA	90220	3011	19	06037	33.89588552	-118.233639	Los Angeles County
245541	Fee-for-Service	1659376689	1659376689	1	1	REZNICK,JAMES W DO	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6509	41	Internal Medicine	0	In state provider	None	3055 W ORANGE AVE	STE 202	ANAHEIM	CA	92804	3154	30	06059	33.8247435	-117.99621	Orange County
245593	Fee-for-Service	1568642353	1568642353	1	1	REYNOLDS, JUSTIN A MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100903	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
245606	Fee-for-Service	1023512142	1023512142	1	1	RECCOW, HUI S LMFT	12/11/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	751 W ORANGETHORPE AVE	None	FULLERTON	CA	92832	2016	30	06059	33.85956584	-117.9391123	Orange County
245630	Fee-for-Service	1639222318	1639222318	1	1	RAMIREZ-AZCARRAGA, G MD	11/8/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75765	01	General Practice	0	In state provider	None	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
245659	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
245701	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
245736	Fee-for-Service	1790799583	1790799583	1	1	ROMNESS, DAVID MD	6/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86918	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
245751	Fee-for-Service	1811375538	1811375538	1	1	ROMAN, ROBERT MD	5/11/2023	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163680	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
245768	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
245780	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
245794	Fee-for-Service	1275182362	1275182362	1	1	RAVI, USHA MD	9/25/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176118	40	Pediatrics	0	In state provider	None	1062 CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22322475	-119.3375086	Tulare County
245797	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
245801	Fee-for-Service	1124185442	1124185442	1	1	RABIN, JOHN A MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83044	36	Psychiatry	0	In state provider	None	3055 W ORANGE AVE	STE 206	ANAHEIM	CA	92804	3154	30	06059	33.8247435	-117.99621	Orange County
245807	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
245809	Fee-for-Service	1710287297	1710287297	1	91	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	8641 WILSHIRE BLVD	115	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
245919	Fee-for-Service	1639222318	1639222318	1	1	RAMIREZ-AZCARRAGA, G MD	11/8/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75765	08	Family Practice	0	In state provider	None	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
245948	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	8/18/2023	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
245974	Fee-for-Service	1407006893	1407006893	1	1	RUBEN RUIZ MD A MED CORP	9/1/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	403 W F ST	None	ONTARIO	CA	91762	3207	36	06071	34.069293	-117.655065	San Bernardino County
245986	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
246009	Fee-for-Service	1356608962	1356608962	1	1	ROMERO, KAIJALEENA MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
246043	Fee-for-Service	1659635134	1659635134	1	1	RUSSELL, DAVID J DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14817	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1617 N CALIFORNIA ST	STE 2A	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
246054	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
246070	Fee-for-Service	1710287297	1710287297	1	116	REGENTS UNIVERSITY OF CALIFO	1/5/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	4343 LANKERSHIM BLVD	200	NORTH HOLLYWOOD	CA	91602	2705	19	06037	34.14917579	-118.3651663	Los Angeles County
246073	Fee-for-Service	1306869185	1306869185	1	1	RUSS, THOMAS MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34080	41	Internal Medicine	0	In state provider	None	2510 AIRPARK DR	STE 302	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
246074	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	10/1/2020	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
246088	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
246097	Fee-for-Service	1457439267	1457439267	1	1	REID, KATHRYN J MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49396	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
246098	Fee-for-Service	1992711899	1992711899	1	1	RODRIGUEZ, JESUS M MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73760	08	Family Practice	0	In state provider	None	2505 E DIVISADERO ST	None	FRESNO	CA	93721	1401	10	06019	36.74334929	-119.7809344	Fresno County
246116	Fee-for-Service	1356681241	1356681241	1	1	ROEBACK, WOODROW A LPCC	8/23/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING SERVICES	1609 E. PALMDALE BLVD	SUITE D	PALMDALE	CA	93551	2943	19	06037	34.57967548	-118.1008305	Los Angeles County
246135	Fee-for-Service	1568973071	1568973071	1	3	REALOPTIONS	7/13/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	400 30TH ST	STE 401	OAKLAND	CA	94609	3317	01	06001	37.81907725	-122.2648838	Alameda County
246158	Fee-for-Service	1528443181	1528443181	1	1	ROIZ, RONALD A MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136897	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
246159	Fee-for-Service	1407201635	1407201635	1	1	ROEMER, SHELBY J LMFT	8/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5053 LAMART DR	STE 207	RIVERSIDE	CA	92507	5990	33	06065	33.95818206	-117.3320081	Riverside County
246190	Fee-for-Service	1417930660	1417930660	1	1	RICHARD J. COLEMAN	6/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 SIVLEY RD	None	HUNTSVILLE	AL	35801	4421	00	None	34.72122889	-86.58120307	Madison County
246201	Fee-for-Service	1679640403	1679640403	1	1	RAJARATNAM, RICHARD G MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39889	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
246210	Fee-for-Service	1184400459	1184400459	1	1	REVITALIZE CARE HOME LLC	2/8/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1913 CARDIFF DRIVE	None	PITTSBURG	CA	94565	4049	07	06013	38.01799186	-121.8784822	Contra Costa County
246236	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
246269	Fee-for-Service	1376705483	1376705483	1	1	RIES, DAVID C MD	10/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127233	41	Internal Medicine	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
246279	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
246280	Fee-for-Service	1194828285	1194828285	1	1	RANI,BOMMAKANTI MD	1/1/2001	207R00000X	NA	Other	026	PHYSICIANS	66780	41	Internal Medicine	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
246290	Fee-for-Service	1932130663	1932130663	1	1	RAMBHATLA, KAMALAKAR MD	12/25/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	32691	01	General Practice	0	In state provider	None	623 W DUARTE RD	STE 1	ARCADIA	CA	91007	7300	19	06037	34.12648672	-118.0522757	Los Angeles County
246296	Fee-for-Service	1285661090	1285661090	1	1	ROBERTS, MARSHA D MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55851	30	Radiology	0	In state provider	None	20103 LAKE CHABOT RD	STE 103	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
246309	Fee-for-Service	1205139581	1205139581	1	2	RANKINS, MARGO M	12/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	STE 178B	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
246325	Fee-for-Service	1821557620	1821557620	1	1	RICHMOND POST ACUTE CARE LLC	4/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	955 23RD ST	None	RICHMOND	CA	94804	1250	07	06013	37.946313	-122.347509	Contra Costa County
246338	Fee-for-Service	1831526300	1831526300	1	1	REWAL, MRIDULA MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127082	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
246339	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	11/18/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
246341	Fee-for-Service	1124439807	1124439807	1	27	REGENTS UNIV OF CALIFORNIA U	2/27/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2 BON AIR RD	SUITE 150	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
246357	Fee-for-Service	1710287297	1710287297	1	116	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	4343 LANKERSHIM BLVD	200	NORTH HOLLYWOOD	CA	91602	2705	19	06037	34.14917579	-118.3651663	Los Angeles County
246359	Fee-for-Service	1710287297	1710287297	1	45	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
246360	Fee-for-Service	1306869185	1306869185	1	1	RUSS, THOMAS MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34080	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2510 AIRPARK DR	STE 302	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
246364	Fee-for-Service	1073554465	1073554465	1	1	RAWAL, ASEEM MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75288	None	None	0	In state provider	None	600 NUT TREE RD	STE 110	VACAVILLE	CA	95687	4656	48	06095	38.36133624	-121.9496789	Solano County
246378	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
246381	Fee-for-Service	1427186303	1427186303	1	1	RAMIREZ, SONIA B LMFT	6/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 OAKDALE RD	STE 440	MODESTO	CA	95355	3363	50	06099	37.662489	-120.957588	Stanislaus County
246388	Fee-for-Service	1447888003	1447888003	1	1	REN, CASEY MD	6/26/2023	207R00000X	NA	Other	026	PHYSICIANS	185349	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246523	Fee-for-Service	1578710158	1578710158	1	1	RAZA, AAMIR MD	3/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126345	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
246526	Fee-for-Service	1710287297	1710287297	1	35	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
246563	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
246591	Fee-for-Service	1760407365	1760407365	1	1	RALPHS GROCERY COMPANY	6/8/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #108	8657 VILLA LA JOLLA DR	None	LA JOLLA	CA	92037	2356	37	06073	32.86657555	-117.2333068	San Diego County
246599	Fee-for-Service	1801889829	1801889829	1	2	REGENTS/UCDPBG/PED NEPHR	5/1/1999	2080P0210X	NA	Nephrology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
246601	Fee-for-Service	1689130171	1689130171	1	1	RINCON, JESSICA LMFT	12/4/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	206A	CHINO	CA	91710	8417	36	06071	33.99723746	-117.7140555	San Bernardino County
246628	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
246647	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
246649	Fee-for-Service	1710287297	1710287297	1	105	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
246665	Fee-for-Service	1326084716	1326084716	1	1	ROHIRA, ASHISH L MD	1/2/2019	207R00000X	NA	Other	026	PHYSICIANS	139946	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
246666	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
246679	Fee-for-Service	1306845862	1306845862	1	1	REDDY, DENISE MD	8/21/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	188338	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
246697	Fee-for-Service	1134224538	1134224538	1	1	RONALD L WILKINSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 STADIUM DR	None	MORGANTOWN	WV	26506	7900	00	None	39.65330334	-79.95441785	Monongalia County
246811	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
246827	Fee-for-Service	1235642950	1235642950	1	1	REGENTS OF THE UNIVERSITY OF	8/3/2016	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	2521 STOCKTON BLVD	SUITE 2200, RM 2117	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
246836	Fee-for-Service	1609174143	1609174143	1	1	REYES, ADRIANA LMFT	5/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	595 E COLORADO BLVD STE	None	PASADENA	CA	91101	2057	19	06037	34.14588202	-118.1380722	Los Angeles County
246853	Fee-for-Service	1710287297	1710287297	1	34	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	501 DEEP VALLEY DRIVE	400	ROLLING HILLS EST	CA	90274	7621	19	06037	33.77279445	-118.3748253	Los Angeles County
246857	Fee-for-Service	1902102023	1902102023	2	1	RESTORATIVE THERAPY	3/13/2017	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ASSOCIATES	15775 LAGUNA CANYON RD	STE 110	IRVINE	CA	92618	3192	30	06059	33.6663745	-117.760682	Orange County
246861	Fee-for-Service	1326098104	1326098104	1	1	ROHRBACK,SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET STREET	None	PORTLAND	OR	97516	2599	00	None	45.51158947	-122.5586205	Multnomah County
246889	Fee-for-Service	1801889829	1801889829	1	2	REGENTS/UCDPBG/PED NEPHR	12/12/2022	2080P0210X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
246896	Fee-for-Service	1316486558	1316486558	1	1	RODRIGUEZ, AMANDA LCSW	10/21/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
246915	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
246935	Fee-for-Service	1710287297	1710287297	1	42	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
246948	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	12/16/2021	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
246952	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
246957	Fee-for-Service	1669532750	1669532750	1	1	ROUND VALLEY INDIAN HEALTH C	9/1/2002	261Q00000X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	CORNER HWY 162 & BIGGAR	None	COVELO	CA	95428	0247	23	06045	39.809763	-123.2481105	Mendocino County
246978	Fee-for-Service	1013336452	1013336452	1	1	RIVA, KATHERINE R MD	9/9/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161204	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
247012	Fee-for-Service	1962598789	1962598789	1	1	RICHMOND, PATRICIA L MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109037	30	Radiology	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
247026	Fee-for-Service	1710316450	1710316450	1	1	RODRIGUEZ JEREZ, ROBERTO D M	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154298	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
247101	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
247115	Fee-for-Service	1750667903	1750667903	1	1	RAMIREZ, LORRAINE LMFT	2/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
247116	Fee-for-Service	1467482554	1467482554	1	1	REEVES, MARK E MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83116	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
247131	Fee-for-Service	1114987500	1114987500	1	1	REDDY, RANGA C MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	31764	20	Orthopedic Surgery	0	In state provider	None	203 W BADILLO ST	None	COVINA	CA	91723	1907	19	06037	34.0863243	-117.8924805	Los Angeles County
247148	Fee-for-Service	1902102023	1902102023	2	1	RESTORATIVE THERAPY	3/13/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES	15775 LAGUNA CANYON RD	STE 110	IRVINE	CA	92618	3192	30	06059	33.6663745	-117.760682	Orange County
247167	Fee-for-Service	1033173836	1033173836	1	1	ROBERT M BERSIN MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 17TH AVE	6TH FL	SEATTLE	WA	98122	5788	00	None	47.60689769	-122.3102467	King County
247191	Fee-for-Service	1043247505	1043247505	1	1	RIVET, PIERRE G MD AMC	3/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36527	08	Family Practice	0	In state provider	None	4033 3RD AVE	STE 104	SAN DIEGO	CA	92103	2136	37	06073	32.75053781	-117.1627168	San Diego County
247205	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
247211	Fee-for-Service	1598758666	1598758666	1	1	REGENTS/UCDPBG/PATHOLOGY	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
247223	Fee-for-Service	1710287297	1710287297	1	116	REGENTS UNIVERSITY OF CALIFO	1/5/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	4343 LANKERSHIM BLVD	200	NORTH HOLLYWOOD	CA	91602	2705	19	06037	34.14917579	-118.3651663	Los Angeles County
247236	Fee-for-Service	1710287297	1710287297	1	44	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	3445 PACIFIC COAST HIGHW	100	TORRANCE	CA	90505	6659	19	06037	33.80164353	-118.3452355	Los Angeles County
247241	Fee-for-Service	1710287297	1710287297	1	83	REGENTS UNIVERSITY OF CALIFO	1/3/2022	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
247245	Fee-for-Service	1669532750	1669532750	1	1	ROUND VALLEY INDIAN HEALTH C	9/5/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	CORNER HWY 162 & BIGGAR	None	COVELO	CA	95428	0247	23	06045	39.809763	-123.2481105	Mendocino County
247368	Fee-for-Service	1447318829	1447318829	1	1	ROCKMAN, STANLEY E MD	2/1/1983	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	31820	10	Gastroenterology (M.D. only)	0	In state provider	None	36 S EL CAMINO REAL	STE 104	SAN MATEO	CA	94401	3825	41	06081	37.56485285	-122.327689	San Mateo County
247388	Fee-for-Service	1710287297	1710287297	1	20	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
247392	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
247403	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
247408	Fee-for-Service	1710287297	1710287297	1	117	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	24302 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	3115	30	06059	33.60911692	-117.7122444	Orange County
247415	Fee-for-Service	1639360449	1639360449	1	1	RYAN, JARLATH N MD	10/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93342	08	Family Practice	0	In state provider	None	946 N BRAND BLVD	None	GLENDALE	CA	91202	2905	19	06037	34.1599383	-118.2550213	Los Angeles County
247428	Fee-for-Service	1437261724	1437261724	1	1	RODACKER,MARK W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MED CENTER ONE	222 N 7TH ST	None	BISMARCK	ND	58501	0000	00	None	46.807308	-100.782459	Burleigh County
247453	Fee-for-Service	1265724975	1265724975	1	1	RANDALL, PENNY K MD	7/13/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77480	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
247459	Fee-for-Service	1578595468	1578595468	1	1	REILEY, MARK A MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	43696	20	Orthopedic Surgery	0	In state provider	None	3010 COLBY ST	STE 118	BERKELEY	CA	94705	2059	01	06001	37.85492078	-122.2576101	Alameda County
247494	Fee-for-Service	1710287297	1710287297	1	88	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
247511	Fee-for-Service	1710287297	1710287297	1	116	REGENTS UNIVERSITY OF CALIFO	1/5/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	4343 LANKERSHIM BLVD	200	NORTH HOLLYWOOD	CA	91602	2705	19	06037	34.14917579	-118.3651663	Los Angeles County
247519	Fee-for-Service	1316910060	1316910060	1	1	RIZVI, DANISH M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
247531	Fee-for-Service	1518632074	1518632074	1	1	RELLORA, MARICAR M CNP	1/21/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
247534	Fee-for-Service	1669532750	1669532750	1	1	ROUND VALLEY INDIAN HEALTH C	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	CORNER HWY 162 & BIGGAR	None	COVELO	CA	95428	0247	23	06045	39.809763	-123.2481105	Mendocino County
247546	Fee-for-Service	1639737141	1639737141	1	1	ROVZAR, COREY PT	6/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
247561	Fee-for-Service	1972146165	1972146165	1	1	RIVYVE BEHAVIORAL HEALTH, IN	4/8/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	1	Border provider	C.	2150 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	8472	00	None	35.11197	-114.567993	Mohave County
247580	Fee-for-Service	1043399181	1043399181	1	1	RUSSELL, RICHARD MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	18135	36	Psychiatry	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
247605	Fee-for-Service	1245250265	1245250265	1	1	REDDY, SUDHA MD	5/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53840	67	Endocrinology	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
247611	Fee-for-Service	1467019430	1467019430	1	1	ROY, COLTON DO	10/1/2023	207P00000X	NA	Other	026	PHYSICIANS	21828	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
247643	Fee-for-Service	1447229323	1447229323	1	1	ROFFE, SHIRLEY P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19300 SW 65TH AVE	None	TUALATIN	OR	97062	7706	00	None	45.378774	-122.740551	Clackamas County
247680	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
247690	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
247698	Fee-for-Service	1710287297	1710287297	1	117	REGENTS UNIVERSITY OF CALIFO	11/24/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	24302 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	3115	30	06059	33.60911692	-117.7122444	Orange County
247710	Fee-for-Service	1235423021	1235423021	1	1	ROSTISLAV MEDVID	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 N NEVADA AVE	None	COLORADO SPGS	CO	80907	6819	00	None	38.86574509	-104.8201477	El Paso County
247738	Fee-for-Service	1679154264	1679154264	1	1	RISING STAR CARE HOME LLC	5/25/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	40600 CHANTEMAR WAY	None	TEMECULA	CA	92591	2844	33	06065	33.5260319	-117.1481584	Riverside County
247750	Fee-for-Service	1679530539	1679530539	1	1	RADZIO, AGNES	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94701	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
247784	Fee-for-Service	1124097035	1124097035	1	1	RAM, VIJAYA MD	2/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88877	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
247806	Fee-for-Service	1497701536	1497701536	1	1	ROBERT DEAN HILL MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
247820	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
247828	Fee-for-Service	1700240603	1700240603	1	1	RODRIGUEZ MARTINEZ, RAQUEL	2/14/2018	390200000X	NA	Other	026	PHYSICIANS	152147	08	Family Practice	0	In state provider	MD	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
247840	Fee-for-Service	1053327239	1053327239	1	1	ROSENBERG RICHARD A DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 306	LONG BEACH	CA	90805	4595	19	06037	33.86018093	-118.1537163	Los Angeles County
247842	Fee-for-Service	1639183247	1639183247	1	1	RASMUSSEN, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 WEST LORAIN STREET	None	OBERLIN	OH	44074	1026	00	None	41.2942505	-82.2246975	Lorain County
247869	Fee-for-Service	1770515421	1770515421	1	1	RAMOS, HECTOR C MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60518	02	General Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 408	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
247893	Fee-for-Service	1245250265	1245250265	1	1	REDDY, SUDHA MD	5/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53840	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
247903	Fee-for-Service	1932543998	1932543998	1	1	ROSS, ANDREW G MD	12/6/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	139763	45	Nephrology (Renal-Kidney)	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
247937	Fee-for-Service	1275675407	1275675407	1	1	REGULA, DONALD P MD	11/1/1998	207ZP0101X	NA	Other	026	PHYSICIANS	56496	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
247950	Fee-for-Service	1922024017	1922024017	1	1	REYES, ERLINDA T MD	5/6/2005	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45176	01	General Practice	0	In state provider	None	200 JOSE FIGUERES AVE	STE 220	SAN JOSE	CA	95116	1604	43	06085	37.36122014	-121.8505998	Santa Clara County
247956	Fee-for-Service	1003130972	1003130972	1	1	RIZZUTI ALLISON	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
247958	Fee-for-Service	1932235181	1932235181	1	1	RAITT, JAMES W MD	3/21/1972	207K00000X	NA	Other	026	PHYSICIANS	5604	41	Internal Medicine	0	In state provider	MENLO MEDICAL CLINIC	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
247964	Fee-for-Service	1265414353	1265414353	1	1	RIBAY, MA TERESITA D MD	12/9/2005	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52090	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
247966	Fee-for-Service	1043276462	1043276462	1	1	ROSEN, MARK A MD	7/1/1981	207L00000X	NA	Other	026	PHYSICIANS	39350	05	Anesthesiology	0	In state provider	U C SAN FRANCISCO	513 PARNASSUS AVE	# 436	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
247968	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
247977	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	4/28/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
247983	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
248021	Fee-for-Service	1508065434	1508065434	1	1	RAHER, LAUREN B MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99272	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248025	Fee-for-Service	1639565799	1639565799	1	1	RAMAN, PRIYA MD	11/8/2019	207RC0200X	NA	Other	026	PHYSICIANS	147801	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248026	Fee-for-Service	1780603779	1780603779	1	1	RINK, DONALD T MD	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	24884	01	General Practice	0	In state provider	None	2323 DE LA VINA ST	STE 209	SANTA BARBARA	CA	93105	3880	42	06083	34.43202913	-119.7212339	Santa Barbara County
248032	Fee-for-Service	1023531613	1023531613	1	1	ROMAN, JULIE M LMFT	10/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	308 W YANONALI ST	None	SANTA BARBARA	CA	93101	3832	42	06083	34.41044288	-119.6954699	Santa Barbara County
248064	Fee-for-Service	1588711311	1588711311	1	1	ROOHPARVAR, SHAHAB MD	6/18/2020	207R00000X	NA	Other	026	PHYSICIANS	81901	41	Internal Medicine	0	In state provider	None	2410 SAMARITAN DRIVE	SUITE 201	SAN JOSE	CA	95124	3909	43	06085	37.25107654	-121.9451342	Santa Clara County
248066	Fee-for-Service	1427050616	1427050616	1	1	RIAZ, KAMRAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1530 NEEDMORE RD	None	DAYTON	OH	45414	3969	00	None	39.81684566	-84.20841949	Montgomery County
248088	Fee-for-Service	1336213594	1336213594	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF II LLC	610 HEGENBERGER ROAD	SUITE 101A	OAKLAND	CA	94621	1914	01	06001	37.746225	-122.195922	Alameda County
248110	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
248136	Fee-for-Service	1982703773	1982703773	1	1	RIVERSIDE RECOVERY RESOURCES	9/8/2017	251300000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	600 3RD STREET	SUITE C	LAKE ELSINORE	CA	92530	2748	33	06065	33.68739553	-117.336692	Riverside County
248147	Fee-for-Service	1669439733	1669439733	1	1	RENNER, CHARLES J MD	11/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	67128	01	General Practice	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3191	07	06013	37.95582533	-121.967442	Contra Costa County
248151	Fee-for-Service	1275526337	1275526337	1	2	REGENTS/UCDPBG/SUR PLAST	5/1/1999	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
248155	Fee-for-Service	1770515421	1770515421	1	1	RAMOS, HECTOR C MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60518	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 408	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
248219	Fee-for-Service	1407904089	1407904089	2	1	RAGHUNATHAN, CHENGALROYAN MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	30339	41	Internal Medicine	0	In state provider	None	16660 PARAMOUNT BLVD	STE 202	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
248238	Fee-for-Service	1922024017	1922024017	1	1	REYES, ERLINDA T MD	5/6/2005	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45176	40	Pediatrics	0	In state provider	None	200 JOSE FIGUERES AVE	STE 220	SAN JOSE	CA	95116	1604	43	06085	37.36122014	-121.8505998	Santa Clara County
248259	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
248267	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	11/9/2020	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
248270	Fee-for-Service	1710287297	1710287297	1	122	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
248273	Fee-for-Service	1245363944	1245363944	1	1	RUBIO, IRIS LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
248274	Fee-for-Service	1134307499	1134307499	1	1	RICHARD PATTEN	4/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3741 W 12600 S	None	RIVERTON	UT	84065	7215	00	None	40.520232	-111.980151	Salt Lake County
248288	Fee-for-Service	1942233853	1942233853	1	1	RAHBAR, GUITA MD	3/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79018	30	Radiology	0	In state provider	None	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
248308	Fee-for-Service	1689609562	1689609562	1	1	RINGDAHL, DAVID K DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC INC	655 N TUSTIN ST	STE L	ORANGE	CA	92867	7126	30	06059	33.797547	-117.835642	Orange County
248316	Fee-for-Service	1316476484	1316476484	1	1	RAMAKRISHNAN, RITHIKA	8/14/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	173190	None	None	0	In state provider	None	1040 ELM AVE,	SUITE 303	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
248317	Fee-for-Service	1780603779	1780603779	1	1	RINK, DONALD T MD	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	24884	08	Family Practice	0	In state provider	None	2323 DE LA VINA ST	STE 209	SANTA BARBARA	CA	93105	3880	42	06083	34.43202913	-119.7212339	Santa Barbara County
248326	Fee-for-Service	1821191883	1821191883	1	1	RAMIREZ, MARTIN MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52585	08	Family Practice	0	In state provider	None	7600 HOSPITAL DR	STE H	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
248340	Fee-for-Service	1932762036	1932762036	1	1	RAMOS, NASHLYNE MD	6/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19495	None	None	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
248395	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
248409	Fee-for-Service	1952309569	1952309569	1	1	ROSE, CHRISTOPHER M MD	5/23/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49966	78	Neoplastic Diseases/Oncology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
248424	Fee-for-Service	1942837760	1942837760	1	1	RIZZI, DEAN MD	6/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
248440	Fee-for-Service	1275526337	1275526337	1	2	REGENTS/UCDPBG/SUR PLAST	9/1/2019	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
248454	Fee-for-Service	1174636583	1174636583	1	1	RUBENSTEIN, MICHELE LCSW	1/1/2000	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1452 26TH ST	STE 102	SANTA MONICA	CA	90404	3042	19	06037	34.03218119	-118.4730364	Los Angeles County
248507	Fee-for-Service	1407904089	1407904089	2	1	RAGHUNATHAN, CHENGALROYAN MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	30339	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16660 PARAMOUNT BLVD	STE 202	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
248545	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
248554	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	4/28/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
248558	Fee-for-Service	1710287297	1710287297	1	122	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
248571	Fee-for-Service	1497051064	1497051064	1	1	ROSS, ALEXANDRA C PSY	1/31/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
248572	Fee-for-Service	1942353800	1942353800	1	1	RASMUSSEN, LEIF MD	3/31/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27227	-	NOT APPLICABLE	0	In state provider	None	1496 - 1498 N BEALE RD	None	MARYSVILLE	CA	95901	6205	58	06115	39.12743446	-121.5621716	Yuba County
248573	Fee-for-Service	1457335200	1457335200	1	1	ROSKO, THOMAS J MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85404	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
248615	Fee-for-Service	1154526093	1154526093	1	1	RUBINSTEIN, ROEE E MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112132	24	Plastic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
248616	Fee-for-Service	1477604080	1477604080	1	1	ROSEN, HOWARD J MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77432	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248630	Fee-for-Service	1275589723	1275589723	1	1	ROSHDIEH, BABAK MD	4/24/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	76333	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
248646	Fee-for-Service	1811415185	1811415185	1	1	REICH, JENAE LPCC	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
248670	Fee-for-Service	1508285933	1508285933	1	1	RAMIREZ, MAGDA L MD	1/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153100	01	General Practice	0	In state provider	None	1633 SOUTH COURT STREET	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
248672	Fee-for-Service	1568482891	1568482891	1	1	RANGEL, JAVIER MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93930	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
248678	Fee-for-Service	1972644227	1972644227	1	1	ROACH, JANINE MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94511	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.07067	-118.4432445	Los Angeles County
248686	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
248690	Fee-for-Service	1982605432	1982605432	1	1	RIVERSIDE RADIOLOGY	10/17/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	18330 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.54037754	-117.2644792	San Bernardino County
248695	Fee-for-Service	1952309569	1952309569	1	1	ROSE, CHRISTOPHER M MD	5/23/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49966	30	Radiology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
248710	Fee-for-Service	1821310269	1821310269	1	1	REGIONAL DIAGNOSTIC IMAGING	11/13/2012	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
248758	Fee-for-Service	1265566285	1265566285	1	1	REYNOLDS, SHERRILL LCSW	5/13/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41945 BIG BEAR BLVD	STE 227	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24334115	-116.8869688	San Bernardino County
248772	Fee-for-Service	1255448171	1255448171	1	1	RANDO, THOMAS A MD	12/31/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	65071	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
248776	Fee-for-Service	1407064876	1407064876	1	1	RESARI, JESSE C	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
248834	Fee-for-Service	1710287297	1710287297	1	39	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	27235 TOURNEY	2200, 2400	SANTA CLARITA	CA	91355	5905	19	06037	34.41755702	-118.5772646	Los Angeles County
248844	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
248847	Fee-for-Service	1710287297	1710287297	1	117	REGENTS UNIVERSITY OF CALIFO	11/24/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	24302 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	3115	30	06059	33.60911692	-117.7122444	Orange County
248856	Fee-for-Service	1295791838	1295791838	1	1	RAMBACHER, THOMAS DPM	2/28/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	26302 LA PAZ RD	101	MISSION VIEJO	CA	92691	5313	30	06059	33.60034452	-117.671202	Orange County
248861	Fee-for-Service	1457335200	1457335200	1	1	ROSKO, THOMAS J MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85404	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
248882	Fee-for-Service	1639304512	1639304512	1	1	ROMO, KAREN L F DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10005	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
248895	Fee-for-Service	1235358821	1235358821	1	1	ROGERS, STEPHEN C LMFT	5/9/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	105277	-	NOT APPLICABLE	0	In state provider	None	5220 W WASHINGTON BLVD	101,104,200,203,206-208	LOS ANGELES	CA	90016	1331	19	06037	34.04141393	-118.3546504	Los Angeles County
248905	Fee-for-Service	1831546589	1831546589	1	1	RILEY, ERIC M MD	9/16/2019	207L00000X	NA	Other	026	PHYSICIANS	147696	05	Anesthesiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
248925	Fee-for-Service	1568767358	1568767358	1	1	REKHI, RACHNA B MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112047	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
248962	Fee-for-Service	1184920399	1184920399	1	1	RUBIO, EDWARD MD	5/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135851	01	General Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
248971	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
248984	Fee-for-Service	1063625044	1063625044	1	1	ROACH, JAMES M MD INC	9/22/1978	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 S IMPERIAL AVE	STE 6	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
248998	Fee-for-Service	1255399341	1255399341	1	1	RITCHKEN, SIMON M MD	7/24/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	34151	10	Gastroenterology (M.D. only)	0	In state provider	None	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
249003	Fee-for-Service	1104476282	1104476282	1	1	RAHN, BAILEY A NP	4/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27555 YNEZ RD	SUITE 370	TEMECULA	CA	92591	4678	33	06065	33.50370608	-117.1492569	Riverside County
249008	Fee-for-Service	1700915394	1700915394	1	1	RATTY, STEPHEN D OD INC	2/18/1988	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2222 E ST	STE 1	BAKERSFIELD	CA	93301	3810	15	06029	35.3796357	-119.0245697	Kern County
249036	Fee-for-Service	1497907455	1497907455	2	2	REDDING RADIATION ONCOLOGIST	2/27/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MT. SHASTA	902 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31781109	-122.3215161	Siskiyou County
249130	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
249136	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	10/25/2023	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
249144	Fee-for-Service	1346731619	1346731619	1	1	RIVERS, KRISTEN H LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	272 S LOS ROBLES AVE	None	PASADENA	CA	91101	2872	19	06037	34.141122	-118.141341	Los Angeles County
249261	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
249264	Fee-for-Service	1194740795	1194740795	1	1	RALPHS GROCERY COMPANY	6/28/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #13	7369 MILLIKEN AVE	None	RANCHO CUCAMONGA	CA	91730	6794	36	06071	34.120206	-117.5584215	San Bernardino County
249302	Fee-for-Service	1245650548	1245650548	1	1	RABBANI, MARJAN MD	12/20/2024	208M00000X	NA	Other	026	PHYSICIANS	175030	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
249304	Fee-for-Service	1902264609	1902264609	1	1	RANGEL, MARINA LCSW	10/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1555 RIVER PARK	SUITE 206-P	SACRAMENTO	CA	95815	4612	34	06067	38.600019	-121.434687	Sacramento County
249391	Fee-for-Service	1013117183	1013117183	1	1	RAISZADEH, KIAN MD	1/7/2008	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	99221	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249413	Fee-for-Service	1235490194	1235490194	1	1	ROYSTON, ERIC J DO	1/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17746	30	Radiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
249418	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	4/28/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
249424	Fee-for-Service	1710287297	1710287297	1	122	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
249426	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
249441	Fee-for-Service	1467238774	1467238774	1	1	ROBLES, RAQUEL PT	11/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
249450	Fee-for-Service	1285705194	1285705194	1	1	RAY, ALBERT MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31935	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249458	Fee-for-Service	1053419069	1053419069	1	1	ROGOW, RUTH L CNM	6/5/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
249510	Fee-for-Service	1265790091	1265790091	1	1	RAAB, LINDA	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2919 SACRAMENTO ST	None	SAN FRANCISCO	CA	94115	2116	38	06075	37.78891604	-122.4409581	San Francisco County
249512	Fee-for-Service	1669091385	1669091385	1	1	RIDDELL, CLINTON D MD	8/27/2024	207L00000X	NA	Other	026	PHYSICIANS	188948	05	Anesthesiology	0	In state provider	None	600 HIGHLAND SPRINGS AVE	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
249539	Fee-for-Service	1295750065	1295750065	1	1	RHEE, JOAN J NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44105 15TH ST W	UNITS 401/3/5/7	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
249543	Fee-for-Service	1760557136	1760557136	2	1	RAY, BROOKE E CNM	11/16/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3110 CAMINO DEL RIO SOUT	SUITE 217	SAN DIEGO	CA	92108	3812	37	06073	32.77309124	-117.1259294	San Diego County
249548	Fee-for-Service	1710287297	1710287297	1	89	REGENTS UNIVERSITY OF CALIFO	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	RNIA	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
249551	Fee-for-Service	1568003366	1568003366	1	1	REGAL HOSPICE AND PALLIATIVE	2/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	3430 OCEAN VIEW BLVD	SUITE B	GLENDALE	CA	91208	1598	19	06037	34.20135989	-118.2282592	Los Angeles County
249566	Fee-for-Service	1487673000	1487673000	1	1	REUSCH,JANE E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
249592	Fee-for-Service	1255070140	1255070140	1	1	REQUIERON, WENNA KAE P CCC-S	9/13/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LP	27393 YNEZ RD STE 153	None	TEMECULA	CA	92591	4605	33	06065	33.50698549	-117.1502918	Riverside County
249641	Fee-for-Service	1396075966	1396075966	1	1	ROMANOWSKI, KATHLEEN S MD	6/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125094	None	None	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
249660	Fee-for-Service	1184610768	1184610768	1	1	RAMON HEALTHCARE	5/5/2005	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES INC	4800 DELTA AVE	None	ROSEMEAD	CA	91770	1127	19	06037	34.09059932	-118.0864735	Los Angeles County
249671	Fee-for-Service	1992143275	1992143275	1	1	RSCR CALIFORNIA INC	7/7/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	21334 COLD SPRING LANE	None	DIAMOND BAR	CA	91765	3442	19	06037	33.97340326	-117.8401507	Los Angeles County
249674	Fee-for-Service	1770776288	1770776288	1	1	RIMEL, BOBBIE J MD	10/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117844	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
249677	Fee-for-Service	1811459043	1811459043	1	1	REZAC, KARI DO	9/16/2024	2081S0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	21020	25	Physical Medicine and Rehabilitation	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
249686	Fee-for-Service	1033563853	1033563853	1	1	RUSSO, KEVIN MD	8/17/2021	207L00000X	NA	Other	026	PHYSICIANS	164846	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
249702	Fee-for-Service	1477577625	1477577625	1	1	REICHERT, ANDREW D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING	None	TUCSON	WA	98405	0000	00	None	47.25960844	-122.4534238	Pierce County
249708	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
249711	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
249714	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
249740	Fee-for-Service	1457892747	1457892747	1	1	ROMIE LANE PHARMACY INC	7/25/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1273 S MAIN ST	None	SALINAS	CA	93901	2185	27	06053	36.65686267	-121.6597154	Monterey County
249815	Fee-for-Service	1124065289	1124065289	1	1	ROUZIER, ROBERT N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35623	08	Family Practice	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
249823	Fee-for-Service	1912325820	1912325820	1	1	RILEY, NATHAN M MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139285	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
249834	Fee-for-Service	1841294758	1841294758	1	1	R. BRAD STAMM	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 S PACHECO ST	None	SANTA FE	NM	87505	3997	00	None	35.65548694	-105.9585291	Santa Fe County
249836	Fee-for-Service	1013578939	1013578939	1	1	RYAN WANG MD A PROFESSIONAL	7/23/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	CORPORATION	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
249840	Fee-for-Service	1568003366	1568003366	1	1	REGAL HOSPICE AND PALLIATIVE	2/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	3430 OCEAN VIEW BLVD	SUITE B	GLENDALE	CA	91208	1598	19	06037	34.20135989	-118.2282592	Los Angeles County
249846	Fee-for-Service	1538363585	1538363585	1	1	RALPHS GROCERY COMPANY	8/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #100	7257 W SUNSET BLVD	None	HOLLYWOOD	CA	90046	3409	19	06037	34.09803149	-118.3484295	Los Angeles County
249849	Fee-for-Service	1487277901	1487277901	1	1	RHYTHMSCIENCE INC.	10/14/2020	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	81 LANGTON ST	UNIT 6	SAN FRANCISCO	CA	94103	3958	38	06075	37.77652161	-122.4086028	San Francisco County
249882	Fee-for-Service	1710910047	1710910047	1	1	RAYHANABAD, SIMON B MD	11/29/1990	2086S0129X	NA	General Surgery	026	PHYSICIANS	36844	02	General Surgery	0	In state provider	None	3300 E SOUTH ST	STE 303	LONG BEACH	CA	90805	4594	19	06037	33.86018093	-118.1537163	Los Angeles County
249911	Fee-for-Service	1942295381	1942295381	1	1	REGIER, BRENDA J MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85561	41	Internal Medicine	0	In state provider	None	2200 CLOVIS AVE	None	CLOVIS	CA	93612	3915	10	06019	36.80635198	-119.7004625	Fresno County
249930	Fee-for-Service	1710472634	1710472634	1	1	RICHARDSON, CORTNEY B LCSW	9/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 HAMILTON AVE.	None	PALO ALTO	CA	94301	2011	43	06085	37.44781256	-122.1575839	Santa Clara County
249933	Fee-for-Service	1346295870	1346295870	1	1	ROSEN, LEE S MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49741	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90045	5632	19	06037	34.06527974	-118.4462792	Los Angeles County
249936	Fee-for-Service	1821263625	1821263625	1	1	REDWOOD RURAL HEALTH CTR	5/10/1989	261QX0200X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PO BOX 769	100 WESTCOAST RD	None	REDWAY	CA	95560	0000	12	06023	40.11763702	-123.8131682	Humboldt County
249947	Fee-for-Service	1083792220	1083792220	1	1	RHOTEN, REX L MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62823	14	Neurological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249957	Fee-for-Service	1033341730	1033341730	1	1	RHEE, MICHELLE S MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102980	08	Family Practice	0	In state provider	None	805 VETERANS BLVD	None	REDWOOD CITY	CA	94063	1734	41	06081	37.49076853	-122.2291439	San Mateo County
249989	Fee-for-Service	1205813474	1205813474	1	1	RUSTY A MOORE DO	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	544 S 400 E	None	ST GEORGE	UT	84770	3705	00	None	37.09902122	-113.5748483	Washington County
249995	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
250000	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
250005	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
250015	Fee-for-Service	1235559972	1235559972	1	1	REYNOLDS, COURTNEY A MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140244	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
250032	Fee-for-Service	1760402614	1760402614	1	1	RATLIFF, JOHN K MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54726	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250035	Fee-for-Service	1588742076	1588742076	1	1	REDDI, SRIDHAR MD	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77359	30	Radiology	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
250038	Fee-for-Service	1861827636	1861827636	1	1	REED, KURTIS B CRNA	1/17/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	110 N LA BREA AVENUE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
250044	Fee-for-Service	1013233550	1013233550	1	1	ROLLER, CAROLYN L LMFT	12/19/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	180-C EAST LELAND RD	None	PITTSBURGH	CA	94565	4949	07	06013	38.01163475	-121.8891333	Contra Costa County
250084	Fee-for-Service	1518967330	1518967330	1	1	RUIZ, GERALD T MD	3/31/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69184	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
250098	Fee-for-Service	1255157608	1255157608	1	1	RODRIGUEZ, RILEIGH OT	2/19/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
250104	Fee-for-Service	1124065289	1124065289	1	1	ROUZIER, ROBERT N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
250115	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
250122	Fee-for-Service	1750389482	1750389482	1	1	RANDOLPH, JOHN F MD	5/1/1991	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	48108	08	Family Practice	0	In state provider	None	399 E HIGHLAND AVE	STE 110	SAN BERNARDINO	CA	92404	3842	36	06071	34.1358627	-117.2757898	San Bernardino County
250136	Fee-for-Service	1154355311	1154355311	1	1	REIL, TODD D MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64977	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
250178	Fee-for-Service	1285886978	1285886978	1	1	REYES, ROSEL LIZA D MD	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108996	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
250227	Fee-for-Service	1346295870	1346295870	1	1	ROSEN, LEE S MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49741	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90045	5632	19	06037	34.06527974	-118.4462792	Los Angeles County
250252	Fee-for-Service	1891718326	1891718326	1	1	ROSELINSKY, HOWARD J MD	7/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83325	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
250267	Fee-for-Service	1275192957	1275192957	1	1	RAHMAN, MAHABUB MD	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	189695	41	Internal Medicine	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
250271	Fee-for-Service	1174566863	1174566863	1	1	ROSENBERG, MURRAY M MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
250281	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	1/28/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
250288	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
250291	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
250317	Fee-for-Service	1235302159	1235302159	1	1	RODRIGUEZ, MICHAEL J MD	11/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105867	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
250350	Fee-for-Service	1659395754	1659395754	1	1	RIZVI, SYED A MD	1/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	36388	41	Internal Medicine	0	In state provider	None	1641 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1137	19	06037	34.04914628	-117.9455606	Los Angeles County
250394	Fee-for-Service	1326068511	1326068511	1	1	ROSS, STEPHEN C MD	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37284	08	Family Practice	0	In state provider	None	1304 15TH ST	STE 400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
250401	Fee-for-Service	1972621654	1972621654	1	1	RYDMAN, MICHAEL LMFT	3/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3300 TULLY RD	B6	MODESTO	CA	95350	0848	50	06099	37.68597355	-121.012414	Stanislaus County
250409	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	1/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
250415	Fee-for-Service	1750389482	1750389482	1	1	RANDOLPH, JOHN F MD	5/1/1991	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	48108	38	Geriatrics	0	In state provider	None	399 E HIGHLAND AVE	STE 110	SAN BERNARDINO	CA	92404	3842	36	06071	34.1358627	-117.2757898	San Bernardino County
250424	Fee-for-Service	1346537859	1346537859	1	1	RECALDE, DANIEL E DPM	5/10/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11100 WARNER AVE	SUITE 306	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
250436	Fee-for-Service	1568701738	1568701738	1	2	REINKING, JASON W MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124450	01	General Practice	0	In state provider	None	9925 ITERNATIONAL BLVD	STE 5	OAKLAND	CA	94603	2558	01	06001	37.74332565	-122.1698542	Alameda County
250491	Fee-for-Service	1255427365	1255427365	1	1	REIFF, ANDREAS O MD	11/30/1996	2080P0216X	NA	Other	026	PHYSICIANS	63957	83	Rheumatology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
250511	Fee-for-Service	1346295870	1346295870	1	1	ROSEN, LEE S MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49741	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90045	5632	19	06037	34.06527974	-118.4462792	Los Angeles County
250514	Fee-for-Service	1588635288	1588635288	1	1	RACEK, EDWARD L MD INC	2/8/2015	2080P0204X	NA	Other	026	PHYSICIANS	34996	02	General Surgery	0	In state provider	None	750 MEDICAL CENTER CT	STE 5	CHULA VISTA	CA	91911	6634	37	06073	32.61830281	-117.0237339	San Diego County
250536	Fee-for-Service	1790830875	1790830875	1	1	RABENA-AMEN, ALICIA K	5/23/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
250571	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	1/28/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
250575	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
250579	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
250581	Fee-for-Service	1467006726	1467006726	1	1	RIZALLA, VERONICA LMFT	11/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
250593	Fee-for-Service	1174814214	1174814214	1	1	RAMAN, BHARGAV MD	4/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122783	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
250627	Fee-for-Service	1043255730	1043255730	1	1	RUXIN, ROBERT J MD	4/12/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81002	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
250637	Fee-for-Service	1659395754	1659395754	1	1	RIZVI, SYED A MD	1/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	36388	45	Nephrology (Renal-Kidney)	0	In state provider	None	1641 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1137	19	06037	34.04914628	-117.9455606	Los Angeles County
250695	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
250721	Fee-for-Service	1568701738	1568701738	1	2	REINKING, JASON W MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124450	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9925 ITERNATIONAL BLVD	STE 5	OAKLAND	CA	94603	2558	01	06001	37.74332565	-122.1698542	Alameda County
250783	Fee-for-Service	1316260540	1316260540	1	1	RYU, ROBERT C MD	3/16/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161890	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
250817	Fee-for-Service	1003910647	1003910647	1	1	ROTHMAN, MICOL S MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
250831	Fee-for-Service	1699725440	1699725440	1	1	RAMAKRISHNAN, SAMPATH K	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73586	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
250856	Fee-for-Service	1134103906	1134103906	1	1	RAFII, AMIR A MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82858	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
250858	Fee-for-Service	1710287297	1710287297	1	54	REGENTS UNIVERSITY OF CALIFO	4/28/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	11980 SAN VICENTE BLVD.	102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
250862	Fee-for-Service	1710287297	1710287297	1	117	REGENTS UNIVERSITY OF CALIFO	11/24/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	24302 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	3115	30	06059	33.60911692	-117.7122444	Orange County
250864	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	6/9/2020	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
250881	Fee-for-Service	1033246681	1033246681	1	1	RSCR CALIFORNIA, INC	10/25/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	988 THE PIKE	None	ARROYO GRANDE	CA	93420	4206	40	06079	35.10640343	-120.5939685	San Luis Obispo County
250888	Fee-for-Service	1558355594	1558355594	1	1	RYDER, JENNIFER B MD	2/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87659	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
250926	Fee-for-Service	1275595019	1275595019	1	1	RHOW, JEAN HYON MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66451	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
250977	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
251015	Fee-for-Service	1356377162	1356377162	1	1	RAO, SURESH MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39156	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	14860 ROSCOE BLVD	STE 200	PANORAMA CITY	CA	91402	4665	19	06037	34.2214515	-118.4573205	Los Angeles County
251029	Fee-for-Service	1114997889	1114997889	1	1	RASHID, BONNIE M MD	4/29/2020	208M00000X	NA	Other	026	PHYSICIANS	160193	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
251050	Fee-for-Service	1588659528	1588659528	1	1	RHODE ISLAND HOSPITAL	5/1/1998	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	593 EDDY ST	None	PROVIDENCE	RI	02903	4923	00	None	41.81122992	-71.40713931	Providence County
251074	Fee-for-Service	1043412448	1043412448	1	1	RUBINSKY, STEVEN N MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92038	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
251085	Fee-for-Service	1730388463	1730388463	1	1	RASTEGARI, KEYKHOSROW MD	12/3/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	81428	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
251104	Fee-for-Service	1639843444	1639843444	1	1	ROBERTSON, JABARRI J NP	8/6/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
251106	Fee-for-Service	1003910647	1003910647	1	1	ROTHMAN, MICOL S MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
251144	Fee-for-Service	1316003304	1316003304	1	1	RANCHOD, TUSHAR M MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113274	None	None	0	In state provider	None	122 LA CASA VIA	STE 223	WALNUT CREEK	CA	94598	3014	07	06013	37.91198028	-122.041845	Contra Costa County
251146	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
251152	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
251153	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
251156	Fee-for-Service	1922441898	1922441898	1	1	RAHVAR, MARAL MD	5/31/2022	207ND0900X	NA	Dermatology	026	PHYSICIANS	138294	None	None	0	In state provider	None	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	15	06029	35.356203	-119.0612695	Kern County
251187	Fee-for-Service	1609893338	1609893338	1	1	ROTHLISBERGER, BRIAN W	7/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92549	18	Ophthalmology	0	In state provider	None	1830 SIERRA GARDENS DR	STE 100	ROSEVILLE	CA	95661	2942	31	06061	38.7469982	-121.2600775	Placer County
251198	Fee-for-Service	1962426304	1962426304	1	1	RUNDLE, KEITH V MD INC	6/1/2000	193400000X	NA	Other	026	PHYSICIANS	79729	18	Ophthalmology	0	In state provider	None	1031 W CHAPMAN AVE	STE 203	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
251217	Fee-for-Service	1295727535	1295727535	1	1	RICHARD JOHN MAUNDER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
251232	Fee-for-Service	1245337344	1245337344	1	1	RATLEY, MARK L MD	7/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83628	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
251273	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
251292	Fee-for-Service	1477840643	1477840643	1	1	ROJAS PAEZ, SANTIAGO MD	12/5/2021	207L00000X	NA	Other	026	PHYSICIANS	134935	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
251299	Fee-for-Service	1528104999	1528104999	1	1	REZNIK, JACOB MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101891	18	Ophthalmology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
251301	Fee-for-Service	1356377162	1356377162	1	1	RAO, SURESH MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39156	41	Internal Medicine	0	In state provider	None	14860 ROSCOE BLVD	STE 200	PANORAMA CITY	CA	91402	4665	19	06037	34.2214515	-118.4573205	Los Angeles County
251339	Fee-for-Service	1912137951	1912137951	1	1	REID, MICHAEL J A MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130942	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251341	Fee-for-Service	1588659528	1588659528	1	1	RHODE ISLAND HOSPITAL	5/1/1998	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	593 EDDY ST	None	PROVIDENCE	RI	02903	4923	00	None	41.81122992	-71.40713931	Providence County
251343	Fee-for-Service	1174056451	1174056451	1	1	ROSENBERG, BRIAN J MD	8/23/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
251356	Fee-for-Service	1043327927	1043327927	1	1	ROGER RODBY MD	9/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1426 W WASHINGTON BLVD	None	CHICAGO	IL	60607	1821	00	None	41.88290348	-87.663744	Cook County
251394	Fee-for-Service	1366564486	1366564486	1	1	RAPHAEL, DAVID H MD	12/31/1995	208600000X	NA	General Surgery	026	PHYSICIANS	83268	02	General Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
251426	Fee-for-Service	1245367275	1245367275	1	1	REGHITTO, MICHAEL R MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
251431	Fee-for-Service	1124439807	1124439807	1	8	REGENTS UNIV OF CALIFORNIA U	11/1/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1240 SOUTH ELISEO DRIVE	SUITE 101	GREENBRAE	CA	94904	2028	21	06041	37.94422763	-122.5361926	Marin County
251435	Fee-for-Service	1710287297	1710287297	1	18	REGENTS UNIVERSITY OF CALIFO	1/28/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
251438	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	10/3/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
251440	Fee-for-Service	1710287297	1710287297	1	15	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
251465	Fee-for-Service	1700802709	1700802709	1	1	RAUF, KHALID MD	4/1/1998	207R00000X	NA	Other	026	PHYSICIANS	63120	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
251495	Fee-for-Service	1417910886	1417910886	1	1	RIVERWALK PEDIATRIC CLIN	11/10/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	9508 STOCKDALE HWY	STE 150	BAKERSFIELD	CA	93311	3623	15	06029	35.35453237	-119.1086014	Kern County
251504	Fee-for-Service	1730125980	1730125980	1	1	RASKIN, STEPHEN MD	5/25/1979	174400000X	NA	Other	026	PHYSICIANS	30547	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
251538	Fee-for-Service	1932757374	1932757374	1	1	ROSEWITZ, ROGER NP	10/28/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
251541	Fee-for-Service	1790927572	1790927572	1	1	RAJENDREN, MEENA MD	3/30/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	118131	36	Psychiatry	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
251542	Fee-for-Service	1407947435	1407947435	1	1	ROGOWSKI, CATHY MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84850	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6699	37	06073	32.61822301	-117.0234938	San Diego County
251551	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	1/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
251569	Fee-for-Service	1558774265	1558774265	1	1	RENNIX, NICOLE L LMFT	6/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1606 MAIN ST	STE 200	NAPA	CA	94559	1854	28	06055	38.30352566	-122.288961	Napa County
251599	Fee-for-Service	1861657595	1861657595	1	1	RUEGNER, RAWNICA L MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97595	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
251606	Fee-for-Service	1720296924	1720296924	1	1	ROYO, LEONELLEN R LAC	11/10/2014	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
251627	Fee-for-Service	1912137951	1912137951	1	1	REID, MICHAEL J A MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130942	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251632	Fee-for-Service	1174056451	1174056451	1	1	ROSENBERG, BRIAN J MD	8/23/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
251643	Fee-for-Service	1497161269	1497161269	1	1	RATANAPRASATPORN, LINDA MD	4/22/2019	282N00000X	NA	Hospitals	026	PHYSICIANS	159456	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
251659	Fee-for-Service	1437131950	1437131950	1	1	RAMSAHAI, KAREN MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54982	01	General Practice	0	In state provider	None	5TH ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.74133607	-121.8503698	Butte County
251704	Fee-for-Service	1912062811	1912062811	1	1	RALIK, ELENA MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66778	41	Internal Medicine	0	In state provider	None	5810 JAMESON CT	None	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
251718	Fee-for-Service	1124439807	1124439807	1	8	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1240 SOUTH ELISEO DRIVE	SUITE 101	GREENBRAE	CA	94904	2028	21	06041	37.94422763	-122.5361926	Marin County
251729	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	4/22/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
251749	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
251750	Fee-for-Service	1285759514	1285759514	1	1	ROSTAMLOO, HELEN R MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99811	41	Internal Medicine	0	In state provider	None	445 W BROADWAY	None	GLENDALE	CA	91204	1208	19	06037	34.14684551	-118.2633525	Los Angeles County
251753	Fee-for-Service	1700802709	1700802709	1	1	RAUF, KHALID MD	4/1/1998	207R00000X	NA	Other	026	PHYSICIANS	63120	41	Internal Medicine	0	In state provider	None	120 WILGART WAY	None	SALINAS	CA	93901	4013	27	06053	36.65913359	-121.6477266	Monterey County
251765	Fee-for-Service	1811382963	1811382963	1	1	ROHLFING, GEOFFREY DO	8/26/2021	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	15259	None	None	0	In state provider	None	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	10	06019	36.83939464	-119.6661479	Fresno County
251781	Fee-for-Service	1588993927	1588993927	1	1	ROMERO, WHITNEY L	2/17/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251834	Fee-for-Service	1013950724	1013950724	1	1	R & C CORPORATION	5/10/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PURITAN MED EQUIP & SUPP	1728 BONNIE COVE AVE	None	GLENDORA	CA	91740	6016	19	06037	34.108362	-117.8550545	Los Angeles County
251856	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
251870	Fee-for-Service	1811481765	1811481765	1	1	RED CROSS HOSPICE INC	6/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8817 RESEDA BLVD	UNIT D	NORTHRIDGE	CA	91324	5365	19	06037	34.231266	-118.536117	Los Angeles County
251896	Fee-for-Service	1306513130	1306513130	1	1	RILEY, JESSIE	9/28/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAK PL	STE 8 & 9	AUBURN	CA	95603	2458	31	06061	38.94059662	-121.0995593	Placer County
251943	Fee-for-Service	1174211072	1174211072	1	1	ROSCOE CARE CENTER LLC	6/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14857 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4617	19	06037	34.22150352	-118.4571405	Los Angeles County
251948	Fee-for-Service	1073697322	1073697322	1	1	RUST, GARY A MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84324	04	Otology, Laryngology, Rhinology	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
251976	Fee-for-Service	1861593006	1861593006	1	1	ROSE, MICHAEL R MD	9/30/1982	174400000X	NA	Other	026	PHYSICIANS	33914	02	General Surgery	0	In state provider	None	3325 N BROADWAY	None	LOS ANGELES	CA	90031	2803	19	06037	34.07380397	-118.20586	Los Angeles County
251977	Fee-for-Service	1407118938	1407118938	1	1	RAMELLI, APRIL M MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127551	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251989	Fee-for-Service	1730262726	1730262726	1	1	ROBERT JOHNSON	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 S AUBURN ST	None	KENNEWICK	WA	99336	5621	00	None	46.19896647	-119.11855	Benton County
252005	Fee-for-Service	1124439807	1124439807	1	8	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1240 SOUTH ELISEO DRIVE	SUITE 101	GREENBRAE	CA	94904	2028	21	06041	37.94422763	-122.5361926	Marin County
252019	Fee-for-Service	1710287297	1710287297	1	100	REGENTS UNIVERSITY OF CALIFO	1/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
252026	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
252035	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
252069	Fee-for-Service	1104303866	1104303866	1	1	RANABHAT, KUSHAL MD	10/12/2021	207R00000X	NA	Other	026	PHYSICIANS	174297	None	None	0	In state provider	None	400 OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
252090	Fee-for-Service	1144200775	1144200775	1	1	REGENTS OF THE UNIVERSITY OF	1/11/2023	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
252091	Fee-for-Service	1417270109	1417270109	1	1	ROBLES, ENEDINA A LCSW	12/30/2015	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
252098	Fee-for-Service	1447316344	1447316344	1	1	RICHLAND SCHOOL DISTRICT	7/1/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	331 SHAFTER AVE	None	SHAFTER	CA	93263	1967	15	06029	35.50408126	-119.2783014	Kern County
252104	Fee-for-Service	1932832623	1932832623	1	1	RIVERA, MARK ANTHONY PT	7/18/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 HILBORN RD.	None	FAIRFIELD	CA	94534	1097	48	06095	38.27621282	-122.0523491	Solano County
252112	Fee-for-Service	1710287297	1710287297	1	129	REGENTS UNIVERSITY OF CALIFO	1/13/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	7230 MEDICAL CENTER DR	604	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
252137	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	12/9/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
252158	Fee-for-Service	1811481765	1811481765	1	1	RED CROSS HOSPICE INC	6/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8817 RESEDA BLVD	UNIT D	NORTHRIDGE	CA	91324	5365	19	06037	34.231266	-118.536117	Los Angeles County
252171	Fee-for-Service	1700053691	1700053691	1	1	RAMZY SAMI NAKAD M.D.	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
252184	Fee-for-Service	1407015266	1407015266	1	1	REDDY, KAVITHA K MD	3/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121263	07	Dermatology	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
252223	Fee-for-Service	1225221641	1225221641	1	1	RODRIGUEZ, LIDIA	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94807	38	Geriatrics	0	In state provider	P MD	847 W CHILDS AVE	None	MERCED	CA	95341	0000	24	06047	37.28825369	-120.4963159	Merced County
252245	Fee-for-Service	1396824546	1396824546	1	1	RYAN, GORDON A MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145619	41	Internal Medicine	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
252267	Fee-for-Service	1861593006	1861593006	1	1	ROSE, MICHAEL R MD	9/30/1982	174400000X	NA	Other	026	PHYSICIANS	33914	18	Ophthalmology	0	In state provider	None	3325 N BROADWAY	None	LOS ANGELES	CA	90031	2803	19	06037	34.07380397	-118.20586	Los Angeles County
252290	Fee-for-Service	1619992823	1619992823	1	1	ROSE, DONALD D	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	6476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
252302	Fee-for-Service	1710287297	1710287297	1	122	REGENTS UNIVERSITY OF CALIFO	4/7/2025	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RNIA	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
252305	Fee-for-Service	1396807426	1396807426	1	1	RACKLIN, JOSEPH M PHD	5/11/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
252314	Fee-for-Service	1578690905	1578690905	1	1	REDDY, VISHNUKRUPA P MD	12/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112346	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
252315	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	12/9/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
252324	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
252348	Fee-for-Service	1417376740	1417376740	1	1	RINGSTED, SARAH K MD	8/28/2020	207RR0500X	NA	Other	026	PHYSICIANS	139874	83	Rheumatology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
252361	Fee-for-Service	1174108450	1174108450	1	1	ROBINSON, MICHELLE E NP	3/25/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252367	Fee-for-Service	1659639557	1659639557	1	1	RYAN D MOORE	9/26/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	890 OAK ST SE	None	SALEM	OR	97301	3905	00	None	44.932887	-123.0341175	Marion County
252380	Fee-for-Service	1144200775	1144200775	1	1	REGENTS OF THE UNIVERSITY OF	8/25/2021	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
252382	Fee-for-Service	1114287497	1114287497	1	1	RAD, SHERVIN F MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135003	None	None	0	In state provider	None	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
252391	Fee-for-Service	1174615611	1174615611	1	1	RIGGS, MICHELE PSYD	10/28/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
252402	Fee-for-Service	1710287297	1710287297	1	129	REGENTS UNIVERSITY OF CALIFO	1/13/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	7230 MEDICAL CENTER DR	604	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
252430	Fee-for-Service	1710287297	1710287297	1	26	REGENTS UNIVERSITY OF CALIFO	1/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
252464	Fee-for-Service	1215030879	1215030879	1	1	RAMSEUR, JAMES E JR MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52648	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	337 EL DORADO ST	STE A1	MONTEREY	CA	93940	4638	27	06053	36.59183357	-121.8924432	Monterey County
252472	Fee-for-Service	1780694646	1780694646	1	1	RIVIERA ALLERGY MEDICAL CENT	1/2/2024	207K00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ER	1970 S PROSPECT AVE	SUITE 3	REDONDO BEACH	CA	90277	6005	19	06037	33.81655778	-118.3768368	Los Angeles County
252474	Fee-for-Service	1770939456	1770939456	1	1	RODRIGUEZ, GEOFFREY H MD	8/4/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172076	None	None	0	In state provider	None	276 DOLORES AVE	None	SAN LEANDRO	CA	94577	4908	01	06001	37.72304518	-122.1521022	Alameda County
252512	Fee-for-Service	1760856975	1760856975	1	1	ROYAL CROWN HOME HEALTH	10/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	10999 RIVERSIDE DR	SUITE 104	STUDIO CITY	CA	91602	2239	19	06037	34.15230395	-118.3693888	Los Angeles County
252513	Fee-for-Service	1225221641	1225221641	1	1	RODRIGUEZ, LIDIA	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94807	41	Internal Medicine	0	In state provider	P MD	847 W CHILDS AVE	None	MERCED	CA	95341	0000	24	06047	37.28825369	-120.4963159	Merced County
252567	Fee-for-Service	1700954914	1700954914	1	1	ROSSMOOR MEDICAL ASSOCIATES	11/19/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1210 ROSSMOOR PARKWAY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87774537	-122.0710148	Contra Costa County
252592	Fee-for-Service	1417976366	1417976366	1	2	ROGET, VANCE R MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1325 SONOMA AVE	None	MODESTO	CA	95355	3922	50	06099	37.66250576	-120.9484554	Stanislaus County
252593	Fee-for-Service	1710287297	1710287297	1	122	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
252594	Fee-for-Service	1568515641	1568515641	1	1	ROSE, CARLEY M LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
252602	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
252612	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
252634	Fee-for-Service	1124439807	1124439807	1	22	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	75 ROWLAND WAY	SUITE 131	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
252638	Fee-for-Service	1417376740	1417376740	1	1	RINGSTED, SARAH K MD	8/28/2020	207RR0500X	NA	Other	026	PHYSICIANS	139874	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
252660	Fee-for-Service	1760449292	1760449292	1	1	RESNECK, JACK S JR MD	4/1/2001	207N00000X	NA	Dermatology	026	PHYSICIANS	66722	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
252662	Fee-for-Service	1699803213	1699803213	1	1	RIOS, RAQUEL LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
252665	Fee-for-Service	1144200775	1144200775	1	1	REGENTS OF THE UNIVERSITY OF	12/4/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
252684	Fee-for-Service	1902184922	1902184922	1	1	ROCHA, JULIANA R LCSW	9/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
252693	Fee-for-Service	1710287297	1710287297	1	129	REGENTS UNIVERSITY OF CALIFO	1/13/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	7230 MEDICAL CENTER DR	604	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
252749	Fee-for-Service	1689293516	1689293516	1	1	RANKIN, NICHOLAS MD	7/8/2023	207P00000X	NA	Other	026	PHYSICIANS	184477	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252757	Fee-for-Service	1336186394	1336186394	1	1	RIVERSIDE HEALTHCARE SYS	5/1/1997	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE COMMUNITY HOSP	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
252800	Fee-for-Service	1871813261	1871813261	1	1	REN, QIANFANG MD A	6/21/2010	207L00000X	NA	Other	026	PHYSICIANS	100838	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
252801	Fee-for-Service	1003319104	1003319104	1	1	REGUEIRO, VERONICA PSYD	4/16/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
252807	Fee-for-Service	1043751506	1043751506	1	1	ROSSPENCER, EMELLY LMFT	3/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 E REDLANDS BLVD	STE 246	REDLANDS	CA	92373	4775	36	06071	34.05731952	-117.181197	San Bernardino County
252810	Fee-for-Service	1386636074	1386636074	1	1	ROCCO, VITO K MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52012	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
252844	Fee-for-Service	1477710069	1477710069	1	1	RAJU, PRAVEEN B MD	3/13/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
252875	Fee-for-Service	1730284290	1730284290	1	1	REESE, JEFFREY H MD	11/30/1986	208800000X	NA	Other	026	PHYSICIANS	40319	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
252886	Fee-for-Service	1164681789	1164681789	1	1	REBER, BRADLEY D MD	7/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108015	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
252891	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
252896	Fee-for-Service	1861849077	1861849077	1	2	RESTORE MEDICAL INC.	1/21/2022	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3125 COFFEE RD	SUITE 2	MODESTO	CA	95355	1768	50	06099	37.68354805	-120.9760392	Stanislaus County
252898	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
252907	Fee-for-Service	1902816135	1902816135	1	1	REYES, MICHELLE E MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78285	18	Ophthalmology	0	In state provider	None	23101 SHERMAN PL	STE 304	WEST HILLS	CA	91307	2022	19	06037	34.20099112	-118.6297991	Los Angeles County
252924	Fee-for-Service	1124439807	1124439807	1	22	REGENTS UNIV OF CALIFORNIA U	2/6/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	SUITE 131	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
252929	Fee-for-Service	1497842900	1497842900	1	1	ROSTEK, BARRY DO	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	4841	40	Pediatrics	0	In state provider	None	1540 5TH AVE	None	SAN RAFAEL	CA	94901	1807	21	06041	37.97487644	-122.5351838	Marin County
252955	Fee-for-Service	1144200775	1144200775	1	1	REGENTS OF THE UNIVERSITY OF	4/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
252960	Fee-for-Service	1629118609	1629118609	1	1	ROCKFORD MEMORIAL HOSP	5/15/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2400 N ROCKTON AVE	None	ROCKFORD	IL	61103	3655	00	None	42.29890121	-89.09680826	Winnebago County
253020	Fee-for-Service	1225172398	1225172398	1	1	REDLANDS COMMUNITY HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
253043	Fee-for-Service	1952457087	1952457087	1	1	ROTH, STEVEN J MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	87049	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
253082	Fee-for-Service	1790217990	1790217990	1	1	ROMO, MELISSA L LMFT	10/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
253093	Fee-for-Service	1386636074	1386636074	1	1	ROCCO, VITO K MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52012	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
253112	Fee-for-Service	1083792188	1083792188	1	1	RILEY-PAULL, KARA L MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	69498	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
253129	Fee-for-Service	1437283553	1437283553	1	1	RIGBY, ROHN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 PIONEER PKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
253148	Fee-for-Service	1578160255	1578160255	1	1	RANDOLPH, SAMUEL L LMFT	2/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1945 PALO VERDE AVE	STE 203	LONG BEACH	CA	90815	3445	19	06037	33.791634	-118.1080175	Los Angeles County
253161	Fee-for-Service	1629359856	1629359856	2	2	RSS PHARMACY ASSOCIATES LLC	7/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	223 E THIRD ST	None	CORONA	CA	92879	1438	33	06065	33.87832551	-117.5643419	Riverside County
253174	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
253178	Fee-for-Service	1154506939	1154506939	1	1	RAMJIT, RUAN T MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121749	22	Pathology (M.D. only)	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
253181	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
253183	Fee-for-Service	1861849077	1861849077	1	2	RESTORE MEDICAL INC.	1/21/2022	335E00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3125 COFFEE RD	SUITE 2	MODESTO	CA	95355	1768	50	06099	37.68354805	-120.9760392	Stanislaus County
253184	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
253188	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
253191	Fee-for-Service	1629286943	1629286943	1	1	RABOW, VICTORIA E PHD	6/6/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23945 CALABASAS RD	#202	CALABASAS	CA	91302	1552	19	06037	34.15340482	-118.6490978	Los Angeles County
253205	Fee-for-Service	1629056460	1629056460	1	1	RAGURAM, PARTHASSARATHY MD	12/5/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	151 N SUNRISE AVE	STE 1205	ROSEVILLE	CA	95661	2926	31	06061	38.74746043	-121.2655348	Placer County
253208	Fee-for-Service	1124439807	1124439807	1	22	REGENTS UNIV OF CALIFORNIA U	7/3/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	75 ROWLAND WAY	SUITE 131	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
253226	Fee-for-Service	1558381145	1558381145	1	2	RASKIND, HARVEY S MD	10/13/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	21569	-	NOT APPLICABLE	0	In state provider	None	2055 SAVIERS ROAD	SUITE A	OXNARD	CA	93033	3608	56	06111	34.179219	-119.1776065	Ventura County
253233	Fee-for-Service	1316963515	1316963515	1	1	RANADE, SMITA S MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81120	40	Pediatrics	0	In state provider	None	1744 UNIVERSITY AVE	STE 100	RIVERSIDE	CA	92507	5364	33	06065	33.97556048	-117.349443	Riverside County
253247	Fee-for-Service	1629118609	1629118609	1	1	ROCKFORD MEMORIAL HOSP	5/15/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2400 N ROCKTON AVE	None	ROCKFORD	IL	61103	3655	00	None	42.29890121	-89.09680826	Winnebago County
253257	Fee-for-Service	1821550245	1821550245	1	1	RASUL, FAHIM DO	8/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21330	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
253309	Fee-for-Service	1225172398	1225172398	1	1	REDLANDS COMMUNITY HOSPITAL	1/25/1988	282N00000X	NA	Hospitals	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
253320	Fee-for-Service	1881050888	1881050888	1	1	RA, JOSHUA MD	6/30/2022	208M00000X	NA	Other	026	PHYSICIANS	177026	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253339	Fee-for-Service	1285960872	1285960872	1	1	RASTOGI, ANISHA	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115969	None	None	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
253372	Fee-for-Service	1942348016	1942348016	1	1	RADIATION ONCOLOGY	1/1/2000	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ALLIANCE MED GROUP INC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
253390	Fee-for-Service	1508301854	1508301854	1	1	RIZK, MICHAEL K NP	11/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
253438	Fee-for-Service	1558409797	1558409797	1	1	RODGERS, NATASHA A MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91406	40	Pediatrics	0	In state provider	None	27555 YNEZ RD	# 370	TEMECULA	CA	92591	4678	33	06065	33.50370608	-117.1492569	Riverside County
253458	Fee-for-Service	1780652073	1780652073	1	1	REDDY, RADHA T MD	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89463	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
253461	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
253462	Fee-for-Service	1972839470	1972839470	1	1	RETHERFORD, LANCE M MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112130	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
253467	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
253471	Fee-for-Service	1699780155	1699780155	1	1	RUPP, FREDERICK	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
253472	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
253474	Fee-for-Service	1861952491	1861952491	1	1	RIETBERG, NATHAN T MD	6/1/2023	207L00000X	NA	Other	026	PHYSICIANS	186243	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
253475	Fee-for-Service	1710287297	1710287297	1	11	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
253481	Fee-for-Service	1184171720	1184171720	1	1	RIVERA, MELISSA N LMFT	6/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
253494	Fee-for-Service	1811996507	1811996507	1	1	ROSEPARK HEALTHCARE	7/1/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES,INC	4029 E ANAHEIM ST	None	LONG BEACH	CA	90804	4110	19	06037	33.78262552	-118.144818	Los Angeles County
253497	Fee-for-Service	1700312154	1700312154	1	1	RAMOS-RIVERA, MARIANA MD	10/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161580	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
253500	Fee-for-Service	1518282821	1518282821	1	1	RAVINDRAN, JAYALAKSHMI MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143731	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
253546	Fee-for-Service	1013970375	1013970375	2	1	REID, JOHN MD	2/27/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
253575	Fee-for-Service	1477207199	1477207199	1	1	ROCHA, LUCIMARA LMFT	7/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
253607	Fee-for-Service	1609834498	1609834498	1	1	RUSS, ISI J MD	3/26/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	37214	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
253610	Fee-for-Service	1780635607	1780635607	1	1	ROBERTS, DAVID K MD	3/31/1994	207R00000X	NA	Other	026	PHYSICIANS	70643	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
253619	Fee-for-Service	1629049853	1629049853	1	1	ROJAS, NEAL L MD	9/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79226	40	Pediatrics	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
253642	Fee-for-Service	1346284759	1346284759	1	1	ROBERT ARDEN VALICE M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1701 SOUTH BLVD EAST	STE 200	ROCHESTER HILLS	MI	48307	0000	00	None	42.62410126	-83.09607701	Oakland County
253660	Fee-for-Service	1942348016	1942348016	1	1	RADIATION ONCOLOGY	1/1/2000	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ALLIANCE MED GROUP INC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
253689	Fee-for-Service	1215430624	1215430624	1	1	RESILIENCE COUNSELING CENTER	7/1/2019	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	, LICENSED CLINICAL SOCI	2695 VISTA LAGUNA TER	None	PASADENA	CA	91103	1026	19	06037	34.19024303	-118.1679559	Los Angeles County
253693	Fee-for-Service	1134207913	1134207913	1	1	REISMAN, JEANNE MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42559	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
253737	Fee-for-Service	1225103641	1225103641	1	1	ROBERTS, RUTH A	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
253748	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
253756	Fee-for-Service	1710287297	1710287297	1	64	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
253759	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
253794	Fee-for-Service	1639113707	1639113707	1	1	ROBERT I GARVER JR.	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	822 S THREE NOTCH ST	None	ANDALUSIA	AL	36420	5310	00	None	31.29892847	-86.49345917	Covington County
253847	Fee-for-Service	1689197063	1689197063	1	1	ROREM, CARLY M LMFT	4/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
253921	Fee-for-Service	1750520821	1750520821	1	1	ROSENSTEIN, MELISSA G MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106674	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
253944	Fee-for-Service	1457341935	1457341935	1	1	ROOKS, VERONICA J MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154240	30	Radiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
253952	Fee-for-Service	1750489993	1750489993	1	1	ROTEN,LISA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDENS PHYS	801 SEVENTH AVENUE	None	FORT WORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
253978	Fee-for-Service	1215430624	1215430624	1	1	RESILIENCE COUNSELING CENTER	2/26/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	, LICENSED CLINICAL SOCI	2695 VISTA LAGUNA TER	None	PASADENA	CA	91103	1026	19	06037	34.19024303	-118.1679559	Los Angeles County
253987	Fee-for-Service	1285803940	1285803940	1	1	ROBINSON, MARK I MD INC	2/19/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
253995	Fee-for-Service	1013412717	1013412717	1	1	REISDORF, CARLI MD	6/1/2024	207P00000X	NA	Other	026	PHYSICIANS	166617	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
254009	Fee-for-Service	1851463723	1851463723	1	7	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	UP	200 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
254036	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	1/7/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
254049	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
254055	Fee-for-Service	1871814830	1871814830	1	1	REED-WILLIAMS, JASMINE JAZEL	1/9/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	J PSYD	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
254056	Fee-for-Service	1619311669	1619311669	1	1	RAMIREZ, VERONICA MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132943	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
254062	Fee-for-Service	1720083157	1720083157	1	1	REDWOOD PULMONARY	7/30/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL ASSOCIATES	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
254146	Fee-for-Service	1205253374	1205253374	1	1	REEDLEY COMMUNITY HOSPITAL	11/27/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	48677 VICTORIA LANE	None	OAKHURST	CA	93644	9216	20	06039	37.32772782	-119.6601883	Madera County
254151	Fee-for-Service	1730698846	1730698846	1	1	RAPOZO, OLIVIA NP	10/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
254177	Fee-for-Service	1144386418	1144386418	1	1	RALPHS GROCERY COMPANY	5/15/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS #016	670 S WESTERN AVE	None	LOS ANGELES	CA	90005	3024	19	06037	34.060041	-118.3090645	Los Angeles County
254185	Fee-for-Service	1083006712	1083006712	1	1	RIVERSIDE HEIGHTS HEALTHCARE	4/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	8951 GRANITE HILL DR	None	RIVERSIDE	CA	92509	1104	33	06065	34.02008839	-117.479631	Riverside County
254190	Fee-for-Service	1184939787	1184939787	1	1	RUHULLAH, YUSUF S MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128203	01	General Practice	0	In state provider	None	1111 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67881307	-121.7823992	Alameda County
254199	Fee-for-Service	1558381145	1558381145	1	1	RASKIND, HARVEY S MD	4/27/1999	207R00000X	NA	Other	026	PHYSICIANS	21569	08	Family Practice	0	In state provider	None	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
254237	Fee-for-Service	1962721118	1962721118	1	1	REEVE, ERIN L MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123362	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90018	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
254239	Fee-for-Service	1003853730	1003853730	1	1	ROSS, IAN B MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87566	14	Neurological Surgery	0	In state provider	None	630 SOUTH RAYMOND AVE	SUITE 330	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
254272	Fee-for-Service	1285803940	1285803940	1	1	ROBINSON, MARK I MD INC	2/19/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
254280	Fee-for-Service	1053498980	1053498980	1	1	RODRIGUEZ, NOAH MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90619	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
254288	Fee-for-Service	1073000980	1073000980	1	1	REYES, GRISELDA A MD	8/25/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166988	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
254289	Fee-for-Service	1972522506	1972522506	1	1	RASTLE, THOMAS E MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	27137	08	Family Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
254302	Fee-for-Service	1023179546	1023179546	1	2	RODRIGUEZ, MARIA E MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43620	None	None	0	In state provider	None	1530 E SOUTH ST	None	LONG BEACH	CA	90805	4341	19	06037	33.86011449	-118.173708	Los Angeles County
254305	Fee-for-Service	1245652585	1245652585	1	1	RENAE, NICOLE D LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
254318	Fee-for-Service	1043609035	1043609035	1	1	ROSA, ARIEL C MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143095	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
254324	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	10/22/2021	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
254336	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
254350	Fee-for-Service	1720083157	1720083157	1	1	REDWOOD PULMONARY	7/30/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL ASSOCIATES	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
254356	Fee-for-Service	1588227532	1588227532	1	1	RODDEN, GREGORY MD	7/13/2023	2080S0012X	NA	Other	026	PHYSICIANS	20864	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
254386	Fee-for-Service	1750728432	1750728432	1	1	RAGASA, REGINA B MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14365	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
254416	Fee-for-Service	1033201108	1033201108	1	1	RAO, MADHU N	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75428	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
254424	Fee-for-Service	1245215391	1245215391	1	1	REDDY, JOSEPH B MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	46472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6699 ALVARADO RD	STE 2301	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
254434	Fee-for-Service	1205253374	1205253374	1	1	REEDLEY COMMUNITY HOSPITAL	8/26/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	48677 VICTORIA LANE	None	OAKHURST	CA	93644	9216	20	06039	37.32772782	-119.6601883	Madera County
254439	Fee-for-Service	1932164530	1932164530	1	1	ROMINE, JOHN S MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35963	13	Neurology (M.D. only)	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
254478	Fee-for-Service	1417927054	1417927054	1	1	RAO, RAVI D MD	3/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53169	78	Neoplastic Diseases/Oncology	0	In state provider	None	7130 N MILLBROOK AVE	STE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
254487	Fee-for-Service	1558381145	1558381145	1	1	RASKIND, HARVEY S MD	4/27/1999	207R00000X	NA	Other	026	PHYSICIANS	21569	01	General Practice	0	In state provider	None	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
254511	Fee-for-Service	1396102943	1396102943	1	1	ROYAL PALMS POST ACUTE, LLC	1/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	630 W BROADWAY	None	GLENDALE	CA	91204	1008	19	06037	34.14676644	-118.2676202	Los Angeles County
254538	Fee-for-Service	1124519343	1124519343	1	1	REYNA, ARLENE E MD	9/9/2021	208M00000X	NA	Other	026	PHYSICIANS	165091	None	None	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
254548	Fee-for-Service	1144238510	1144238510	1	1	RAJAPURAM, GURUNATH MD	1/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51558	41	Internal Medicine	0	In state provider	None	3200 LONETREE WAY	None	ANTIOCH	CA	94509	5556	07	06013	37.98987084	-121.8077375	Contra Costa County
254561	Fee-for-Service	1669520052	1669520052	1	1	RIDDLE, TRACY H	11/23/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	107 MACINNIS	None	NAPA	CA	94558	3159	28	06055	38.31501134	-122.3223464	Napa County
254573	Fee-for-Service	1972522506	1972522506	1	1	RASTLE, THOMAS E MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	27137	01	General Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
254589	Fee-for-Service	1831567221	1831567221	1	1	ROMANO CORREA, MINERVA P MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
254590	Fee-for-Service	1740672708	1740672708	1	1	ROBINSON, SERGEI DO	12/3/2021	208M00000X	NA	Other	026	PHYSICIANS	18787	None	None	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
254591	Fee-for-Service	1871768200	1871768200	1	1	REDWOOD WOMENS CENTER PC	1/31/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3309 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239969	-124.1358904	Humboldt County
254593	Fee-for-Service	1730253337	1730253337	1	1	RANGA, RAJEEVA DO	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84050	41	Internal Medicine	0	In state provider	None	280 WEST MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
254602	Fee-for-Service	1568758548	1568758548	1	1	RYABETS-LIENHARD, ANNA DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11301	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
254611	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
254618	Fee-for-Service	1639173107	1639173107	1	1	ROCHA FAROOQ, MARLENE A	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	53701	01	General Practice	0	In state provider	None	4300 LONG BEACH BLVD	SUITE 410	LONG BEACH	CA	90807	2016	19	06037	33.83662572	-118.1900605	Los Angeles County
254619	Fee-for-Service	1831531870	1831531870	1	1	ROMERO-VELA, JENNIFER LCSW	10/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
254627	Fee-for-Service	1710287297	1710287297	1	63	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
254641	Fee-for-Service	1356366488	1356366488	2	1	RYU, RICHARD K MD	12/15/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	47160	None	None	0	In state provider	None	2936 DE LA VINA ST	BUILDING - FIRST AND SEC	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
254645	Fee-for-Service	1275748949	1275748949	1	1	RAI, BAROON MD	9/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129752	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 SULLIVAN AVE	STE 504	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
254684	Fee-for-Service	1598363335	1598363335	1	1	RJM DIAGNOSTICS LLC	2/7/2023	2279P1006X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1045 ATLANTIC AVE STE 61	616	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
254694	Fee-for-Service	1952715815	1952715815	1	1	RUIZ-CANGCO, MONICA DO	7/10/2017	390200000X	NA	Other	026	PHYSICIANS	14905	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
254714	Fee-for-Service	1245215391	1245215391	1	1	REDDY, JOSEPH B MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	46472	10	Gastroenterology (M.D. only)	0	In state provider	None	6699 ALVARADO RD	STE 2301	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
254722	Fee-for-Service	1205253374	1205253374	1	1	REEDLEY COMMUNITY HOSPITAL	8/26/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	48677 VICTORIA LANE	None	OAKHURST	CA	93644	9216	20	06039	37.32772782	-119.6601883	Madera County
254738	Fee-for-Service	1720179989	1720179989	1	1	RUIZ, ANGELICA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91832	40	Pediatrics	0	In state provider	None	3605 HOSPITAL RD	STE H	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
254767	Fee-for-Service	1417927054	1417927054	1	1	RAO, RAVI D MD	3/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53169	68	Hematology	0	In state provider	None	7130 N MILLBROOK AVE	STE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
254773	Fee-for-Service	1164780151	1164780151	1	1	ROBERTS, JORDAN A DO	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11940	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
254827	Fee-for-Service	1629089941	1629089941	1	1	RUDIN, GUY J MD	9/8/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	65200	20	Orthopedic Surgery	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
254838	Fee-for-Service	1144238510	1144238510	1	1	RAJAPURAM, GURUNATH MD	1/31/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51558	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3200 LONETREE WAY	None	ANTIOCH	CA	94509	5556	07	06013	37.98987084	-121.8077375	Contra Costa County
254878	Fee-for-Service	1871768200	1871768200	1	1	REDWOOD WOMENS CENTER PC	1/31/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3309 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239969	-124.1358904	Humboldt County
254889	Fee-for-Service	1568758548	1568758548	1	1	RYABETS-LIENHARD, ANNA DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11301	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
254902	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
254931	Fee-for-Service	1598843096	1598843096	1	1	RODGERS, BENNYE D JR MD	5/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71596	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
254934	Fee-for-Service	1275748949	1275748949	1	1	RAI, BAROON MD	9/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129752	45	Nephrology (Renal-Kidney)	0	In state provider	None	1800 SULLIVAN AVE	STE 504	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
254936	Fee-for-Service	1275031551	1275031551	1	1	RIVERA MAYORDOMO, HYACILLE K	7/5/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
254954	Fee-for-Service	1316041270	1316041270	1	1	RANJITH SHETTY M.D.	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
254956	Fee-for-Service	1821039025	1821039025	1	1	RYAN, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6200 W EMERALD	None	BOISE	ID	83704	0000	00	None	43.61196146	-116.2587475	Ada County
254982	Fee-for-Service	1407008261	1407008261	1	1	READY SET GO THERAPY, INC.	6/17/2021	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 GATE 5 RD	None	SAUSALITO	CA	94965	2805	21	06041	37.86963558	-122.5000199	Marin County
255003	Fee-for-Service	1700969235	1700969235	1	1	RIESS, WILLIAM F PHD	3/7/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2417 CARLETON ST	None	BERKELEY	CA	94704	3310	01	06001	37.86229264	-122.259327	Alameda County
255030	Fee-for-Service	1396752838	1396752838	1	1	ROBERT E KELLY JR	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
255089	Fee-for-Service	1821075383	1821075383	1	1	RASAMIMARI, PHORNPHAT MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
255132	Fee-for-Service	1093797649	1093797649	1	1	ROLF HULTSCH MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E THOMPSON PEAK PKW	None	SCOTTSDALE	AZ	85255	4109	00	None	33.670791	-111.921669	Maricopa County
255150	Fee-for-Service	1467567131	1467567131	2	1	RAOOF, TOORAJ MD	12/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42698	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	STE 340	ENCINO	CA	91436	2428	19	06037	34.15656164	-118.4849569	Los Angeles County
255166	Fee-for-Service	1871768200	1871768200	1	1	REDWOOD WOMENS CENTER PC	1/31/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3309 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239969	-124.1358904	Humboldt County
255187	Fee-for-Service	1407932676	1407932676	1	1	RUTHERFORD, MARY R MD	5/11/2004	207PE0004X	NA	Other	026	PHYSICIANS	43608	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
255190	Fee-for-Service	1710287297	1710287297	1	27	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
255194	Fee-for-Service	1063452779	1063452779	1	1	RAO, ROHIT P MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54276	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
255201	Fee-for-Service	1144211889	1144211889	1	1	ROSENBLUM, DALE M DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	704 N HARBOR BLVD	None	FULLERTON	CA	92832	1520	30	06059	33.87672293	-117.9243089	Orange County
255206	Fee-for-Service	1932466760	1932466760	1	1	REYES, ELIZABETH R MD A PC	1/10/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67305	40	Pediatrics	0	In state provider	None	301 W BASTANCHURY RD	STE 115	FULLERTON	CA	92835	3423	30	06059	33.89397383	-117.9316737	Orange County
255221	Fee-for-Service	1275748949	1275748949	1	1	RAI, BAROON MD	9/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129752	41	Internal Medicine	0	In state provider	None	1800 SULLIVAN AVE	STE 504	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
255234	Fee-for-Service	1427475599	1427475599	1	1	RUIZ, RAYMOND R N MD	4/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
255261	Fee-for-Service	1124439807	1124439807	1	20	REGENTS UNIV OF CALIFORNIA U	9/6/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5 BON AIR RD	SUITE 129	LARKSPUR	CA	94939	1143	21	06041	37.9438204	-122.5395357	Marin County
255281	Fee-for-Service	1093755563	1093755563	1	1	ROLLER, KATHERINE W MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62718	08	Family Practice	0	In state provider	None	100A SAN PABLO TOWN CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
255349	Fee-for-Service	1497850564	1497850564	1	1	RISING, CHRISTINA E MD	3/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63076	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
255350	Fee-for-Service	1942380787	1942380787	1	1	REY, ROBERTO MD	4/3/2023	208200000X	NA	General Surgery	026	PHYSICIANS	76688	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
255355	Fee-for-Service	1386934149	1386934149	1	1	RAZAL, XOCHITL M LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
255417	Fee-for-Service	1306824198	1306824198	1	1	REDDING CRITICAL CARE	8/1/1995	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1625 PINE STREET	SUITE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
255473	Fee-for-Service	1407932676	1407932676	1	1	RUTHERFORD, MARY R MD	5/11/2004	207PE0004X	NA	Other	026	PHYSICIANS	43608	66	Emergency Medicine (Urgent Care)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
255479	Fee-for-Service	1770987760	1770987760	1	1	RAHMAN-MAYET, SADAF LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
255511	Fee-for-Service	1316163462	1316163462	1	2	RATLIFF, MICHAEL JAY	8/6/2013	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5900 KING RD	STE 209	LOOMIS	CA	95650	7948	31	06061	38.82508947	-121.1958945	Placer County
255527	Fee-for-Service	1568755296	1568755296	1	1	ROSENBLUTH, JENNIFER M MD	12/2/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	173843	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255535	Fee-for-Service	1770625543	1770625543	1	1	RUCK, JERALD	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
255549	Fee-for-Service	1124439807	1124439807	1	20	REGENTS UNIV OF CALIFORNIA U	9/6/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5 BON AIR RD	SUITE 129	LARKSPUR	CA	94939	1143	21	06041	37.9438204	-122.5395357	Marin County
255567	Fee-for-Service	1093755563	1093755563	1	1	ROLLER, KATHERINE W MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62718	01	General Practice	0	In state provider	None	100A SAN PABLO TOWN CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
255589	Fee-for-Service	1891893020	1891893020	1	1	REBOLLEDO, MICHAEL A MD	3/16/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52896	40	Pediatrics	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
255633	Fee-for-Service	1679960157	1679960157	1	1	RAMBHATLA, ANUPAMA MD	2/24/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163854	None	None	0	In state provider	None	1000 TRANCAS ST	SUITE 1	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
255667	Fee-for-Service	1760515415	1760515415	1	1	RASHIDI, ROBERT N MD	3/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88757	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
255740	Fee-for-Service	1780789859	1780789859	1	1	ROMERO, LUKE L MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71023	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
255820	Fee-for-Service	1053338624	1053338624	1	1	ROSE, STEVEN C MD	6/30/1990	2085R0204X	NA	Other	026	PHYSICIANS	71241	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
255836	Fee-for-Service	1992830905	1992830905	1	1	REGENTS OF THE UNIVERSIT	2/15/2006	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL CNT	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
255839	Fee-for-Service	1124439807	1124439807	1	20	REGENTS UNIV OF CALIFORNIA U	2/6/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5 BON AIR RD	SUITE 129	LARKSPUR	CA	94939	1143	21	06041	37.9438204	-122.5395357	Marin County
255876	Fee-for-Service	1629894324	1629894324	1	1	RENEW HEALTH MEDICAL CORPORA	2/19/2025	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	30230 RANCHO VIEJO RD	STE 134	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
255916	Fee-for-Service	1528086014	1528086014	1	1	ROBINSON, TRACY	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79940	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
255980	Fee-for-Service	1104904838	1104904838	1	1	REYES, TINA T MD	7/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74646	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255983	Fee-for-Service	1295165645	1295165645	1	1	RAZI MEDICAL GROUP INC	9/11/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18092 WIKA ROAD	SUITE 220	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
255985	Fee-for-Service	1902821333	1902821333	1	1	ROSEN-LEVIN, ELISE M MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48805	22	Pathology (M.D. only)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
255990	Fee-for-Service	1538208210	1538208210	1	1	RIVERSIDE MEDICAL CENTER	12/4/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	350 N WALL STREET	None	KANKAKEE	IL	60901	2901	00	None	41.12547621	-87.88343789	Kankakee County
255995	Fee-for-Service	1831227156	1831227156	1	1	ROMAN, RAY	7/11/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
256026	Fee-for-Service	1114954195	1114954195	1	1	RABBANI, SHAWN-SHAHRAM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	18909 SHERMAN WAY	STE A	RESEDA	CA	91335	7700	19	06037	34.20119347	-118.5451065	Los Angeles County
256058	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
256070	Fee-for-Service	1275753790	1275753790	1	1	RYAN, EDWIN E	3/1/2025	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	291 EAST MAIN ST.	D, E	LOS GATOS	CA	95030	6137	43	06085	37.22109751	-121.9747502	Santa Clara County
256116	Fee-for-Service	1962877217	1962877217	1	1	ROBINSON, JAIMIE	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
256123	Fee-for-Service	1124439807	1124439807	1	20	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5 BON AIR RD	SUITE 129	LARKSPUR	CA	94939	1143	21	06041	37.9438204	-122.5395357	Marin County
256160	Fee-for-Service	1275605099	1275605099	1	1	RAPPORT, NAOMI J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39690	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
256202	Fee-for-Service	1336208073	1336208073	1	1	RAHMAN, SHOWKOT A MD	1/23/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	87423	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
256210	Fee-for-Service	1619164712	1619164712	1	1	RAI CARE CENTERS OF	7/28/2008	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OAKLAND I LLC	2710 TELEGRAPH AVE	STE 205	OAKLAND	CA	94612	1771	01	06001	37.81647593	-122.2677965	Alameda County
256219	Fee-for-Service	1831812072	1831812072	1	1	RIVERSIDE PRIMARY CARE DOCTO	1/18/2024	207QA0505X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RS-INC	9041 MAGNOLIA AVE	STE 6	RIVERSIDE	CA	92503	3941	33	06065	33.92541585	-117.4378266	Riverside County
256276	Fee-for-Service	1538208210	1538208210	1	1	RIVERSIDE MEDICAL CENTER	12/4/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	350 N WALL STREET	None	KANKAKEE	IL	60901	2901	00	None	41.12547621	-87.88343789	Kankakee County
256313	Fee-for-Service	1922282284	1922282284	1	1	REZAPOUR, JOHN G MD INC	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77006	18	Ophthalmology	0	In state provider	None	240 S LA CIENEGA BLVD	SUITE 250	BEVERLY HILLS	CA	90211	3314	19	06037	34.06392928	-118.3761548	Los Angeles County
256335	Fee-for-Service	1588674766	1588674766	1	1	ROBINSON, SARAH M MD	3/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52945	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
256357	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
256411	Fee-for-Service	1578241873	1578241873	1	1	RESILIENT MIND INSTITUTE ADV	9/30/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ANCED NURSING SERVICES	2001 S BARRINGTON AVE	STE 215	LOS ANGELES	CA	90025	5385	19	06037	34.03672191	-118.4500156	Los Angeles County
256445	Fee-for-Service	1699785014	1699785014	1	1	REISMAN, BRUCE K MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	59056	None	None	0	In state provider	None	665 CAMINO DE LOS MARES	STE 100	SAN CLEMENTE	CA	92673	2840	30	06059	33.45730192	-117.6483252	Orange County
256479	Fee-for-Service	1700364833	1700364833	1	1	REYES, AUDREY RCP	5/14/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
256500	Fee-for-Service	1528266186	1528266186	1	1	REYES, DONNA LCSW	5/12/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
256508	Fee-for-Service	1831812072	1831812072	1	1	RIVERSIDE PRIMARY CARE DOCTO	1/18/2024	207QA0505X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RS-INC	9041 MAGNOLIA AVE	STE 6	RIVERSIDE	CA	92503	3941	33	06065	33.92541585	-117.4378266	Riverside County
256549	Fee-for-Service	1902862212	1902862212	2	1	RAULINO, MARGARET OD	1/7/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 NORTH LAKE BLVD	None	TAHOE CITY	CA	96145	7170	31	06061	39.17647058	-120.134634	Placer County
256560	Fee-for-Service	1891025862	1891025862	1	1	ROSAS, LIZBETH E LMFT	2/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
256600	Fee-for-Service	1922282284	1922282284	1	1	REZAPOUR, JOHN G MD INC	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77006	41	Internal Medicine	0	In state provider	None	240 S LA CIENEGA BLVD	SUITE 250	BEVERLY HILLS	CA	90211	3314	19	06037	34.06392928	-118.3761548	Los Angeles County
256604	Fee-for-Service	1043392335	1043392335	1	1	RODRIGUEZ, ORLANDO MD	2/28/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53076	08	Family Practice	0	In state provider	None	1336 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.69908763	-121.6352503	Monterey County
256609	Fee-for-Service	1073122925	1073122925	1	1	REDIKER, ASHLEY PSYD	8/4/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
256635	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
256657	Fee-for-Service	1285753368	1285753368	1	1	RABE, MICHAEL N LCSW	10/2/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 PENNINSULA DR	STE 3	LAKE ALMANOR	CA	96137	9626	32	06063	40.27657064	-121.1288685	Plumas County
256726	Fee-for-Service	1043670235	1043670235	1	1	ROBSAG INC	1/4/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2612 LINCOLN AVE	None	ALTADENA	CA	91001	4904	19	06037	34.19061235	-118.1587478	Los Angeles County
256789	Fee-for-Service	1760226260	1760226260	1	1	RIALTO FAMILY HEALTH SERVICE	11/23/2024	251B00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	S INC.	214 N PALM AVE	STE 504	RIALTO	CA	92376	5826	36	06071	34.1027049	-117.3728897	San Bernardino County
256823	Fee-for-Service	1245258235	1245258235	1	1	RUSS, KENNETH C	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48224	41	Internal Medicine	0	In state provider	None	555 E TACHEVAH DR	STE 2E104	PALM SPRINGS	CA	92262	5746	33	06065	33.83753681	-116.5424435	Riverside County
256826	Fee-for-Service	1194891234	1194891234	1	1	REZAI, FARIDEH HASSANI	9/30/1988	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6367 ALVARADO CT	STE 102	SAN DIEGO	CA	92120	4914	37	06073	32.77665968	-117.0614306	San Diego County
256867	Fee-for-Service	1841325123	1841325123	1	1	ROBINSON, THOMAS N MD	5/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71633	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
256892	Fee-for-Service	1720371537	1720371537	1	1	RYAN EDWARD SNYDER MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
256909	Fee-for-Service	1992922587	1992922587	1	1	RICHEY, LISA A DO	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9058	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
256922	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
256949	Fee-for-Service	1861494601	1861494601	1	2	RAPEPORT MEDICAL CORP	3/18/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8851 CENTER DR	STE 612	LA MESA	CA	91942	3065	37	06073	32.78189749	-117.0075062	San Diego County
256971	Fee-for-Service	1093919961	1093919961	1	1	REYNOLDS, SARAH J	8/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
256989	Fee-for-Service	1851725253	1851725253	1	1	RODGERS, ANGELA R MD	1/5/2018	390200000X	NA	Other	026	PHYSICIANS	152109	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
256996	Fee-for-Service	1619401569	1619401569	1	1	REDDY, KRITIKA G MD	8/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167365	08	Family Practice	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
257001	Fee-for-Service	1528037892	1528037892	1	1	RUSSELL, SUDHA A MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54900	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
257005	Fee-for-Service	1316965239	1316965239	1	1	READ, LECK MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146841	08	Family Practice	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
257009	Fee-for-Service	1497774798	1497774798	1	1	RAO, RAJNI K MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79165	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
257054	Fee-for-Service	1275609588	1275609588	1	1	RAZA, SYED J MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52952	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17270 BEAR VALLEY RD	STE 106	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
257091	Fee-for-Service	1770618548	1770618548	1	1	ROSENBERG, DAVID S MD	2/8/2021	208200000X	NA	General Surgery	026	PHYSICIANS	92453	None	None	0	In state provider	None	145 N ROBERTSON	None	BEVERLY HILLS	CA	90211	2103	19	06037	34.06812719	-118.3837687	Los Angeles County
257112	Fee-for-Service	1326054776	1326054776	1	1	REBONG, KENNETH P MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45813	01	General Practice	0	In state provider	None	2350 MCKEE RD	SUITE 1	SAN JOSE	CA	95116	1617	43	06085	37.36631785	-121.848368	Santa Clara County
257117	Fee-for-Service	1922023985	1922023985	1	1	ROSENSITTO, KIMBERLY Y A S	12/5/2003	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
257189	Fee-for-Service	1295958601	1295958601	1	1	REYNOSO, LILIANA MD	5/7/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	90376	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
257195	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
257197	Fee-for-Service	1679644561	1679644561	1	1	RAMSAY, EVETTE W MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76495	07	Dermatology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
257198	Fee-for-Service	1275722415	1275722415	1	1	REGENTS OF THE UNIVERSITY	1/1/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
257209	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
257214	Fee-for-Service	1881658615	1881658615	1	1	RAHHAL, FIRAS M MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78656	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
257238	Fee-for-Service	1386669984	1386669984	1	1	RAPLHS GROCERY COMPANY	8/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS SOTRE #721	22333 SHERMAN WAY	None	CANOGA PARK	CA	91303	1050	19	06037	34.20105046	-118.6135515	Los Angeles County
257239	Fee-for-Service	1861494601	1861494601	1	2	RAPEPORT MEDICAL CORP	3/18/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 612	LA MESA	CA	91942	3065	37	06073	32.78189749	-117.0075062	San Diego County
257287	Fee-for-Service	1528037892	1528037892	1	1	RUSSELL, SUDHA A MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
257344	Fee-for-Service	1275609588	1275609588	1	1	RAZA, SYED J MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52952	40	Pediatrics	0	In state provider	None	17270 BEAR VALLEY RD	STE 106	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
257350	Fee-for-Service	1689855595	1689855595	1	1	RAHMAN, NABEELA M MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104967	36	Psychiatry	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
257355	Fee-for-Service	1770580649	1770580649	1	1	ROSENQUIST, RONALD W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34099	34	Urology and Urological Surgery	0	In state provider	None	24953 PASEO DE VALENCIA	STE 7C	LAGUNA HILLS	CA	92653	4337	30	06059	33.60028568	-117.7010887	Orange County
257364	Fee-for-Service	1649670191	1649670191	1	1	RIZZO, ISAURA LCSW	4/30/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2300 7TH STREET	None	WASCO	CA	93280	1585	15	06029	35.59431549	-119.3517135	Kern County
257386	Fee-for-Service	1255455333	1255455333	1	1	ROBERTS, JEANETTE S LMFT	5/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
257399	Fee-for-Service	1326054776	1326054776	1	1	REBONG, KENNETH P MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45813	41	Internal Medicine	0	In state provider	None	2350 MCKEE RD	SUITE 1	SAN JOSE	CA	95116	1617	43	06085	37.36631785	-121.848368	Santa Clara County
257406	Fee-for-Service	1174552855	1174552855	1	1	RUDO, NEIL D MD APC	1/15/2009	208600000X	NA	General Surgery	026	PHYSICIANS	32385	02	General Surgery	0	In state provider	None	236 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
257419	Fee-for-Service	1851674469	1851674469	1	2	RAHIMZADEH, ALI LMFT	6/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
257435	Fee-for-Service	1588773519	1588773519	1	1	RUBIN, VALERIE P MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69117	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
257457	Fee-for-Service	1588742365	1588742365	1	1	REYNOSA,KIMBERLY A MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66039	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
257485	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
257490	Fee-for-Service	1124159215	1124159215	1	1	REYNOSO, CARMEN V LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
257496	Fee-for-Service	1376988204	1376988204	1	1	RODRIGUEZ, SARA E PT	10/16/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
257515	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
257541	Fee-for-Service	1477936466	1477936466	1	1	RAI, MANOJ MD	8/17/2020	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
257546	Fee-for-Service	1588748073	1588748073	1	1	REGAL MEDICAL GROUP INC	9/5/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	117 E LIVE OAK AVE	STE 101	ARCADIA	CA	91006	5271	19	06037	34.10801594	-118.0269719	Los Angeles County
257550	Fee-for-Service	1447420294	1447420294	1	1	ROGERS, BILL S MD	1/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99913	None	None	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
257552	Fee-for-Service	1134625254	1134625254	1	1	REYES, LUZ M LMFT	6/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
257571	Fee-for-Service	1396701611	1396701611	1	1	REED, JOHN MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	72398	05	Anesthesiology	0	In state provider	None	320 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
257590	Fee-for-Service	1255359121	1255359121	1	1	RAJ, VINUTHA	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88374	41	Internal Medicine	0	In state provider	None	1900 DRESDEN DRIVE	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
257639	Fee-for-Service	1407219389	1407219389	1	1	RUSTEMI, MASOOD DO	9/20/2020	207R00000X	NA	Other	026	PHYSICIANS	17445	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
257642	Fee-for-Service	1447454137	1447454137	1	1	RODRIGUEZ-TOLEDO, JOHANNA MD	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109148	40	Pediatrics	0	In state provider	FAAP	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
257705	Fee-for-Service	1447582218	1447582218	1	1	RICE, AMY W LMFT	3/14/2019	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
257717	Fee-for-Service	1841491727	1841491727	1	1	RYU, JAEWON MD	2/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95021	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
257730	Fee-for-Service	1235281452	1235281452	1	1	RAJPAL, SUPRIYA MD	12/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83455	78	Neoplastic Diseases/Oncology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
257756	Fee-for-Service	1295267326	1295267326	1	1	RAOUF, SANED M MD	7/30/2021	207P00000X	NA	Other	026	PHYSICIANS	160947	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
257765	Fee-for-Service	1013906973	1013906973	1	3	REGENTS OF THE UNIV OF CA	8/13/2020	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1111 EXPOSITION BLVD	BUILDING 200	SACRAMENTO	CA	95815	4324	34	06067	38.598876	-121.4502885	Sacramento County
257773	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
257783	Fee-for-Service	1992992887	1992992887	1	1	RESTREPO, BIBIANA M MD	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151456	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
257787	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
257841	Fee-for-Service	1831435551	1831435551	1	1	ROWLAND, SCOTT A LMFT	11/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	19	06037	34.00134941	-118.4039837	Los Angeles County
257861	Fee-for-Service	1912987553	1912987553	1	2	REGENTS OF THE UNIVERSITY OF	4/26/2023	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
257867	Fee-for-Service	1396498580	1396498580	1	1	REGENTS OF THE UNIVERSITY OF	11/10/2022	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3575 BUSINESS DR	# 1601	SACRAMENTO	CA	95820	2160	34	06067	38.541465	-121.4175285	Sacramento County
257885	Fee-for-Service	1992887236	1992887236	1	1	RASMUSSEN, MAYNARD R MD	5/25/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	31406	40	Pediatrics	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
257919	Fee-for-Service	1134200983	1134200983	1	1	RENAISSANCE RADIOLOGY	11/28/2011	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	10841 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	4849	36	06071	34.10467596	-117.5661881	San Bernardino County
257935	Fee-for-Service	1649239971	1649239971	1	1	RONAN, STEPHEN JOHN MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72320	24	Plastic Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
257941	Fee-for-Service	1518029321	1518029321	3	1	REDLANDS PHARMACY INC	10/10/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	REDLANDS PHARMACY	245 TERRACINA BLVD	#201	REDLANDS	CA	92373	4867	36	06071	34.03858912	-117.2066515	San Bernardino County
258010	Fee-for-Service	1144308982	1144308982	1	1	ROUILLARD, SMITA S MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81627	13	Neurology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
258061	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
258064	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
258090	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
258110	Fee-for-Service	1710046842	1710046842	1	2	RETINA CONSULTANTS OF	11/20/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SOUTHERN CALIFORNIA INC	11340 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3858	36	06071	34.04699925	-117.2436953	San Bernardino County
258123	Fee-for-Service	1336489988	1336489988	1	1	ROONEY, MARY E PHD	9/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258126	Fee-for-Service	1528455474	1528455474	1	1	RHYU, JANE MD	7/6/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	147780	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258142	Fee-for-Service	1235533779	1235533779	2	1	REALTOX LABS, LLC	6/22/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	200 BUSINESS CENTER DR	None	REISTERSTOWN	MD	21136	1230	00	None	39.46602538	-76.82661097	Baltimore County
258150	Fee-for-Service	1912987553	1912987553	1	2	REGENTS OF THE UNIVERSITY OF	11/3/2021	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
258163	Fee-for-Service	1659502201	1659502201	1	1	RUDICK, ANTHONY J OD	6/14/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7056 SKYWAY	None	PARADISE	CA	95969	3960	04	06007	39.76482102	-121.6183741	Butte County
258165	Fee-for-Service	1710319447	1710319447	2	1	ROMANA, BHUPINDER S MD	9/17/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	156389	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
258171	Fee-for-Service	1992887236	1992887236	1	1	RASMUSSEN, MAYNARD R MD	5/25/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	31406	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
258176	Fee-for-Service	1437822442	1437822442	1	1	RAVULAPALLI, BHAVANI LCSW	11/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
258233	Fee-for-Service	1629019583	1629019583	1	1	RITHAPORN, RUTHACHAI MD	1/31/1987	174400000X	NA	Other	026	PHYSICIANS	34296	01	General Practice	0	In state provider	None	1735 N FRESNO ST	None	FRESNO	CA	93703	3031	10	06019	36.766647	-119.781557	Fresno County
258251	Fee-for-Service	1255303541	1255303541	1	1	REGHITTO, CHARMAINE D MD	5/26/2020	207R00000X	NA	Other	026	PHYSICIANS	165877	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
258293	Fee-for-Service	1689831638	1689831638	1	1	ROMEA, RAUL J MD INC	8/1/2008	207RR0500X	NA	Other	026	PHYSICIANS	53197	83	Rheumatology	0	In state provider	None	9300 W STOCKTON BLVD	STE 112	ELK GROVE	CA	95758	8070	34	06067	38.419101	-121.3945425	Sacramento County
258328	Fee-for-Service	1922391226	1922391226	2	1	RURAL-METRO OF CALIFORNIA	8/25/2014	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1345 VANDER WAY	None	SAN JOSE	CA	95112	2809	43	06085	37.36881041	-121.8956147	Santa Clara County
258342	Fee-for-Service	1447518642	1447518642	1	1	ROYAL MK MEDICAL NON-	6/4/2012	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	EMERGENCY TRANSPORTATION	815 SOUTH CENTRAL AVENUE	STE 9	GLENDALE	CA	91204	2078	19	06037	34.13606127	-118.2578932	Los Angeles County
258350	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
258353	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
258362	Fee-for-Service	1710287297	1710287297	1	61	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	23550 HAWTHORNE BLVD	180	TORRANCE	CA	90505	4721	19	06037	33.81149085	-118.3510183	Los Angeles County
258400	Fee-for-Service	1730535253	1730535253	1	1	RAO, SHRAVAN MD	9/6/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	155593	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 GRANT ST	STE 106	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
258418	Fee-for-Service	1528455474	1528455474	1	1	RHYU, JANE MD	7/6/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	147780	67	Endocrinology	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258429	Fee-for-Service	1326246885	1326246885	1	1	ROTH, LOREN MD	1/24/2025	2084F0202X	NA	Psychiatry	026	PHYSICIANS	153313	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
258436	Fee-for-Service	1386625440	1386625440	1	1	RENATO,ALBARAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 BARCLAY,CIR STE 200	None	ROCHESTER HILLS	MI	48307	0000	00	None	42.64278826	-83.13000713	Oakland County
258437	Fee-for-Service	1912987553	1912987553	1	2	REGENTS OF THE UNIVERSITY OF	11/3/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
258472	Fee-for-Service	1215017462	1215017462	1	1	RAYMUNDO, VIRGIL S MD	2/25/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	78947	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
258522	Fee-for-Service	1629019583	1629019583	1	1	RITHAPORN, RUTHACHAI MD	1/31/1987	174400000X	NA	Other	026	PHYSICIANS	34296	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1735 N FRESNO ST	None	FRESNO	CA	93703	3031	10	06019	36.766647	-119.781557	Fresno County
258537	Fee-for-Service	1780771527	1780771527	1	1	ROBERTS, JESSICA B MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91831	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
258594	Fee-for-Service	1346404308	1346404308	1	1	RAJU, MENAKA MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112937	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
258605	Fee-for-Service	1306860531	1306860531	1	1	ROSENBERG, JEFFREY V. DO	12/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
258636	Fee-for-Service	1710287297	1710287297	1	60	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	4TH FLOOR	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
258640	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
258654	Fee-for-Service	1154463222	1154463222	1	1	RUDY, SCOTT M MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84278	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
258659	Fee-for-Service	1194161703	1194161703	1	1	RIVERO, JORGE A MD INC	11/12/2015	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	45653	None	None	0	In state provider	None	23521 PASEO DE VALENCIA	STE 108	LAGUNA HILLS	CA	92653	3137	30	06059	33.61113028	-117.7126684	Orange County
258671	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	5/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
258702	Fee-for-Service	1982100145	1982100145	1	1	RODE, JORDAN T MD	8/29/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
258725	Fee-for-Service	1912987553	1912987553	1	2	REGENTS OF THE UNIVERSITY OF	11/8/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2035 LYNDELL TERRACE	SUITE 100	DAVIS	CA	95616	6222	57	06113	38.56303319	-121.7694148	Yolo County
258741	Fee-for-Service	1689785834	1689785834	1	1	ROUTCHENKOV, ALEXANDER	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81662	08	Family Practice	0	In state provider	None	5810 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
258762	Fee-for-Service	1922133388	1922133388	1	1	RIVERA, LUIS E MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	37834	02	General Surgery	0	In state provider	None	2222 S MAIN ST	None	SANTA ANA	CA	92707	3220	30	06059	33.717168	-117.867929	Orange County
258817	Fee-for-Service	1780277145	1780277145	1	1	RANGEL, DOLORES NP	11/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
258824	Fee-for-Service	1730352089	1730352089	1	1	ROLSTON, ANNE K	6/5/2008	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	#200	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
258848	Fee-for-Service	1093196529	1093196529	1	1	REEVES, JENNIFER M CNP	12/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
258851	Fee-for-Service	1942438791	1942438791	1	1	ROCKWELL, ROXANNE E PHD	4/21/2017	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
258878	Fee-for-Service	1558310409	1558310409	1	1	RHEW, MIRIAM M MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63066	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
258890	Fee-for-Service	1922084607	1922084607	1	1	REYNOLDS, GENE E MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	19118	02	General Surgery	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
258929	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
258937	Fee-for-Service	1306168661	1306168661	1	1	RIZI, H ROGER MD INC	1/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35863	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 E 27TH	None	LONG BEACH	CA	90806	1601	19	06037	33.80615859	-118.1885497	Los Angeles County
258945	Fee-for-Service	1972857233	1972857233	1	1	REED-DRAKE, SYLVIA D LMFT	3/4/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	111650	-	NOT APPLICABLE	0	In state provider	None	525 N PARKER ST	None	ORANGE	CA	92868	1323	30	06059	33.7956127	-117.8596317	Orange County
258955	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	5/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
258961	Fee-for-Service	1073958641	1073958641	1	1	ROSENBAUM, SARAH MD	10/25/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	149485	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259121	Fee-for-Service	1457430597	1457430597	1	1	RIEL, NESTOR D MD	12/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70170	36	Psychiatry	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
259178	Fee-for-Service	1922084607	1922084607	1	1	REYNOLDS, GENE E MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	19118	47	Miscellaneous	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
259191	Fee-for-Service	1275621716	1275621716	1	1	RIGGS AMBULANCE SERV	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	100 RIGGS AVE	None	MERCED	CA	95340	6464	24	06047	37.28609385	-120.5102737	Merced County
259203	Fee-for-Service	1003908823	1003908823	1	1	RIVERA, ERNEST J PHD	1/7/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1623 PARAMOUNT BLVD	None	MONTEBELLO	CA	90640	2133	19	06037	34.03718412	-118.0934942	Los Angeles County
259215	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
259235	Fee-for-Service	1710287297	1710287297	1	3	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2701 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	5200	19	06037	34.01830697	-118.4569168	Los Angeles County
259241	Fee-for-Service	1235675646	1235675646	1	1	RIVERSIDE COUNTY LATINO	10/5/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	COMMISSION ON ALCOHOL	43485 HOLLYHOCK ST	None	INDIO	CA	92201	1976	33	06065	33.73268124	-116.2444907	Riverside County
259249	Fee-for-Service	1710287297	1710287297	1	75	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1399 S ROXBURY DR	100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
259251	Fee-for-Service	1871644468	1871644468	1	1	RABINOVICI, GIL D MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81458	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259305	Fee-for-Service	1487281523	1487281523	1	1	ROJAS, TAMY DO	6/27/2023	207P00000X	NA	Other	026	PHYSICIANS	21056	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
259372	Fee-for-Service	1093977555	1093977555	1	1	RAMSEY, ROBIN M	11/15/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
259400	Fee-for-Service	1184896193	1184896193	1	1	REHAB FOCUS HOME HEALTH	5/19/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	377 W FALLBROOK AVENUE	STE 101	FRESNO	CA	93711	6224	10	06019	36.84933148	-119.7990225	Fresno County
259472	Fee-for-Service	1831603539	1831603539	2	1	RIALTO HEALTHCARE GROUP INC	11/26/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1851 N RIVERSIDE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
259504	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
259508	Fee-for-Service	1720191422	1720191422	1	1	REYES, STEVEN LMFT	3/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 COLTON AVE	114	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
259512	Fee-for-Service	1639193873	1639193873	2	1	ROY, SWAPNA B MD	3/29/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	26098	40	Pediatrics	0	In state provider	None	220 LAGUNA RD	STE 5	FULLERTON	CA	92835	2523	30	06059	33.89562646	-117.9305833	Orange County
259521	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
259587	Fee-for-Service	1386743201	1386743201	1	1	RHIE, FRANCIS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33629	41	Internal Medicine	0	In state provider	None	1140 W LA VETA AVE	STE 420	ORANGE	CA	92868	4226	30	06059	33.7802984	-117.8651669	Orange County
259605	Fee-for-Service	1932989977	1932989977	1	1	RIVERSIDE-SAN BERNARDINO COU	1/4/2024	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	C PHARMACY	53000 CAHUILLA RD	None	ANZA	CA	92539	9142	33	06065	33.54344233	-116.7356692	Riverside County
259617	Fee-for-Service	1629750153	1629750153	1	1	ROMERO HEARING AIDS, LLC	8/15/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1370 BREA BLVD	105	FULLERTON	CA	92835	4132	30	06059	33.88482917	-117.9236469	Orange County
259681	Fee-for-Service	1598839227	1598839227	1	1	RAI CARE CENTERS SO CA	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	II LLC	41501 CORPORATE WAY	None	PALM DESERT	CA	92260	1974	33	06065	33.746805	-116.3623665	Riverside County
259699	Fee-for-Service	1134823636	1134823636	1	1	RM GOLDEN CARE, INC	7/5/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9030 WHITAKER AVENUE	None	NORTHRIDGE	CA	91343	4036	19	06037	34.234911	-118.499053	Los Angeles County
259705	Fee-for-Service	1588848725	1588848725	1	1	REY, FERNANDO A DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	8780 VAN NUYS BLVD	STE B	PANORAMA CITY	CA	91402	2454	19	06037	34.22956721	-118.4502171	Los Angeles County
259742	Fee-for-Service	1497797088	1497797088	1	1	REX HOSPITAL INC	6/12/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4420 LAKE BOONE TRL	None	RALEIGH	NC	27607	6599	00	None	35.81555472	-78.70402278	Wake County
259768	Fee-for-Service	1811553811	1811553811	1	1	ROXAS, KRISTOFFER A MD	6/27/2022	390200000X	NA	Other	026	PHYSICIANS	177483	None	None	0	In state provider	None	1640 NEWPORT BLVD	SUITE 210	COSTA MESA	CA	92627	3786	30	06059	33.63437128	-117.9221659	Orange County
259791	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	9/9/2024	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
259801	Fee-for-Service	1538330766	1538330766	2	1	RANKIN, APRIL L LMFT	6/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 ADAMS STREET	A405	RIVERSIDE	CA	92504	8305	33	06065	33.9214315	-117.4148549	Riverside County
259802	Fee-for-Service	1013320175	1013320175	1	1	REYNARD, JOELLE R MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
259810	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
259824	Fee-for-Service	1003980947	1003980947	1	1	RUBIN, NANCY R DO	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	7207	41	Internal Medicine	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
259901	Fee-for-Service	1902933468	1902933468	1	1	RAMIREZ, JENNY Y LMFT	6/14/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	330 E. LAMBERT RD	225	BREA	CA	92821	4100	30	06059	33.92494139	-117.8918336	Orange County
259923	Fee-for-Service	1922411453	1922411453	1	1	ROLAND, JOSHUA MD	5/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167607	08	Family Practice	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
259953	Fee-for-Service	1770117400	1770117400	1	1	RUBI, VANESSA A PT	4/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
259969	Fee-for-Service	1174266209	1174266209	1	1	ROBINSON, MERCEDES N LMFT	12/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CEDES ROBINSON, LMFT	500 OLIVE ST	None	MARYSVILLE	CA	95901	5637	58	06115	39.1397517	-121.5989699	Yuba County
259993	Fee-for-Service	1255595427	1255595427	1	1	RABKIN, DAVID G	8/1/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	104603	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
260030	Fee-for-Service	1497797088	1497797088	1	1	REX HOSPITAL INC	6/12/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4420 LAKE BOONE TRL	None	RALEIGH	NC	27607	6599	00	None	35.81555472	-78.70402278	Wake County
260032	Fee-for-Service	1700440013	1700440013	1	1	RDH FAMILY COUNSELING CORPOR	8/28/2019	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ATION	601 E YORBA LINDA BLVD	STE 2C	PLACENTIA	CA	92870	3006	30	06059	33.88937165	-117.8544856	Orange County
260066	Fee-for-Service	1629368519	1629368519	1	1	ROZELL, JOSEPH M MD	7/26/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	155612	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9076	36	06071	34.26577765	-117.1695461	San Bernardino County
260080	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
260099	Fee-for-Service	1710287297	1710287297	1	3	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2701 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	5200	19	06037	34.01830697	-118.4569168	Los Angeles County
260103	Fee-for-Service	1639549736	1639549736	1	1	RUBIN, DAVID N LMFT	3/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	109 CENTRAL AVE	207B	SALINAS	CA	93901	0007	27	06053	36.67653613	-121.6581049	Monterey County
260110	Fee-for-Service	1003980947	1003980947	1	1	RUBIN, NANCY R DO	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	7207	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
260136	Fee-for-Service	1609803733	1609803733	1	1	RAM, ASHER MD	11/29/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45553	None	None	0	In state provider	CENTRO MEDICO FAMILIAR	14547 VICTORY BLVD	None	VAN NUYS	CA	91411	1619	19	06037	34.18668853	-118.450395	Los Angeles County
260198	Fee-for-Service	1225112220	1225112220	1	1	REINHARD, MICHAEL A MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56003	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
260255	Fee-for-Service	1659313039	1659313039	1	1	ROZYCKI, MAREK Z MD	9/30/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	41131	30	Radiology	0	In state provider	None	709 18TH ST	None	MODESTO	CA	95354	1210	50	06099	37.64364413	-120.9896383	Stanislaus County
260282	Fee-for-Service	1255595427	1255595427	1	1	RABKIN, DAVID G	8/1/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	104603	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
260326	Fee-for-Service	1518520311	1518520311	1	1	RECIO, MELODY NP	12/17/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1215 34TH ST	None	BAKERSFIELD	CA	93301	2107	15	06029	35.39050249	-119.015775	Kern County
260343	Fee-for-Service	1487612354	1487612354	1	1	RICH, MARK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	270 E STATE ST	STE G100	ALLIANCE	OH	44601	4300	00	None	40.90171645	-81.101718	Stark County
260351	Fee-for-Service	1568771640	1568771640	1	1	ROBILLARD, COLLIN J OD	2/14/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 COLORADO AVE	STE A	TURLOCK	CA	95382	2002	50	06099	37.51154259	-120.8352538	Stanislaus County
260368	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
260369	Fee-for-Service	1154462323	1154462323	1	1	ROUILLARD, SHARON G NP	4/15/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
260376	Fee-for-Service	1831147305	1831147305	1	1	ROUINE-RAPP, KATHRYN MD	12/31/1990	207L00000X	NA	Other	026	PHYSICIANS	59233	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
260387	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
260402	Fee-for-Service	1003980947	1003980947	1	1	RUBIN, NANCY R DO	9/19/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	7207	68	Hematology	0	In state provider	None	101 WILSON RD	None	MONTEREY	CA	93940	7834	27	06053	36.57377882	-121.8093374	Monterey County
260453	Fee-for-Service	1245224732	1245224732	1	1	RIVERSIDE SANITARIUM LLC	2/2/2016	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4580 PALM AVE	None	RIVERSIDE	CA	92501	3950	33	06065	33.97790607	-117.3899372	Riverside County
260472	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
260546	Fee-for-Service	1447592308	1447592308	1	1	RADEAS LLC	1/10/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	907 GATEWAY COMMONS CIR	STE 100	WAKE FOREST	NC	27587	5993	00	None	35.965368	-78.497244	Wake County
260579	Fee-for-Service	1598102725	1598102725	1	1	ROMERO, JONATHAN F MD	2/4/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
260591	Fee-for-Service	1497258545	1497258545	1	1	REEDER, CASSANDRA LMFT	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
260659	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
260669	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
260675	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
260693	Fee-for-Service	1679986046	1679986046	1	1	RAGU, RAHUL LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
260702	Fee-for-Service	1679604714	1679604714	1	1	ROMERO, KENNETH A MD INC	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66351	05	Anesthesiology	0	In state provider	None	752 MEDICAL CENT CT	STE 206	CHULA VISTA	CA	91911	6658	37	06073	32.61800405	-117.0232585	San Diego County
260709	Fee-for-Service	1972603553	1972603553	1	1	ROTH,ISADORA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	0000	00	None	45.53024175	-122.6966202	Multnomah County
260751	Fee-for-Service	1346696028	1346696028	1	1	ROTHMAN, RICHARD K MD	5/18/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161997	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
260762	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
260820	Fee-for-Service	1083652572	1083652572	1	1	RAYA, JULIO A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	39126	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
260847	Fee-for-Service	1770223042	1770223042	2	1	ROYALTY MEDICAL TRANSPORTATI	5/5/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON, LLC	2169 YOSEMITE PARKWAY	45	MERCED	CA	95340	0000	24	06047	37.29524597	-120.4490894	Merced County
260853	Fee-for-Service	1457312753	1457312753	1	1	ROE, TAIYUN MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85651	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
260858	Fee-for-Service	1770937427	1770937427	1	1	RAMIREZ, MICHAEL V MD	7/14/2022	207R00000X	NA	Other	026	PHYSICIANS	152286	None	None	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
260869	Fee-for-Service	1336212059	1336212059	1	1	RAI CARE CTRS SO CA I	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	11859 COMPTON AVE	None	LOS ANGELES	CA	90059	2958	19	06037	33.92489921	-118.2463202	Los Angeles County
260938	Fee-for-Service	1194003756	1194003756	1	1	ROMINE, HEATHER N MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122440	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	STE 101	ANTIOCH	CA	94531	6200	07	06013	37.97569499	-121.800733	Contra Costa County
260944	Fee-for-Service	1710287297	1710287297	1	86	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
260956	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	5/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
260963	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
260978	Fee-for-Service	1851460208	1851460208	1	1	RAEL, JAMES A MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70812	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
260988	Fee-for-Service	1720273055	1720273055	1	1	RIVERA, RYAN N DO	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9999	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
261031	Fee-for-Service	1467435859	1467435859	1	1	RIVERO, CINDY V	7/27/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
261041	Fee-for-Service	1962712943	1962712943	1	1	RAMIREZ ROBLES, ESTRELLA	8/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	13200 CROSSROADS PKWY	STE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
261048	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
261052	Fee-for-Service	1851987234	1851987234	1	1	RG LEGACY 1, LLC	12/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1899 N RAYMOND AVE	None	PASADENA	CA	91103	1733	19	06037	34.17830578	-118.1492133	Los Angeles County
261054	Fee-for-Service	1710287297	1710287297	1	1	REGENTS UNIVERSITY OF CALIFO	3/31/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
261072	Fee-for-Service	1912502782	1912502782	1	1	REALITY CARE HOSPICE INC	8/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6360 VAN NUYS BLVD	SUITE 117	VAN NUYS	CA	91401	6645	19	06037	34.186023	-118.448701	Los Angeles County
261080	Fee-for-Service	1639137540	1639137540	1	1	RUSSELL, MARK MD	5/29/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	144701	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	600 E WILLIAMS ST	None	BARSTOW	CA	92311	2943	36	06071	34.89759308	-117.0207351	San Bernardino County
261083	Fee-for-Service	1588680060	1588680060	1	1	ROSS, BARRY J MD	6/30/1991	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	49520	25	Physical Medicine and Rehabilitation	0	In state provider	None	433 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1310	42	06083	34.44682583	-119.7794619	Santa Barbara County
261084	Fee-for-Service	1881670016	1881670016	1	1	ROBINSON, MICHAEL L MD	6/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67644	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
261112	Fee-for-Service	1245258235	1245258235	1	2	RUSS, KENNETH C	3/20/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	48224	-	NOT APPLICABLE	0	In state provider	None	41945 BIG BEAR BLVD	SUITE 208	BIG BEAR LAKE	CA	92315	6070	36	06071	34.24334115	-116.8869688	San Bernardino County
261132	Fee-for-Service	1881734234	1881734234	1	1	RUBENSTEIN, PETER R MD	9/16/1970	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORP	18411 CLARK ST	STE 307	TARZANA	CA	91356	3545	19	06037	34.16981538	-118.5337442	Los Angeles County
261143	Fee-for-Service	1649784414	1649784414	1	1	RAMIREZ, DESIREE M CNP	12/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
261159	Fee-for-Service	1215269014	1215269014	1	1	REIMERT, MATTHEW M MD	8/20/2012	207RR0500X	NA	Other	026	PHYSICIANS	107593	83	Rheumatology	0	In state provider	None	2025 SOQUEL AVENUE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
261202	Fee-for-Service	1467593459	1467593459	1	1	RASHID, KHADIJA MD	1/6/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	96966	None	None	0	In state provider	None	4042 S DEMAREE ST	None	VISALIA	CA	93277	9476	54	06107	36.294165	-119.3295825	Tulare County
261217	Fee-for-Service	1992098487	1992098487	1	1	RATNAYAKE, DILANGANI B MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133925	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
261222	Fee-for-Service	1821355850	1821355850	1	1	RODRIGUEZ, ARMANDO D	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129545	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
261233	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	4/30/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
261243	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
261252	Fee-for-Service	1710287297	1710287297	1	112	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	892 AEROVISTA PLACE	210	SAN LUIS OBISPO	CA	93401	8252	40	06079	35.24277125	-120.6405941	San Luis Obispo County
261257	Fee-for-Service	1124439807	1124439807	1	11	REGENTS UNIV OF CALIFORNIA U	2/18/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	75 ROWLAND WAY	STE 101	NOVATO	CA	94945	5057	21	06041	38.09501878	-122.5589434	Marin County
261312	Fee-for-Service	1396823159	1396823159	1	1	ROSENTHAL, HARVEY MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36469	36	Psychiatry	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
261337	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
261344	Fee-for-Service	1710287297	1710287297	1	1	REGENTS UNIVERSITY OF CALIFO	9/24/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
261346	Fee-for-Service	1083672877	1083672877	1	1	RALPH, NORBERT B PHD	6/30/1989	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2501 MCHENRY AVE	STE E	MODESTO	CA	95350	3257	50	06099	37.677753	-120.9941595	Stanislaus County
261359	Fee-for-Service	1912502782	1912502782	1	1	REALITY CARE HOSPICE INC	8/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6360 VAN NUYS BLVD	SUITE 117	VAN NUYS	CA	91401	6645	19	06037	34.186023	-118.448701	Los Angeles County
261373	Fee-for-Service	1881670016	1881670016	1	1	ROBINSON, MICHAEL L MD	6/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67644	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
261395	Fee-for-Service	1003849936	1003849936	1	1	RAY, KIMBERLY M MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82746	30	Radiology	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
261479	Fee-for-Service	1639335995	1639335995	1	1	RODRIGUEZ FAHRNI, ANA M MD	8/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109108	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
261483	Fee-for-Service	1548374028	1548374028	1	1	RAY, CANDACE M NP	4/8/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND STREET W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
261488	Fee-for-Service	1720039753	1720039753	1	1	ROCCO, JOSEPH J MD	3/29/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	7934	30	Radiology	0	In state provider	None	1150 N VENTURA RD	None	OXNARD	CA	93030	3837	56	06111	34.21334043	-119.1944	Ventura County
261504	Fee-for-Service	1982250833	1982250833	1	1	RICHARDSON, STEPHANIE M NP	9/9/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
261522	Fee-for-Service	1710287297	1710287297	1	59	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
261531	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
261536	Fee-for-Service	1336117167	1336117167	1	1	RICHARD LARI M.D.	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
261539	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	5/28/2021	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
261547	Fee-for-Service	1124439807	1124439807	1	11	REGENTS UNIV OF CALIFORNIA U	7/19/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	STE 101	NOVATO	CA	94945	5057	21	06041	38.09501878	-122.5589434	Marin County
261582	Fee-for-Service	1902321698	1902321698	1	1	RUSSELL, JAZMINE LMFT	10/12/2024	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
261614	Fee-for-Service	1164787800	1164787800	1	1	ROCKETSHIP EDUCATION	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	350 TWIN DOLPHIN DRIVE	SUITE 109	REDWOOD CITY	CA	94065	1458	41	06081	37.52044383	-122.2572491	San Mateo County
261620	Fee-for-Service	1164477410	1164477410	1	1	RYU, THOMAS K DO	9/30/1990	207PE0004X	NA	Other	026	PHYSICIANS	5251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
261622	Fee-for-Service	1023054640	1023054640	1	1	ROHRER,DAVID A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LISA & LAURA	400 13TH AVE S STE 101	None	GREAT FALLS	MT	59405	0000	00	None	47.489958	-111.299688	Cascade County
261629	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	1/17/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
261630	Fee-for-Service	1710287297	1710287297	1	1	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
261646	Fee-for-Service	1639145600	1639145600	2	1	ROTENBERG, SAMUEL MD	11/30/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	30586	30	Radiology	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
261676	Fee-for-Service	1356511232	1356511232	1	2	REES-TAYLOR LLC	10/10/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	43732 SENTRY LANE	None	LANCASTER	CA	93535	3030	19	06037	34.6764209	-118.1800185	Los Angeles County
261709	Fee-for-Service	1821176652	1821176652	1	1	RIOS, DANIEL MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67837	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
261729	Fee-for-Service	1518045194	1518045194	1	1	RODRIGUEZ, RICHARD Z MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92502	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
261758	Fee-for-Service	1669470639	1669470639	2	1	RAINCROSS OUTPATIENT	1/9/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	4646 BROCKTON AVE	STE 104	RIVERSIDE	CA	92506	0103	33	06065	33.9760171	-117.3860626	Riverside County
261759	Fee-for-Service	1093942864	1093942864	1	1	RAJPOOT, DEEPAK MD	10/12/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	118562	None	None	0	In state provider	None	24432 MUIRLANDS BLVD	SUTIE 131	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
261778	Fee-for-Service	1639335995	1639335995	1	1	RODRIGUEZ FAHRNI, ANA M MD	8/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109108	78	Neoplastic Diseases/Oncology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
261781	Fee-for-Service	1336137025	1336137025	1	1	RYBKIN, ALEXANDER V MD	8/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75048	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261819	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
261826	Fee-for-Service	1710287297	1710287297	1	3	REGENTS UNIVERSITY OF CALIFO	2/25/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2701 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	5200	19	06037	34.01830697	-118.4569168	Los Angeles County
261827	Fee-for-Service	1467500256	1467500256	1	1	RAND, DIANE E MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	59943	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
261833	Fee-for-Service	1124439807	1124439807	1	11	REGENTS UNIV OF CALIFORNIA U	12/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	STE 101	NOVATO	CA	94945	5057	21	06041	38.09501878	-122.5589434	Marin County
261893	Fee-for-Service	1275604191	1275604191	1	1	RYMAN, KATHLEEN S MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66600	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
261913	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
261918	Fee-for-Service	1710287297	1710287297	1	1	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
261921	Fee-for-Service	1225186182	1225186182	1	1	RUSSO, TERRI A MD	10/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	81001	22	Pathology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
261939	Fee-for-Service	1104191535	1104191535	1	1	ROBERTSON, SABRINA J LCSW	8/2/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
261965	Fee-for-Service	1356683635	1356683635	1	1	RIVERO, ALEXANDER R MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136256	84	Surgery-Head and Neck	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
262010	Fee-for-Service	1710245824	1710245824	1	1	RICHARDSON, ZACHARY MD	11/25/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161126	18	Ophthalmology	0	In state provider	None	622 ABBOTT ST	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
262017	Fee-for-Service	1730296575	1730296575	1	2	RAJ, RISHI MD	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148274	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	SANTA CLARA	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara
262023	Fee-for-Service	1356511232	1356511232	1	1	REES-TAYLOR LLC	3/20/2008	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	DAVID JAMES TAYLOR	434E LANCASTER BLVD	None	LANCASTER	CA	93535	3030	19	06037	34.6967477	-118.1230194	Los Angeles County
262046	Fee-for-Service	1225268501	1225268501	1	1	RAMIREZ, ELIZABETH A	8/14/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168076	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
262069	Fee-for-Service	1578757068	1578757068	1	1	RAPHAEL, DARREN R MD	4/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105292	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
262109	Fee-for-Service	1710287297	1710287297	1	79	REGENTS UNIVERSITY OF CALIFO	5/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RNIA	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
262116	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
262121	Fee-for-Service	1124439807	1124439807	1	11	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	75 ROWLAND WAY	STE 101	NOVATO	CA	94945	5057	21	06041	38.09501878	-122.5589434	Marin County
262123	Fee-for-Service	1285076836	1285076836	1	1	REYES-BERMUDEZ, VANESSA	1/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101232	-	NOT APPLICABLE	0	In state provider	None	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	19	06037	34.08461594	-118.2570874	Los Angeles County
262136	Fee-for-Service	1043278641	1043278641	1	1	RANGARAJ, ARAVIND T MD	10/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145930	02	General Surgery	0	In state provider	None	2333 MOWRY AVE	SUITE 300	FREMONT	CA	94538	1626	01	06001	37.55614438	-121.9822469	Alameda County
262153	Fee-for-Service	1386787505	1386787505	1	1	RAO, IRRAM A MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92730	41	Internal Medicine	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
262156	Fee-for-Service	1831306497	1831306497	1	1	RUDERMAN, SUSAN B	12/17/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1940 W ORANGEWOOD	STE 110	ORANGE	CA	92868	5042	30	06059	33.79574869	-117.8734735	Orange County
262176	Fee-for-Service	1407824162	1407824162	1	1	RANCHO PHYSICAL THERAPY, INC	11/24/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.	31764 CASINO DR	STE 106A&B	LAKE ELSINORE	CA	92530	4571	33	06065	33.65724839	-117.29582	Riverside County
262180	Fee-for-Service	1275604191	1275604191	1	1	RYMAN, KATHLEEN S MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66600	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
262198	Fee-for-Service	1124279385	1124279385	1	1	ROXAS, RODERICK C MD	2/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121302	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
262202	Fee-for-Service	1710287297	1710287297	1	31	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	1010 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	19	06037	34.06108607	-118.4503417	Los Angeles County
262207	Fee-for-Service	1043738529	1043738529	1	1	REES-JONES, ANGHARAD PHD	2/23/2020	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
262208	Fee-for-Service	1710287297	1710287297	1	1	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
262221	Fee-for-Service	1093140733	1093140733	1	1	RUIZ, MORGAN A L OD	5/26/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	414 CENTRAL AVE	None	FILLMORE	CA	93015	1330	56	06111	34.4012415	-118.9138415	Ventura County
262335	Fee-for-Service	1841850914	1841850914	1	1	RENDON, DANIELA LCSW	8/22/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
262343	Fee-for-Service	1063076669	1063076669	1	1	REEDS, LAIRD PT	5/24/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
262352	Fee-for-Service	1174652911	1174652911	1	1	ROSSER, SHERICA N MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96532	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
262358	Fee-for-Service	1457412355	1457412355	1	1	ROBERTS, NANCY H PHD	8/5/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
262377	Fee-for-Service	1982894572	1982894572	1	1	RUBIN, LAWRENCE I DPM INC	4/2/2013	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	STE 106	GARDENA	CA	90247	4276	19	06037	33.89247044	-118.2931941	Los Angeles County
262380	Fee-for-Service	1134347834	1134347834	1	1	RDD ICF INC	7/25/2006	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	741 ADA ST	None	SAN MATEO	CA	94401	3101	41	06081	37.57036392	-122.3070493	San Mateo County
262403	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	3/31/2021	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
262405	Fee-for-Service	1881759207	1881759207	1	1	RAJAN, VIGNA MD	1/1/1998	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	53631	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
262407	Fee-for-Service	1861416653	1861416653	1	1	RILEY, COLLEEN N MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2648 E 14TH ST	None	OAKLAND	CA	94601	1506	01	06001	37.78093089	-122.2316571	Alameda County
262464	Fee-for-Service	1407824162	1407824162	1	1	RANCHO PHYSICAL THERAPY, INC	11/24/2020	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.	31764 CASINO DR	STE 106A&B	LAKE ELSINORE	CA	92530	4571	33	06065	33.65724839	-117.29582	Riverside County
262474	Fee-for-Service	1316072622	1316072622	1	1	RES-CARE CALIFORNIA, INC	11/17/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1775 AUGUSTA LN	None	YUBA CITY	CA	95993	8241	51	06101	39.10472659	-121.6464424	Sutter County
262556	Fee-for-Service	1558690651	1558690651	1	1	ROBINSON, JAMES M NP	1/17/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262598	Fee-for-Service	1194881763	1194881763	1	1	RASLEAR-HENDRICKSON,	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84000	None	None	0	In state provider	MARIA A MD	4987 GOLDEN FOOTHILL PKW	None	EL DORADO HILLS	CA	95762	9364	09	06017	38.63795293	-121.0685958	El Dorado County
262607	Fee-for-Service	1629061643	1629061643	1	1	REGENTS/UCDPBG/IM HEMOTO	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
262612	Fee-for-Service	1275556607	1275556607	1	16	REDWOOD REGIONAL MEDICAL	11/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	347 ANDRIEUX ST	STE 1	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
262655	Fee-for-Service	1700281367	1700281367	1	1	ROBINSON, CAROL A LCSW	6/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
262658	Fee-for-Service	1104185644	1104185644	1	1	ROLLO, JOHNATHON C MD	7/19/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	130427	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
262661	Fee-for-Service	1144622762	1144622762	1	1	RAMOS, OSCAR V MD	3/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133369	01	General Practice	0	In state provider	None	374 W OLIVE AVE	STE A	MERCED	CA	95348	3137	24	06047	37.31914092	-120.4749911	Merced County
262663	Fee-for-Service	1285723254	1285723254	1	1	REYES, NORMAN D MD	8/1/1983	2086S0129X	NA	General Surgery	026	PHYSICIANS	40111	02	General Surgery	0	In state provider	None	3941 J ST	STE 368	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
262677	Fee-for-Service	1700252541	1700252541	1	1	REDDINGTON, DANIEL F	3/26/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE DRIVE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
262682	Fee-for-Service	1235257999	1235257999	1	1	RAMSINGH, DAVINDER S MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103738	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
262690	Fee-for-Service	1710287297	1710287297	1	3	REGENTS UNIVERSITY OF CALIFO	8/20/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2701 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	5200	19	06037	34.01830697	-118.4569168	Los Angeles County
262710	Fee-for-Service	1598827370	1598827370	1	1	REGENTS OF THE UNIV CA	7/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER-SAN DIEGO	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
262712	Fee-for-Service	1457482358	1457482358	2	1	RIGGIO, LEQUYEN LMFT	9/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6845 INDIANA AVE STE 101	None	RIVERSIDE	CA	92506	4224	33	06065	33.94258863	-117.3925691	Riverside County
262716	Fee-for-Service	1063677565	1063677565	1	1	ROMAN, AMY R CCC-SP	4/8/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
262720	Fee-for-Service	1629464474	1629464474	1	1	RIVERA, ANDREW MD	10/1/2024	207L00000X	NA	Other	026	PHYSICIANS	180547	05	Anesthesiology	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
262728	Fee-for-Service	1982684528	1982684528	1	1	REGENTS OF THE UNIV CA	12/1/1996	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	3111 PROFESSIONAL DR	None	AUBURN	CA	95603	2456	31	06061	38.940327	-121.1007585	Placer County
262742	Fee-for-Service	1891521738	1891521738	1	1	RAMIREZ, JOSE D CRNA	11/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
262744	Fee-for-Service	1881734234	1881734234	1	2	RUBENSTEIN, PETER R MD	5/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	19156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	15243 VANOWEN ST	STE 508	VAN NUYS	CA	91405	3668	19	06037	34.19394848	-118.4654115	Los Angeles County
262780	Fee-for-Service	1245469956	1245469956	1	1	RAMIREZ, DANEYDA M LMFT	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
262860	Fee-for-Service	1326034042	1326034042	1	1	ROBERT H MCCOY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7320 216TH ST SW	STE 20	EDMONDS	WA	98026	0000	00	None	47.80320858	-122.3319504	Snohomish County
262878	Fee-for-Service	1053499871	1053499871	1	1	REN, YAFEI MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75902	22	Pathology (M.D. only)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
262949	Fee-for-Service	1285723254	1285723254	1	1	REYES, NORMAN D MD	8/1/1983	2086S0129X	NA	General Surgery	026	PHYSICIANS	40111	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J ST	STE 368	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
262979	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	2/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
263004	Fee-for-Service	1427144989	1427144989	1	1	RIEUX, SHERRIL M MD	12/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48881	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
263010	Fee-for-Service	1922234210	1922234210	1	1	RADASA, TRINETTE L NP	5/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
263044	Fee-for-Service	1497804777	1497804777	1	1	REDDY, VISWANATHA J MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87285	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
263069	Fee-for-Service	1710940077	1710940077	1	1	RODRIGUEZ, GEORGE MD	5/31/1987	207P00000X	NA	Other	026	PHYSICIANS	44901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3030 BUNKER HILL ST	None	SAN DIEGO	CA	92109	5754	37	06073	32.80346216	-117.2151829	San Diego County
263070	Fee-for-Service	1629275383	1629275383	1	1	RAI CARE CTRS GOLDENWEST LLC	4/30/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	15330 GOLDENWEST ST	None	WESTMINSTER	CA	92683	6150	30	06059	33.73959293	-118.0069075	Orange County
263141	Fee-for-Service	1275094450	1275094450	1	1	RANASINGHE, SACHINI MD	9/16/2024	208M00000X	NA	Other	026	PHYSICIANS	176850	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
263144	Fee-for-Service	1841677978	1841677978	1	1	RAVN, JULIE M CRNA	9/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
263147	Fee-for-Service	1023517133	1023517133	1	1	RAMIREZ, CHRISTINA E CRNA	3/6/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
263152	Fee-for-Service	1417035304	1417035304	1	1	REHBEIN, MICHAEL S MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60370	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
263195	Fee-for-Service	1740013770	1740013770	1	1	REYES RHEUMATOLOGY PC	3/21/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	7417 N CEDAR AVE.	# 102	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
263199	Fee-for-Service	1144453754	1144453754	1	1	RIEGO, SUZANNE N NP	2/14/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
263262	Fee-for-Service	1497979470	1497979470	1	1	RIETA, FELICIA LCSW	12/19/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE	STE 215	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
263266	Fee-for-Service	1710287297	1710287297	1	112	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	892 AEROVISTA PLACE	210	SAN LUIS OBISPO	CA	93401	8252	40	06079	35.24277125	-120.6405941	San Luis Obispo County
263306	Fee-for-Service	1073670907	1073670907	1	1	ROMFH, ANITRA W MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56164	41	Internal Medicine	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263330	Fee-for-Service	1811137482	1811137482	1	1	REZNICHENKO, ALEKSANDR A	11/12/2008	193400000X	NA	Other	026	PHYSICIANS	100964	02	General Surgery	0	In state provider	MD APC	470 N GREENFIELD AVE	STE 37	HANFORD	CA	93230	4926	16	06031	36.32996137	-119.6580167	Kings County
263331	Fee-for-Service	1932659059	1932659059	1	1	RUSSO, STEVEN J MD	10/22/2021	208M00000X	NA	Other	026	PHYSICIANS	163836	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
263340	Fee-for-Service	1528081064	1528081064	1	1	ROSENTHAL, STEPHEN M MD	9/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42045	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
263402	Fee-for-Service	1922282284	1922282284	1	2	REZAPOUR, JOHN G MD INC	10/13/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77006	41	Internal Medicine	0	In state provider	None	16661 VENTURA BLVD	STE 211	ENCINO	CA	91436	1938	19	06037	34.15820737	-118.496492	Los Angeles County
263405	Fee-for-Service	1740271063	1740271063	1	1	RICHARD J MILCHAK MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 ROCKY MOUNTAIN AVE	None	LOVELAND	CO	80538	9004	00	None	40.415778	-104.99715	Larimer County
263411	Fee-for-Service	1235615741	1235615741	1	1	RICHARD J. KANG, MD, INC.	11/30/2019	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
263440	Fee-for-Service	1497730394	1497730394	1	1	REM DIAGNOSTICS INC	2/27/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1329 BROAD STREET	SUITE C	SAN LUIS OBISPO	CA	93401	2572	40	06079	35.27695082	-120.6627828	San Luis Obispo County
263447	Fee-for-Service	1235571019	1235571019	1	1	RHOADES, CHELSEA N MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138125	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
263551	Fee-for-Service	1932373149	1932373149	1	1	RODIGIN, ANTHONY MD	3/24/2010	207P00000X	NA	Other	026	PHYSICIANS	102242	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
263555	Fee-for-Service	1275725061	1275725061	1	1	RUIZ, MARITZA E MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107484	68	Hematology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
263556	Fee-for-Service	1710287297	1710287297	1	3	REGENTS UNIVERSITY OF CALIFO	5/28/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RNIA	2701 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	5200	19	06037	34.01830697	-118.4569168	Los Angeles County
263595	Fee-for-Service	1073670907	1073670907	1	1	ROMFH, ANITRA W MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56164	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263611	Fee-for-Service	1942704630	1942704630	1	1	RILEY, FRAN H MD	9/19/2022	207P00000X	NA	Other	026	PHYSICIANS	180686	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263612	Fee-for-Service	1124439807	1124439807	1	3	REGENTS UNIV OF CALIFORNIA U	1/21/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 TAMAL PLAZA	200	CORTE MADERA	CA	94925	1128	21	06041	37.93574053	-122.5199024	Marin County
263628	Fee-for-Service	1528081064	1528081064	1	1	ROSENTHAL, STEPHEN M MD	9/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42045	67	Endocrinology	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
263638	Fee-for-Service	1932287844	1932287844	1	1	REEVE, AMANDA D MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67395	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
263683	Fee-for-Service	1538324645	1538324645	1	1	RAMIN ASHTIANI, MD A PROFESS	10/1/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	600 E WILLIAMS ST	None	BARSTOW	CA	92311	2943	36	06071	34.89759308	-117.0207351	San Bernardino County
263687	Fee-for-Service	1881873123	1881873123	1	1	RAHIMI, MOSTAFA S.	5/26/2009	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1551 W 13TH ST	STE 103	UPLAND	CA	91786	2900	36	06071	34.1105382	-117.6797484	San Bernardino County
263694	Fee-for-Service	1922282284	1922282284	1	2	REZAPOUR, JOHN G MD INC	10/13/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77006	18	Ophthalmology	0	In state provider	None	16661 VENTURA BLVD	STE 211	ENCINO	CA	91436	1938	19	06037	34.15820737	-118.496492	Los Angeles County
263775	Fee-for-Service	1144225236	1144225236	1	1	RAE BOYD	6/20/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2320 FREEWAY DR	None	MOUNT VERNON	WA	98273	5445	00	None	48.44169	-122.3431015	Skagit County
263784	Fee-for-Service	1124014923	1124014923	1	1	REDDY, ANANTHRAM P MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52423	10	Gastroenterology (M.D. only)	0	In state provider	None	6699 ALVARADO RD	STE 2301	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
263820	Fee-for-Service	1306006705	1306006705	1	1	RAJPUT, KARTIC MD	11/12/2019	208VP0000X	NA	Other	026	PHYSICIANS	160187	None	None	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
263824	Fee-for-Service	1871631861	1871631861	2	2	RELIANCE IMPERIAL PHARMACY L	1/23/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1692 S 4TH ST	STE F	EL CENTRO	CA	92243	4747	13	06025	32.7785663	-115.5524203	Imperial County
263838	Fee-for-Service	1396726634	1396726634	1	1	RODERICK PHARMACY GROUP	11/13/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RX EXPRESS PHARMACY	711 E MARKET ST	None	STOCKTON	CA	95202	3104	39	06077	37.95313772	-121.281387	San Joaquin County
263841	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	4/11/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
263842	Fee-for-Service	1275725061	1275725061	1	1	RUIZ, MARITZA E MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107484	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
263862	Fee-for-Service	1831169010	1831169010	1	1	RYAN, PAUL H JR MD	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41682	18	Ophthalmology	0	In state provider	None	1420 TARA HILLS DR	STE D	PINOLE	CA	94564	2530	07	06013	37.99573909	-122.304492	Contra Costa County
263881	Fee-for-Service	1073670907	1073670907	1	1	ROMFH, ANITRA W MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56164	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263899	Fee-for-Service	1124439807	1124439807	1	3	REGENTS UNIV OF CALIFORNIA U	9/5/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 TAMAL PLAZA	200	CORTE MADERA	CA	94925	1128	21	06041	37.93574053	-122.5199024	Marin County
263925	Fee-for-Service	1932287844	1932287844	1	1	REEVE, AMANDA D MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67395	15	Obstetrics (D.O. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
263937	Fee-for-Service	1578084455	1578084455	1	1	ROMEROGARCIA, ULMA LCSW	10/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
263993	Fee-for-Service	1700312956	1700312956	1	2	RAMAN, DAYA MD	1/28/2021	207R00000X	NA	Other	026	PHYSICIANS	163968	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
263996	Fee-for-Service	1437465515	1437465515	1	1	RAMAN, SHANKAR INC	2/11/2011	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	46570	41	Internal Medicine	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
264004	Fee-for-Service	1952441859	1952441859	1	1	RALPH BATTLES	12/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	95 S PAGOSA BLVD	None	PAGOSA SPGS	CO	81147	8329	00	None	37.25234518	-107.0771155	Archuleta County
264060	Fee-for-Service	1629178975	1629178975	1	1	RODRIGUEZ, MARLENE MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84528	40	Pediatrics	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
264061	Fee-for-Service	1518001999	1518001999	1	1	ROSENOW, ELDON L OD	10/21/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	817 COFFEE RD	STE D	MODESTO	CA	95355	4241	50	06099	37.655235	-120.975616	Stanislaus County
264072	Fee-for-Service	1124014923	1124014923	1	1	REDDY, ANANTHRAM P MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52423	41	Internal Medicine	0	In state provider	None	6699 ALVARADO RD	STE 2301	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
264101	Fee-for-Service	1922186667	1922186667	1	1	RATHORE, VIJAY S MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49698	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
264129	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	2/25/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
264130	Fee-for-Service	1275725061	1275725061	1	1	RUIZ, MARITZA E MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107484	40	Pediatrics	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
264140	Fee-for-Service	1245471945	1245471945	1	1	RUANO-GARCIA, LAURA LMFT	11/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 FIRST STREET	SUITE 5	BRENTWOOD	CA	94513	1430	07	06013	37.93394493	-121.6960606	Contra Costa County
264184	Fee-for-Service	1508096918	1508096918	1	1	RUSHTON-MILLER, JILL E MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122346	08	Family Practice	0	In state provider	None	4700 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.440899	-122.6643975	Sonoma County
264185	Fee-for-Service	1770669327	1770669327	1	1	ROSE LU ANN HOMES INC	10/29/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5101 RIDGLEA AVE	None	BUENA PARK	CA	90621	1440	30	06059	33.88662	-117.9891565	Orange County
264187	Fee-for-Service	1124439807	1124439807	1	3	REGENTS UNIV OF CALIFORNIA U	9/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	200 TAMAL PLAZA	200	CORTE MADERA	CA	94925	1128	21	06041	37.93574053	-122.5199024	Marin County
264257	Fee-for-Service	1467743864	1467743864	1	1	ROLLINS, TAMI J DO	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12553	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
264273	Fee-for-Service	1881038800	1881038800	1	1	RABER, BENJAMIN M MD	7/10/2020	208600000X	NA	General Surgery	026	PHYSICIANS	163163	02	General Surgery	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
264283	Fee-for-Service	1437465515	1437465515	1	1	RAMAN, SHANKAR INC	2/11/2011	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	46570	77	Infectious Disease	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
264300	Fee-for-Service	1619961349	1619961349	1	1	ROBERTS, KISMET T MD	2/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54967	08	Family Practice	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95765	3710	31	06061	38.8125	-121.2848698	Placer County
264316	Fee-for-Service	1659893295	1659893295	1	1	RAHMANIAN, RONAK MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150309	04	Otology, Laryngology, Rhinology	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
264324	Fee-for-Service	1710523758	1710523758	1	1	ROSELLE CARE LLC	8/20/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	226 HANNAH WAY	None	PLACENTIA	CA	92870	4636	30	06059	33.8794566	-117.864283	Orange County
264358	Fee-for-Service	1174035836	1174035836	1	1	ROGERS, GIMEL	12/10/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10065 OLD GROVE RD	102	SAN DIEGO	CA	92131	1664	37	06073	32.89886709	-117.1101984	San Diego County
264359	Fee-for-Service	1144200775	1144200775	1	2	REGENTS OF THE UNIVERSITY OF	3/24/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INIC	1620 E ROSEVILLE PARKWAY	200	ROSEVILLE	CA	95661	3303	31	06061	38.74929858	-121.2417037	Placer County
264362	Fee-for-Service	1619090438	1619090438	1	1	RODGERS, ROSEANNE L MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106924	40	Pediatrics	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
264381	Fee-for-Service	1316479603	1316479603	1	1	ROSADO, IVAN H MD	12/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169434	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
264388	Fee-for-Service	1922186667	1922186667	1	1	RATHORE, VIJAY S MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49698	45	Nephrology (Renal-Kidney)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
264389	Fee-for-Service	1881150530	1881150530	1	1	REYNA, ARIANNA M LMFT	7/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
264422	Fee-for-Service	1710287297	1710287297	1	112	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	892 AEROVISTA PLACE	210	SAN LUIS OBISPO	CA	93401	8252	40	06079	35.24277125	-120.6405941	San Luis Obispo County
264430	Fee-for-Service	1104131242	1104131242	1	1	RIVAS, JOSE L MD A PROF CORP	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33853	33	Thoracic Surgery	0	In state provider	None	3100 E FLORENCE AVE	STE 7	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
264433	Fee-for-Service	1740336783	1740336783	1	1	ROMERO, MARISOL B PSYD	1/28/2025	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264448	Fee-for-Service	1336164938	1336164938	1	1	RALPH'S GROCERY COMPANY	4/1/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPH'S #45	12660 LIMONITE AVE	None	CORONA	CA	92880	3201	33	06065	33.97524852	-117.56034	Riverside County
264458	Fee-for-Service	1689935355	1689935355	1	1	RIVADENEYRA, ADAM R MD	7/12/2016	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132857	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
264470	Fee-for-Service	1356668503	1356668503	1	1	RICHMAN, SARAH A MD	8/14/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	168851	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
264476	Fee-for-Service	1124439807	1124439807	1	23	REGENTS UNIV OF CALIFORNIA U	10/24/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	75 ROWLAND WAY	SUITE 275	NOVATO	CA	94945	5061	21	06041	38.09501878	-122.5589434	Marin County
264491	Fee-for-Service	1114079571	1114079571	1	1	RAJA, NANDITA MD	7/1/1998	207RH0000X	NA	Hematology	026	PHYSICIANS	54294	68	Hematology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
264523	Fee-for-Service	1699705772	1699705772	1	1	RAMEZAN-ARAB, NIMA MD	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80191	13	Neurology (M.D. only)	0	In state provider	None	3791 KATELLA AVE	STE 106	LOS ALAMITOS	CA	90720	2000	30	06059	33.80318449	-118.0672965	Orange County
264548	Fee-for-Service	1962530220	1962530220	1	1	RSCR CALIFORNIA, INC	10/22/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1010 OCCIDENTAL DR	None	CLAREMONT	CA	91711	2553	19	06037	34.11948548	-117.7339095	Los Angeles County
264606	Fee-for-Service	1992476279	1992476279	1	1	RAMIREZ HERNANDEZ, MARVIN I	6/4/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	780 ATLANTIC AVE	None	LONG BEACH	CA	90813	4565	19	06037	33.776325	-118.1850235	Los Angeles County
264609	Fee-for-Service	1013477330	1013477330	1	1	RAO, RENEE L MD	6/16/2022	208M00000X	NA	Other	026	PHYSICIANS	177505	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
264647	Fee-for-Service	1144200775	1144200775	1	2	REGENTS OF THE UNIVERSITY OF	8/25/2021	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INIC	1620 E ROSEVILLE PARKWAY	200	ROSEVILLE	CA	95661	3303	31	06061	38.74929858	-121.2417037	Placer County
264666	Fee-for-Service	1891953816	1891953816	1	1	REDELMAN, RYAN MD	8/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	1	Border provider	None	2874 N CARSON ST	STE 300	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
264675	Fee-for-Service	1922186667	1922186667	1	1	RATHORE, VIJAY S MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49698	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
264707	Fee-for-Service	1710287297	1710287297	1	112	REGENTS UNIVERSITY OF CALIFO	11/19/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	892 AEROVISTA PLACE	210	SAN LUIS OBISPO	CA	93401	8252	40	06079	35.24277125	-120.6405941	San Luis Obispo County
264717	Fee-for-Service	1104131242	1104131242	1	1	RIVAS, JOSE L MD A PROF CORP	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33853	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3100 E FLORENCE AVE	STE 7	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
264741	Fee-for-Service	1750169017	1750169017	1	1	R ALEX MANCILLA OD PC	3/13/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	435 W ATEN RD	STE 3	IMPERIAL	CA	92251	9819	13	06025	32.82551409	-115.5729141	Imperial County
264755	Fee-for-Service	1689935355	1689935355	1	1	RIVADENEYRA, ADAM R MD	7/12/2016	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132857	25	Physical Medicine and Rehabilitation	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
264762	Fee-for-Service	1881600336	1881600336	1	1	ROZANSKY,DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2241 LLOYD CENTER	None	PORTLAND	OR	97232	1315	00	None	45.5335562	-122.6538721	Multnomah County
264763	Fee-for-Service	1124439807	1124439807	1	23	REGENTS UNIV OF CALIFORNIA U	10/24/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	75 ROWLAND WAY	SUITE 275	NOVATO	CA	94945	5061	21	06041	38.09501878	-122.5589434	Marin County
264805	Fee-for-Service	1801230891	1801230891	1	1	ROCHA, EVITA MD	8/19/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	138937	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
264806	Fee-for-Service	1225579444	1225579444	1	1	RAPAPORT, ARIELLE LMFT	9/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
264832	Fee-for-Service	1437922531	1437922531	1	1	RADIANT PHYSICAL THERAPY & W	1/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ELLNESS INC	1590 OLD OAKLAND RD	B 102	SAN JOSE	CA	95131	2444	43	06085	37.38046042	-121.8952819	Santa Clara County
264834	Fee-for-Service	1659669489	1659669489	1	1	ROCCHI, MARINA L OD	11/4/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6283 CLARK RD	STE 10	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
264836	Fee-for-Service	1457821639	1457821639	1	1	RADIANT HOSPICE INC	11/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19725 SHERMAN WAY	STE 295D	WINNETKA	CA	91306	3650	19	06037	34.20117847	-118.563057	Los Angeles County
264849	Fee-for-Service	1245877091	1245877091	1	1	RAYO, XIOMARA Y PT	10/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
264887	Fee-for-Service	1811280746	1811280746	1	1	RASTEGAR, JESSICA MD	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115366	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 468W	SANTA MONICA	CA	90404	2180	19	06037	34.02891163	-118.4797466	Los Angeles County
264909	Fee-for-Service	1740388222	1740388222	1	1	RACE, PAOLA F	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
264924	Fee-for-Service	1437142452	1437142452	1	1	REGENTS/UCDPBG/IM INF DI	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
264938	Fee-for-Service	1144200775	1144200775	1	2	REGENTS OF THE UNIVERSITY OF	12/4/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INIC	1620 E ROSEVILLE PARKWAY	200	ROSEVILLE	CA	95661	3303	31	06061	38.74929858	-121.2417037	Placer County
264951	Fee-for-Service	1972528552	1972528552	1	1	RIZKALLA, WEDAD M MD	8/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38657	40	Pediatrics	0	In state provider	None	2201 MOUNT VERNON AVE	STE 211	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
264959	Fee-for-Service	1770962219	1770962219	1	1	ROBBINS VILLARREAL, RICHARD	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ARREAL LMFT	41690 ENTERPRISE CIR N	STE 204	TEMECULA	CA	92590	5627	33	06065	33.51949343	-117.1693521	Riverside County
264972	Fee-for-Service	1568039352	1568039352	1	1	RELIABLE HOME HEALTH SERVICE	12/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3959 FOOTHILL BLVD	STE 302	GLENDALE	CA	91214	1664	19	06037	34.24025956	-118.2658392	Los Angeles County
264997	Fee-for-Service	1255736476	1255736476	1	1	RODRIGUEZ, ROSA D MD	11/9/2020	2080P0006X	NA	Psychiatry	026	PHYSICIANS	149935	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
264998	Fee-for-Service	1710287297	1710287297	1	48	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
265038	Fee-for-Service	1225312218	1225312218	1	1	RAMBHATLA, SAVITRI K MD INC	2/5/2016	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	36245	40	Pediatrics	0	In state provider	None	101 EAST BEVERLY BLVD	STE 407	MONTEBELLO	CA	90640	4300	19	06037	34.01556395	-118.0983878	Los Angeles County
265052	Fee-for-Service	1124439807	1124439807	1	23	REGENTS UNIV OF CALIFORNIA U	2/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	75 ROWLAND WAY	SUITE 275	NOVATO	CA	94945	5061	21	06041	38.09501878	-122.5589434	Marin County
265091	Fee-for-Service	1952468811	1952468811	1	1	ROBERTS, ALISON CNM	8/13/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
265104	Fee-for-Service	1568910289	1568910289	1	1	RIGHETTI, PATRICIA S CSW	6/22/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93266	-	NOT APPLICABLE	0	In state provider	None	1523 LONGBRANCH AVE	None	GROVER BEACH	CA	93433	2508	40	06079	35.11917729	-120.6126498	San Luis Obispo County
265109	Fee-for-Service	1942644398	1942644398	1	1	RUELAN, JUSEL M DO	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13811	01	General Practice	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
265121	Fee-for-Service	1457821639	1457821639	1	1	RADIANT HOSPICE INC	11/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19725 SHERMAN WAY	STE 295D	WINNETKA	CA	91306	3650	19	06037	34.20117847	-118.563057	Los Angeles County
265161	Fee-for-Service	1992981260	1992981260	1	1	RANDEL, KATHRYN E MD	1/20/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	92626	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
265170	Fee-for-Service	1306924436	1306924436	1	1	RUTHERFORD, KATHARINE MD	3/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59585	66	Emergency Medicine (Urgent Care)	0	In state provider	None	529 E CENTER ST	None	MANTECA	CA	95336	4719	39	06077	37.7991466	-121.2100354	San Joaquin County
265191	Fee-for-Service	1972760411	1972760411	1	1	RANCHERO, REBEKAH R DO	10/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14787	01	General Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
265197	Fee-for-Service	1659561710	1659561710	1	1	REYNOLDS, NAOMI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100605	01	General Practice	0	In state provider	None	3227 STANISLAUS ST	STE A	RIVERBANK	CA	95367	2464	50	06099	37.73504644	-120.9365506	Stanislaus County
265212	Fee-for-Service	1437142452	1437142452	1	1	REGENTS/UCDPBG/IM INF DI	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
265223	Fee-for-Service	1144200775	1144200775	1	2	REGENTS OF THE UNIVERSITY OF	1/11/2023	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INIC	1620 E ROSEVILLE PARKWAY	200	ROSEVILLE	CA	95661	3303	31	06061	38.74929858	-121.2417037	Placer County
265238	Fee-for-Service	1235191388	1235191388	1	1	REX SPEAR	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
265255	Fee-for-Service	1013051143	1013051143	1	1	RICHMOND, STEPHEN H MD	1/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	71303	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
265259	Fee-for-Service	1982017844	1982017844	1	1	REDWOOD COMMUNITY SERVICES	12/22/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	140 GIBSON ST	None	UKIAH	CA	95482	3941	23	06045	39.15783474	-123.2091256	Mendocino County
265279	Fee-for-Service	1710287297	1710287297	1	52	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
265290	Fee-for-Service	1992749584	1992749584	1	1	ROBERT DEAN ACTON M.D.	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 RIVERSIDE AVE	None	MINNEAPOLIS	MN	55454	1450	00	None	44.96613258	-93.23756795	Hennepin County
265306	Fee-for-Service	1437591211	1437591211	1	1	RAHMANI, SINA MD	4/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131829	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
265330	Fee-for-Service	1760508980	1760508980	1	1	RAYGOZA, ANJELICA LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
265342	Fee-for-Service	1720518889	1720518889	1	1	ROMAN GONZALEZ, JENNIFER LM	7/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
265345	Fee-for-Service	1689150070	1689150070	1	1	RESHALE L THOMAS, A PSYCHOLO	1/31/2019	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2900 FRESNO ST	STE 108	FRESNO	CA	93721	1439	10	06019	36.74256783	-119.7827878	Fresno County
265381	Fee-for-Service	1447319017	1447319017	1	1	RAVAD, GUY A MD	9/30/1995	207U00000X	NA	Other	026	PHYSICIANS	81223	42	Nuclear Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
265410	Fee-for-Service	1184025074	1184025074	1	1	REHAB OF FRESNO ASSISTED	2/2/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING LLC	1665 M ST	None	FRESNO	CA	93721	1121	10	06019	36.74258317	-119.7942345	Fresno County
265411	Fee-for-Service	1629085873	1629085873	2	1	ROSE, ROBERT J MD	3/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52454	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
265452	Fee-for-Service	1306924436	1306924436	1	1	RUTHERFORD, KATHARINE MD	3/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59585	01	General Practice	0	In state provider	None	529 E CENTER ST	None	MANTECA	CA	95336	4719	39	06077	37.7991466	-121.2100354	San Joaquin County
265484	Fee-for-Service	1598758666	1598758666	1	2	REGENTS/UCDPBG/PATHOLOGY	5/8/2020	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
265494	Fee-for-Service	1538693759	1538693759	1	1	ROBINSON, AMANDA	2/28/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
265510	Fee-for-Service	1780601534	1780601534	1	1	RAZALAN, LEE G MD APC	3/28/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	30884	01	General Practice	0	In state provider	None	2511 PACIFIC AVE	None	LONG BEACH	CA	90806	3033	19	06037	33.802893	-118.193809	Los Angeles County
265513	Fee-for-Service	1285654889	1285654889	1	1	RIEDL, MARC A MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75551	07	Dermatology	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
265535	Fee-for-Service	1588632335	1588632335	1	1	REDDY, SHASHI K MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78663	34	Urology and Urological Surgery	0	In state provider	None	10515 BALBOA BLVD	STE 140	GRANADA HILLS	CA	91344	6350	19	06037	34.261497	-118.502318	Los Angeles County
265538	Fee-for-Service	1427441922	1427441922	1	1	RAHMANY, SAEMA	6/25/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
265553	Fee-for-Service	1023054012	1023054012	1	1	RENO HEART PHYSICIANS	7/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	343 ELM ST	STE 400	RENO	NV	89503	4541	00	None	39.53251653	-119.8196372	Washoe County
265590	Fee-for-Service	1427277664	1427277664	1	1	RAGHAVAN, USHA M MD	8/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	53861	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
265597	Fee-for-Service	1902016082	1902016082	1	1	RAFIE, SHERVIN MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97184	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
265608	Fee-for-Service	1518304252	1518304252	1	1	ROTH, SARAH DO	12/12/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
265642	Fee-for-Service	1245399740	1245399740	1	1	ROSANIO, SALVATORE MD	10/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55461	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27555 YNEZ RD	STE 400	TEMECULA	CA	92591	4679	33	06065	33.50370608	-117.1492569	Riverside County
265688	Fee-for-Service	1033391966	1033391966	1	1	ROCHA-CADMAN, XIOMARA D MD	7/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155903	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
265736	Fee-for-Service	1306924436	1306924436	1	1	RUTHERFORD, KATHARINE MD	3/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59585	08	Family Practice	0	In state provider	None	529 E CENTER ST	None	MANTECA	CA	95336	4719	39	06077	37.7991466	-121.2100354	San Joaquin County
265768	Fee-for-Service	1598758666	1598758666	1	2	REGENTS/UCDPBG/PATHOLOGY	5/1/1999	207ZP0105X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
265776	Fee-for-Service	1780631127	1780631127	1	1	RAM L MITTAL MD	3/27/2003	261Q00000X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	DISEASE MEDICAL CTR, INC	7215 N FRESNO ST	STE 101	FRESNO	CA	93720	2969	10	06019	36.84149009	-119.7829064	Fresno County
265837	Fee-for-Service	1720643729	1720643729	1	1	REBHAN, ANH D DO	5/20/2022	390200000X	NA	Other	026	PHYSICIANS	19556	None	None	0	In state provider	None	1640 NEWPORT BLVD	SUITE 210	COSTA MESA	CA	92627	3786	30	06059	33.63437128	-117.9221659	Orange County
265896	Fee-for-Service	1851675524	1851675524	1	1	REGO, ROBERT E OD	1/12/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
265900	Fee-for-Service	1033485990	1033485990	1	1	RAJU, SAAGAR K MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122181	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
265985	Fee-for-Service	1184981474	1184981474	1	1	READ, BLAKE M MD	10/4/2018	208600000X	NA	General Surgery	026	PHYSICIANS	126722	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
266042	Fee-for-Service	1407152481	1407152481	1	1	RICHTER, GRACE M MD	4/8/2014	193400000X	NA	Other	026	PHYSICIANS	115137	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
266055	Fee-for-Service	1932287638	1932287638	1	1	RIZZO, MICHAEL J MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	57547	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
266066	Fee-for-Service	1063513554	1063513554	1	1	ROSENSTEIN, ALEXANDER MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	50598	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266100	Fee-for-Service	1083083505	1083083505	1	1	RAZO, MYRNA NP	4/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95002919	-	NOT APPLICABLE	0	In state provider	None	8898 CLAIREMONT MESA	BOULEVARD SUITE H	SAN DIEGO	CA	92123	1148	37	06073	32.83151508	-117.1370233	San Diego County
266109	Fee-for-Service	1689892622	1689892622	1	1	REAVES, MIRIAM L MD	11/25/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99809	08	Family Practice	0	In state provider	None	147 N BRENT STREET	COMM MEM HOSP	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
266118	Fee-for-Service	1225445729	1225445729	1	1	RANDALL, TIFFANY PSYD	10/23/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
266149	Fee-for-Service	1518031822	1518031822	1	1	RACHMAT, MARIA C MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80454	40	Pediatrics	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
266176	Fee-for-Service	1992012306	1992012306	1	10	ROLLING HILLS CLINIC	5/16/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14893664	-122.2178101	Tehama County
266228	Fee-for-Service	1598791600	1598791600	1	3	RANCHO FAMILY MEDICAL GROUP,	8/22/2024	207V00000X	NA	Obstetrics & Gynecology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	WELLNESS	31170 TEMECULA PKWY	STE 201	TEMECULA	CA	92592	2914	33	06065	33.47598766	-117.1199967	Riverside County
266240	Fee-for-Service	1295286326	1295286326	1	1	RUAN, JAY J LCSW	5/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
266257	Fee-for-Service	1902081813	1902081813	1	1	RICHARDS, JASON P MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120201	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
266280	Fee-for-Service	1215570239	1215570239	1	1	RENNACKER, ERIC LMFT	10/17/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84379	-	NOT APPLICABLE	0	In state provider	None	3525 PRESLEY AVE	None	RIVERSIDE	CA	92507	4453	33	06065	33.978609	-117.3469995	Riverside County
266285	Fee-for-Service	1265457287	1265457287	1	1	ROSENTHAL, EBEN L MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136361	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266292	Fee-for-Service	1811968126	1811968126	1	1	ROSEN, STEVEN T MD	11/28/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	129723	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
266352	Fee-for-Service	1417222878	1417222878	1	1	ROMERO, PATRICIA V MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127083	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
266353	Fee-for-Service	1013906973	1013906973	1	4	REGENTS OF THE UNIV OF CA	8/13/2020	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1801 E MARCH	C-330	STOCKTON	CA	95210	6658	39	06077	38.00315652	-121.2868715	San Joaquin County
266400	Fee-for-Service	1992324032	1992324032	1	1	RAMSEIER, JULIE MD	11/17/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	187146	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
266462	Fee-for-Service	1992012306	1992012306	1	10	ROLLING HILLS CLINIC	5/16/2023	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14893664	-122.2178101	Tehama County
266464	Fee-for-Service	1366804403	1366804403	1	1	RUBIO, LUIS A	6/30/2021	390200000X	NA	Other	026	PHYSICIANS	152775	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
266475	Fee-for-Service	1710669973	1710669973	1	1	RASMUSSEN, MELISSA A PT	12/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5255 EL CAMINO REAL	SUITE C	ATASCADERO	CA	93422	3351	40	06079	35.49280107	-120.6762923	San Luis Obispo County
266502	Fee-for-Service	1326078361	1326078361	1	1	ROOZROKH, BABAK MD	11/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	81646	41	Internal Medicine	0	In state provider	None	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	19	06037	34.05159882	-118.4385447	Los Angeles County
266519	Fee-for-Service	1598791600	1598791600	1	3	RANCHO FAMILY MEDICAL GROUP,	4/30/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	WELLNESS	31170 TEMECULA PKWY	STE 201	TEMECULA	CA	92592	2914	33	06065	33.47598766	-117.1199967	Riverside County
266529	Fee-for-Service	1205007317	1205007317	1	1	RANA, NAEEM A MD APC	9/24/2008	174400000X	NA	Other	026	PHYSICIANS	52541	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	535 E ROMIE LANE	SUITE 14	SALINAS	CA	93901	4026	27	06053	36.65969283	-121.6449044	Monterey County
266545	Fee-for-Service	1801871439	1801871439	1	1	ROAN, RALPH R MD	1/1/1979	208600000X	NA	General Surgery	026	PHYSICIANS	31574	02	General Surgery	0	In state provider	None	3838 CALIFORNIA ST	STE 6	SAN FRANCISCO	CA	94118	1522	38	06075	37.78591809	-122.4575439	San Francisco County
266557	Fee-for-Service	1093827248	1093827248	1	1	RAHMATI, ELHAM MD	2/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	135444	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
266579	Fee-for-Service	1811968126	1811968126	1	1	ROSEN, STEVEN T MD	11/28/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	129723	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
266605	Fee-for-Service	1740252493	1740252493	1	1	ROSS, EDWARD V JR MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50069	07	Dermatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
266640	Fee-for-Service	1427184233	1427184233	1	1	REYNOLDS, PAUL MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64135	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266710	Fee-for-Service	1225187628	1225187628	1	1	RIOS-RAMOS, ALEJANDRO MD	11/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89613	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266752	Fee-for-Service	1063468783	1063468783	1	1	ROTTER, ARNOLD J MD	8/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47249	30	Radiology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
266760	Fee-for-Service	1689845513	1689845513	1	1	RODRIGUEZ, YOLANDA B LMFT	4/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
266786	Fee-for-Service	1730256579	1730256579	1	1	RAYMUNDO, CLARISSA G OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	22550 E SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
266790	Fee-for-Service	1730648619	1730648619	1	1	RIGAUD, RACHELLE MD	7/23/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
266799	Fee-for-Service	1598791600	1598791600	1	3	RANCHO FAMILY MEDICAL GROUP,	4/30/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	WELLNESS	31170 TEMECULA PKWY	STE 201	TEMECULA	CA	92592	2914	33	06065	33.47598766	-117.1199967	Riverside County
266828	Fee-for-Service	1801871439	1801871439	1	1	ROAN, RALPH R MD	1/1/1979	208600000X	NA	General Surgery	026	PHYSICIANS	31574	01	General Practice	0	In state provider	None	3838 CALIFORNIA ST	STE 6	SAN FRANCISCO	CA	94118	1522	38	06075	37.78591809	-122.4575439	San Francisco County
266836	Fee-for-Service	1033519210	1033519210	1	1	RONCEVIC, MICHELLE LPCC	12/20/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
266842	Fee-for-Service	1093827248	1093827248	1	1	RAHMATI, ELHAM MD	2/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	135444	77	Infectious Disease	0	In state provider	None	2335 E KASHIAN LN	STE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
266847	Fee-for-Service	1679829733	1679829733	1	1	RUHL, ELIZABETH K PSYD	4/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266853	Fee-for-Service	1659518595	1659518595	1	1	REICHENBACH, AMY PHD	3/12/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13524 SHERMAN WAY	None	VAN NUYS	CA	91405	2830	19	06037	34.20116047	-118.4276835	Los Angeles County
266860	Fee-for-Service	1235192378	1235192378	1	1	RENAL TREATMENT CENTERS	12/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	40945 COUNTY CENTER DR	STE G	TEMECULA	CA	92591	6006	33	06065	33.52874922	-117.1597633	Riverside County
266876	Fee-for-Service	1336170075	1336170075	1	1	RIAZ, HASSAN MD	3/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91582	01	General Practice	0	In state provider	None	16444 PARAMOUNT BLVD	STE 103	PARAMOUNT	CA	90723	5453	19	06037	33.8848179	-118.1599671	Los Angeles County
266881	Fee-for-Service	1265469142	1265469142	1	1	RIGGS AMBULANCE SERVICE	12/4/2000	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1827 CANAL ST	None	MERCED	CA	95340	4812	24	06047	37.30299517	-120.482479	Merced County
266883	Fee-for-Service	1598726242	1598726242	1	1	RYAN, DAVID I MD	12/21/2021	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
266897	Fee-for-Service	1144223934	1144223934	1	1	RANA, JASBIR K MD	4/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	29810	40	Pediatrics	0	In state provider	None	2600 PARK AVE	STE 208	CONCORD	CA	94520	1923	07	06013	37.98468938	-122.0340623	Contra Costa County
266936	Fee-for-Service	1700809233	1700809233	1	1	RAZO, PABLO R MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73487	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
266969	Fee-for-Service	1598339681	1598339681	1	1	RIDDICK, TYLER A NP	7/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
267015	Fee-for-Service	1699297135	1699297135	1	1	ROBINSON, ANISSA R	3/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
267072	Fee-for-Service	1730648619	1730648619	1	1	RIGAUD, RACHELLE MD	7/23/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
267152	Fee-for-Service	1982177267	1982177267	1	1	ROBEL, HELENA PT	6/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
267159	Fee-for-Service	1730123662	1730123662	1	1	ROSEN, MITCHELL P MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79422	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
267161	Fee-for-Service	1831247618	1831247618	1	1	RAMANATHAN, BHUVANA K MD	3/31/1992	207R00000X	NA	Other	026	PHYSICIANS	78086	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
267173	Fee-for-Service	1225667181	1225667181	1	1	RALEY'S	2/22/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4690 FREEPORT BLVD	None	SACRAMENTO	CA	95822	2068	34	06067	38.533158	-121.4961615	Sacramento County
267179	Fee-for-Service	1699782987	1699782987	1	1	RIVAS, JAIME B MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	80889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
267298	Fee-for-Service	1285912741	1285912741	1	1	RODRIGUEZ, MARGARITA A MD	9/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117502	01	General Practice	0	In state provider	None	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	19	06037	33.97478347	-118.253943	Los Angeles County
267327	Fee-for-Service	1306340534	1306340534	1	1	RUBIO, GABRIEL R MD	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	167002	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
267358	Fee-for-Service	1457712333	1457712333	1	1	RADIANCE HOSPICE INC	1/4/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4201 LONG BEACH BLVD	STE 412A	LONG BEACH	CA	90807	2010	19	06037	33.83493255	-118.1895197	Los Angeles County
267398	Fee-for-Service	1316988256	1316988256	1	1	RENAISSANCE RADIOLOGY	10/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	550 N MONTEREY AVE	None	ONTARIO	CA	91764	3318	36	06071	34.069239	-117.642987	San Bernardino County
267443	Fee-for-Service	1083835276	1083835276	1	1	RHEE, CONNIE M MD	6/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124707	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
267474	Fee-for-Service	1245423136	1245423136	1	1	ROSSE, TOMASZ A MD	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	92896	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
267482	Fee-for-Service	1659623429	1659623429	1	1	RIEBER, ALEXIS K MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123143	04	Otology, Laryngology, Rhinology	0	In state provider	None	547 E UNION STREET	None	PASADENA	CA	91101	1743	19	06037	34.1472385	-118.139094	Los Angeles County
267491	Fee-for-Service	1023634375	1023634375	1	1	REEDLEY COMMUNITY HOSPITAL	7/30/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
267503	Fee-for-Service	1619934239	1619934239	1	1	RANJI, SUMANT R MD	6/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79938	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267528	Fee-for-Service	1245293810	1245293810	1	1	ROBERTS, TIMOTHY L CRNA	8/8/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
267598	Fee-for-Service	1013264811	1013264811	1	1	RUSOVICK, RICHARD M LMFT	1/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
267623	Fee-for-Service	1992881478	1992881478	1	1	RADY CHILDREN'S HOSPITAL	4/25/1990	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8291 AERO PL	STE 130	SAN DIEGO	CA	92123	2037	37	06073	32.80793485	-117.1471048	San Diego County
267641	Fee-for-Service	1457712333	1457712333	1	1	RADIANCE HOSPICE INC	1/4/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4201 LONG BEACH BLVD	STE 412A	LONG BEACH	CA	90807	2010	19	06037	33.83493255	-118.1895197	Los Angeles County
267644	Fee-for-Service	1770056772	1770056772	1	1	RAHIMI, SINA DO	6/3/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	17399	None	None	0	In state provider	None	4060 FOURTH AVE	STE 220	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
267659	Fee-for-Service	1316371834	1316371834	1	1	RIVAS, CECILIA A OD	7/12/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
267660	Fee-for-Service	1881663979	1881663979	1	1	RANDAZZO, GUY P MD	5/28/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	22452	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	STE 608	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
267706	Fee-for-Service	1558709956	1558709956	1	1	REIGNS, STEVEN D MFT	7/26/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	92675	-	NOT APPLICABLE	0	In state provider	None	1849 SAWTELLE BLVD	SUITE 100	LOS ANGELES	CA	90025	7082	19	06037	34.04266851	-118.4451527	Los Angeles County
267726	Fee-for-Service	1508084690	1508084690	1	1	RIVES, ADAM W MD	6/11/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	120223	46	Hand Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
267729	Fee-for-Service	1891314134	1891314134	1	1	RUIZ, PAIGE	3/22/2024	390200000X	NA	Other	026	PHYSICIANS	184087	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
267801	Fee-for-Service	1366519126	1366519126	1	1	ROUSE, NANCY A CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	18081 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	1304	30	06059	33.69987737	-117.9892394	Orange County
267812	Fee-for-Service	1962459990	1962459990	1	1	ROSEVILLE ORTHO. SURG. &	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	SPORTS MEDICINE	151 N SUNRISE AVE	STE 1005	ROSEVILLE	CA	95661	2930	31	06061	38.74746043	-121.2655348	Placer County
267839	Fee-for-Service	1164614400	1164614400	1	1	RANADE, RAJDEEP V MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105766	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95834	2309	34	06067	38.647737	-121.510467	Sacramento County
267853	Fee-for-Service	1861766354	1861766354	1	1	RODRIGUEZ, ANA P LMFT	9/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8325 HAVEN AVENUE	SUITE 207	RANCHO CUCAMONGA	CA	91730	3894	36	06071	34.10122106	-117.5757252	San Bernardino County
267867	Fee-for-Service	1003942277	1003942277	1	1	RENSCHLER, MARKUS F MD	8/5/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	65164	41	Internal Medicine	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
267928	Fee-for-Service	1386669265	1386669265	1	1	RUPER, ROBERT F MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	30076	18	Ophthalmology	0	In state provider	OPTHALMIC CONSLT LAB	436 S GLASSELL ST	STE 5	ORANGE	CA	92866	1906	30	06059	33.78169507	-117.8531509	Orange County
267931	Fee-for-Service	1295798338	1295798338	1	1	RENAL TREATMENT CENTERS	4/2/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	312 S FAIRMONT AVE	STE A	LODI	CA	95240	3840	39	06077	38.129112	-121.285892	San Joaquin County
267944	Fee-for-Service	1881663979	1881663979	1	1	RANDAZZO, GUY P MD	5/28/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	22452	41	Internal Medicine	0	In state provider	None	1201 W LA VETA AVE	STE 608	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
267956	Fee-for-Service	1346834132	1346834132	1	1	REYNOSO, JACOB PT	9/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B ST	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
267957	Fee-for-Service	1154313088	1154313088	1	1	ROBERT M FARNER	5/28/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
267993	Fee-for-Service	1245501899	1245501899	1	1	RASANIA, SURAJ P MD	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148534	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	255 E BONITA AVE	SUITE 101	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
267994	Fee-for-Service	1528131786	1528131786	1	1	RIVEIRA, MARY A CRNA	10/3/2003	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
267995	Fee-for-Service	1992893424	1992893424	1	1	RAMIN, DAVID S MD APMC	11/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64295	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVE	STE 707	CULVER CITY	CA	90232	6841	19	06037	34.02243278	-118.3981492	Los Angeles County
268026	Fee-for-Service	1225055270	1225055270	1	1	ROZESKI, JASON	6/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
268055	Fee-for-Service	1669481214	1669481214	1	1	RUTHENBERG, JOANNA C MD	2/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80604	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
268071	Fee-for-Service	1558449447	1558449447	1	1	RUBIN, PAUL J MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77179	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
268173	Fee-for-Service	1992178735	1992178735	1	1	REED, CHRISTINA Y MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	77539	01	General Practice	0	In state provider	None	3202 DUKE ST	None	SAN DIEGO	CA	92110	5401	37	06073	32.75280396	-117.2187575	San Diego County
268285	Fee-for-Service	1699965723	1699965723	1	1	ROMERO, ALICIA S MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97704	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2925 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78196609	-122.4503642	San Francisco County
268294	Fee-for-Service	1053949115	1053949115	1	1	ROBINSON, MERCEDES L MD	6/26/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	188910	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268304	Fee-for-Service	1821221227	1821221227	1	1	ROACHE, JANELLE LCSW	2/7/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
268310	Fee-for-Service	1225055270	1225055270	1	1	ROZESKI, JASON	6/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
268377	Fee-for-Service	1144568908	1144568908	1	1	RIOS, CAROLYN CRNA	9/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
268381	Fee-for-Service	1578706693	1578706693	1	1	RAHMAN, SHAYAN UR MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98224	02	General Surgery	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
268399	Fee-for-Service	1962510198	1962510198	1	1	RAYNER, SANDRA E AU	1/17/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
268445	Fee-for-Service	1972636272	1972636272	1	1	ROSEBOROUGH, INGRID E MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	92548	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268455	Fee-for-Service	1245012038	1245012038	1	1	RAMIREZ, ANNA NP	11/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
268472	Fee-for-Service	1255968566	1255968566	1	1	ROGERS, HILARY E MD	7/26/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	190910	15	Obstetrics (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
268499	Fee-for-Service	1386678159	1386678159	1	1	REISS-HOLT, AMBER MD	5/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83063	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
268528	Fee-for-Service	1073275681	1073275681	1	1	REGIONAL HEALTH SERVICES,	11/17/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	12501 CHANDLER BLVD	STE 206A	VALLEY VILLAGE	CA	91607	1941	19	06037	34.16870346	-118.4056065	Los Angeles County
268558	Fee-for-Service	1437142452	1437142452	1	2	REGENTS/UCDPBG/IM INF DI	5/1/1999	207RI0200X	NA	HIV/AIDS/Infectious Disease	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
268565	Fee-for-Service	1235386178	1235386178	1	1	RAMSEY, MEGHAN C MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109107	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
268586	Fee-for-Service	1144308743	1144308743	1	1	RICHARDS, TOBY D NP	12/3/2019	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
268595	Fee-for-Service	1033447677	1033447677	1	1	ROMERO, SANDRA P	12/27/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
268708	Fee-for-Service	1932474988	1932474988	1	1	REMULLA, HEIDI D MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126957	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
268732	Fee-for-Service	1679513857	1679513857	1	1	ROCKOFF, MARK R MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37042	30	Radiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
268738	Fee-for-Service	1821478397	1821478397	1	1	REGHUNATHAN, ARUN MD	9/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172665	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
268756	Fee-for-Service	1255968566	1255968566	1	1	ROGERS, HILARY E MD	7/26/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	190910	09	Gynecology (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
268769	Fee-for-Service	1356352660	1356352660	1	1	RADIOLOGICAL ASSOCIATES	7/1/1983	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
268772	Fee-for-Service	1225186109	1225186109	1	1	REYES, EDWARDO P MD	3/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50239	08	Family Practice	0	In state provider	None	1615 VERDUGO BLVD	None	LA CANADA	CA	91011	3012	19	06037	34.20570147	-118.2122685	Los Angeles County
268813	Fee-for-Service	1255872651	1255872651	1	1	RYCEWICZ, DEREK C MD	6/28/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177757	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268820	Fee-for-Service	1588773667	1588773667	1	1	RANDHAWA, TEJINDER S MD	3/27/2007	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	APC	805 FRESNO ST	None	FRESNO	CA	93706	3118	10	06019	36.72759914	-119.8041481	Fresno County
268823	Fee-for-Service	1336481886	1336481886	1	1	ROCKOFF, STEVEN J MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156278	30	Radiology	0	In state provider	None	2315 STOCKTION BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
268851	Fee-for-Service	1437142452	1437142452	1	2	REGENTS/UCDPBG/IM INF DI	9/8/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
268903	Fee-for-Service	1093126856	1093126856	1	1	RORVIG, LEAH B MD	6/22/2018	390200000X	NA	Other	026	PHYSICIANS	138658	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
268952	Fee-for-Service	1104026681	1104026681	1	1	RAJU, ROMAN MD	5/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173729	30	Radiology	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
268954	Fee-for-Service	1659367647	1659367647	1	1	RUBEN VILLA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KIDNEY DISEASE ASSOCIATE	1607 W LOOP 289	None	LUBBOCK	TX	79416	0000	00	None	33.5794397	-101.942969	Lubbock County
268969	Fee-for-Service	1811442874	1811442874	1	1	REGIONAL ANESTHESIA	10/6/2016	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ASSOCIATES INC	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
268980	Fee-for-Service	1730264268	1730264268	2	3	ROBERG, SCOT L DPM	8/9/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	451 GONZALES RD	None	OXNARD	CA	93036	9004	56	06111	34.21921445	-119.1816945	Ventura County
268986	Fee-for-Service	1891092359	1891092359	1	1	ROLLINS, MARLON R LPCC	5/13/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
269007	Fee-for-Service	1063702694	1063702694	1	1	ROURKE, SARA S MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137469	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
269055	Fee-for-Service	1841275930	1841275930	1	1	RODMAN, NORJA N PT	6/21/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8790 CUYAMACA ST.	SUITE A	SANTEE	CA	92071	4295	37	06073	32.83583009	-116.9839098	San Diego County
269071	Fee-for-Service	1831694215	1831694215	1	1	RANEY, EMERALD MD	12/23/2020	207P00000X	NA	Other	026	PHYSICIANS	164897	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
269134	Fee-for-Service	1346269297	1346269297	1	1	REITER, ROBERT E MD	8/31/1994	208800000X	NA	Other	026	PHYSICIANS	67515	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
269139	Fee-for-Service	1134194822	1134194822	1	1	RANGASWAMY, RAJESH MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
269143	Fee-for-Service	1366401432	1366401432	1	1	RIMPEL, NICOLE R MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76140	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
269203	Fee-for-Service	1780770990	1780770990	1	1	REDDY, ANURADHA MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74645	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
269247	Fee-for-Service	1134556509	1134556509	1	1	RUIZ, MICHAEL PSYD	6/12/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1050 LAKES DR	225	WEST COVINA	CA	91790	2910	19	06037	34.07127962	-117.9226429	Los Angeles County
269249	Fee-for-Service	1811442874	1811442874	1	1	REGIONAL ANESTHESIA	10/6/2016	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOCIATES INC	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
269255	Fee-for-Service	1194207829	1194207829	1	1	ROARK, RUFUS	1/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
269267	Fee-for-Service	1679632244	1679632244	1	1	RODRIGUEZ, GILBERT E MD	12/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	66367	08	Family Practice	0	In state provider	MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
269292	Fee-for-Service	1962509067	1962509067	1	1	RIEMER, RICHARD B DO	9/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	5069	13	Neurology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
269305	Fee-for-Service	1255362919	1255362919	1	1	ROACHE, PAUL B MD	2/8/2015	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	48445	20	Orthopedic Surgery	0	In state provider	None	2351 CLAY ST	STE 134	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
269342	Fee-for-Service	1497807853	1497807853	1	2	RUTHERFORD, KEINO A MD	10/17/2019	207R00000X	NA	Other	026	PHYSICIANS	80432	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
269387	Fee-for-Service	1467544452	1467544452	1	1	RYPINS, ERIC B MD	5/21/2010	193400000X	NA	Other	026	PHYSICIANS	47250	02	General Surgery	0	In state provider	None	161 THUNDER DR	STE 210	VISTA	CA	92083	6052	37	06073	33.18638925	-117.2882216	San Diego County
269411	Fee-for-Service	1841252533	1841252533	1	1	RESNIKOFF, PAMELA M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80358	01	General Practice	0	In state provider	None	9850 GENESEE AVE	STE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
269444	Fee-for-Service	1790876332	1790876332	1	1	REDMAN, ANN R CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
269495	Fee-for-Service	1104540855	1104540855	1	1	RIOS, GABRIELA CNP	4/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
269542	Fee-for-Service	1306487715	1306487715	1	1	REINECKER, CAMILLE R LMFT	1/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	1808 4TH ST	None	SAN FERNANDO	CA	91403	5715	19	06037	34.2915034	-118.4422524	Los Angeles County
269544	Fee-for-Service	1598747495	1598747495	1	1	RICHARDS, WINSTON H MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	31343	34	Urology and Urological Surgery	0	In state provider	None	9041 MAGNOLIA AVE	STE 307	RIVERSIDE	CA	92503	3900	33	06065	33.92541585	-117.4378266	Riverside County
269550	Fee-for-Service	1629006457	1629006457	1	1	REGIONS HOSPITAL	3/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	640 JACKSON ST	None	ST PAUL	MN	55101	2595	00	None	44.95496967	-93.09587426	Ramsey County
269562	Fee-for-Service	1306004940	1306004940	1	1	RATNAM, KRISHNA K MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115443	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
269592	Fee-for-Service	1255665741	1255665741	1	1	ROGERS, LAURA L OD	7/8/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	650 HOWE AVE	STE 830	SACRAMENTO	CA	95825	4797	34	06067	38.577294	-121.4146395	Sacramento County
269651	Fee-for-Service	1508840919	1508840919	1	1	RUSSELL, LAURA A MD	5/1/2014	207L00000X	NA	Other	026	PHYSICIANS	61396	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
269662	Fee-for-Service	1669853370	1669853370	1	1	RUSS, KARL F	9/25/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153548	40	Pediatrics	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
269673	Fee-for-Service	1477035053	1477035053	1	1	RAY, JENNIFER E PT	4/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8135 SARATOGA WAY	STE 200	EL DORADO HILLS	CA	95762	4590	09	06017	38.65291812	-121.0731598	El Dorado County
269686	Fee-for-Service	1356531289	1356531289	1	1	ROBERTSON, CHRISTINE B LCSW	2/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
269692	Fee-for-Service	1841252533	1841252533	1	1	RESNIKOFF, PAMELA M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80358	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9850 GENESEE AVE	STE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
269724	Fee-for-Service	1437424793	1437424793	1	1	RALEIGH, DAVID R MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128389	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
269738	Fee-for-Service	1790172450	1790172450	1	1	RAMSEY, ANDREA M MD	2/11/2022	207R00000X	NA	Other	026	PHYSICIANS	155319	None	None	0	In state provider	None	4136 BACHMAN PL	None	SAN DIEGO	CA	92103	2028	37	06073	32.75258794	-117.1632586	San Diego County
269828	Fee-for-Service	1629006457	1629006457	1	1	REGIONS HOSPITAL	3/1/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	640 JACKSON ST	None	ST PAUL	MN	55101	2595	00	None	44.95496967	-93.09587426	Ramsey County
269857	Fee-for-Service	1568667475	1568667475	1	1	ROMERO, ANDREA R OT	1/6/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
269933	Fee-for-Service	1477972628	1477972628	1	1	RO, KEVIN MD	5/31/2019	390200000X	NA	Other	026	PHYSICIANS	140511	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
269970	Fee-for-Service	1841252533	1841252533	1	1	RESNIKOFF, PAMELA M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80358	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9850 GENESEE AVE	STE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
269995	Fee-for-Service	1588059794	1588059794	1	1	RUGG, CAITLIN MD	10/22/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	147401	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
270000	Fee-for-Service	1194975003	1194975003	1	1	RHOADES, CLAUDETTE NP	6/8/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
270005	Fee-for-Service	1437424793	1437424793	1	1	RALEIGH, DAVID R MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128389	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
270019	Fee-for-Service	1801864509	1801864509	1	1	RAD, SIMA MD	8/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132547	None	None	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
270032	Fee-for-Service	1871770271	1871770271	1	1	RASHIDI, HOOMAN H MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102240	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
270090	Fee-for-Service	1649770579	1649770579	1	1	ROMERO-VIGUERIAS, SANDRA LC	3/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	1400 E COOLEY DR	SUITE 200A	COLTON	CA	92324	3939	36	06071	34.05447652	-117.305298	San Bernardino County
270114	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	8/22/2017	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
270116	Fee-for-Service	1811315583	1811315583	1	1	ROJEK, NATHAN MD	6/28/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	154167	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
270130	Fee-for-Service	1972021095	1972021095	1	1	RUZIN, GABRIELLA R PSYD	5/10/2022	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	755 BAYWOOD DR	FL 2	PETALUMA	CA	94954	5510	49	06097	38.23130634	-122.6132832	Sonoma County
270139	Fee-for-Service	1497741714	1497741714	1	1	RIECK, RICHARD W MD	7/5/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153759	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
270157	Fee-for-Service	1447347877	1447347877	1	1	RINGROSE, ELIZABETH R MD	12/1/2003	207N00000X	NA	Dermatology	026	PHYSICIANS	22961	07	Dermatology	0	In state provider	None	2828 TELEGRAPH AVE	None	BERKELEY	CA	94705	1119	01	06001	37.85882239	-122.2593405	Alameda County
270196	Fee-for-Service	1417299009	1417299009	1	1	ROSATI, ANDREA D MD	8/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	132044	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
270286	Fee-for-Service	1518116367	1518116367	1	1	REEDER, JENNIFER R	6/10/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N BELLFLOWER BLVD	SUITE 315	LONG BEACH	CA	90815	1129	19	06037	33.805692	-118.1251805	Los Angeles County
270328	Fee-for-Service	1912240920	1912240920	1	1	RICHARDSON, JANINE C	3/3/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18057	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
270344	Fee-for-Service	1720050842	1720050842	1	1	RAHIMY, SODABEH MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90082	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
270382	Fee-for-Service	1619294840	1619294840	1	1	RODRIGUEZ, SOPHIA	5/25/2010	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2530 ATLANTIC AVE	STE D	LONG BEACH	CA	90806	2741	19	06037	33.803172	-118.185004	Los Angeles County
270394	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	1/9/2023	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
270403	Fee-for-Service	1013906973	1013906973	1	1	REGENTS OF THE UNIV OF CA	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
270404	Fee-for-Service	1386865988	1386865988	1	1	RON, EYAL MD	7/15/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87286	30	Radiology	0	In state provider	None	250 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	3805	42	06083	34.43089516	-119.7216367	Santa Barbara County
270415	Fee-for-Service	1679635569	1679635569	1	1	REIMAGINE NETWORK	7/28/1993	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	OF SOUTHERN CALIFORNIA	1601 E SAINT ANDREW PL	None	SANTA ANA	CA	92705	4940	30	06059	33.72292198	-117.8481954	Orange County
270439	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
270458	Fee-for-Service	1215398433	1215398433	1	1	RICHARDSON, MARINA LCSW	11/5/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
270514	Fee-for-Service	1487997912	1487997912	1	1	RINKER, SHAWNA M MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132550	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
270521	Fee-for-Service	1063438166	1063438166	1	1	RAHIMI, NASSRIN MD	11/21/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56214	40	Pediatrics	0	In state provider	None	1000 VALE TERRACE	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
270608	Fee-for-Service	1346414273	1346414273	1	1	RICHARD G LUCAS MD	1/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	508 S CHURCH ST	None	MT PLEASANT	PA	15666	1702	00	None	40.14564213	-79.54790049	Westmoreland County
270617	Fee-for-Service	1679039804	1679039804	1	1	ROSEWOOD HOME & PALLIATIVE	4/10/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1241 S GLENDALE AVE	STE 301	GLENDALE	CA	91205	3386	19	06037	34.13065269	-118.2524619	Los Angeles County
270625	Fee-for-Service	1487980538	1487980538	1	1	RUSCH, M THERESA MD INC	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51083	40	Pediatrics	0	In state provider	None	1077 W MORTON AVE	STE 101	PORTERVILLE	CA	93257	1989	54	06107	36.07321848	-119.0412045	Tulare County
270661	Fee-for-Service	1851388607	1851388607	2	1	RAZAVI, MAHMOOD K MD	12/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66274	30	Radiology	0	In state provider	None	1140 W LA VETA AVE	STE 850	ORANGE	CA	92868	4210	30	06059	33.7802984	-117.8651669	Orange County
270672	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	10/28/2021	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
270680	Fee-for-Service	1669617197	1669617197	1	10	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8010 FROST STREET	None	SAN DIEGO	CA	92123	2778	37	06073	32.80026879	-117.1520059	San Diego County
270690	Fee-for-Service	1881835858	1881835858	1	1	REYES, RYAN C	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91076	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
270716	Fee-for-Service	1003173816	1003173816	1	1	RIVAS, RAY H MD	5/7/2020	208600000X	NA	General Surgery	026	PHYSICIANS	164066	02	General Surgery	0	In state provider	None	1325 E CHURCH STREET	SUITE 204	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
270718	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
270726	Fee-for-Service	1275792962	1275792962	1	1	RIALON, KRISTY L MD	2/10/2023	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
270781	Fee-for-Service	1245261023	1245261023	1	2	R. RUIZ, M.D., A PROFESSIONA	12/28/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	NTAL	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	19	06037	34.01035039	-118.109564	Los Angeles County
270799	Fee-for-Service	1346382132	1346382132	1	1	RODRIGUEZ, DOMINGO LMFT	8/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18077 OUTER HWY 18	STE 306	APPLE VALLEY	CA	92307	2197	36	06071	34.54062543	-117.2693795	San Bernardino County
270847	Fee-for-Service	1376834937	1376834937	1	1	REDONDO EMERGENCY PHYSICIANS	8/1/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
270859	Fee-for-Service	1962631101	1962631101	1	1	RANEY, AIDAN R MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106672	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2501 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
270886	Fee-for-Service	1003014119	1003014119	1	1	ROUSE, CHERYL L LMFT	11/4/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
270950	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
270960	Fee-for-Service	1669617197	1669617197	1	10	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SAN DIEGO	8010 FROST STREET	None	SAN DIEGO	CA	92123	2778	37	06073	32.80026879	-117.1520059	San Diego County
270995	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	5/28/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
271029	Fee-for-Service	1376916031	1376916031	1	1	ROSALES, MAYRA A	4/4/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
271059	Fee-for-Service	1245261023	1245261023	1	2	R. RUIZ, M.D., A PROFESSIONA	12/28/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	NTAL	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	19	06037	34.01035039	-118.109564	Los Angeles County
271101	Fee-for-Service	1952411621	1952411621	1	1	RALEY'S DRUG CENTER #194	4/30/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	930 TAHOE BLVD	None	INCLINE VLG	NV	89451	9451	00	None	39.24960556	-119.9500436	Washoe County
271134	Fee-for-Service	1962631101	1962631101	1	1	RANEY, AIDAN R MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106672	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
271139	Fee-for-Service	1215133079	1215133079	1	2	ROSSER, MEAGAN R LMFT	7/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
271145	Fee-for-Service	1376276725	1376276725	1	1	ROSIE MO WONG, OD, OPTOMETRI	2/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	945 W DUARTE RD	None	MONROVIA	CA	91016	4306	19	06037	34.13122228	-118.0198532	Los Angeles County
271153	Fee-for-Service	1750587804	1750587804	1	1	R & G HOME HEALTH CARE	4/1/2016	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	539 GLENOAKS BLVD	SUITE 204B	BURBANK	CA	91502	3208	19	06037	34.18652984	-118.310858	Los Angeles County
271162	Fee-for-Service	1639159197	1639159197	1	1	RYAN, JOSEPH P PT	2/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
271196	Fee-for-Service	1356538722	1356538722	1	1	REFAAT, PARISA	5/30/2009	174400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY	4028 E BROADWAY	None	LONG BEACH	CA	90803	1502	19	06037	33.76442452	-118.1451465	Los Angeles County
271228	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
271233	Fee-for-Service	1003896648	1003896648	1	1	REGENTS OF THE UNIV CA	6/12/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
271253	Fee-for-Service	1851463723	1851463723	1	11	REGENTS OF THE UNIVERSITY OF	3/16/2021	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	2020 SANTA MONICA BLVD	220	SANTA MONICA	CA	90404	2023	19	06037	34.02901811	-118.4795396	Los Angeles County
271273	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	10/28/2021	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
271338	Fee-for-Service	1245261023	1245261023	1	2	R. RUIZ, M.D., A PROFESSIONA	12/28/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	NTAL	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	19	06037	34.01035039	-118.109564	Los Angeles County
271352	Fee-for-Service	1639206584	1639206584	1	1	ROTH, LORENA L LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
271458	Fee-for-Service	1669640785	1669640785	1	1	RUSHER, ANGELA B	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271487	Fee-for-Service	1306924493	1306924493	1	1	ROGERS, ANNE B MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43324	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
271491	Fee-for-Service	1154495869	1154495869	1	1	RUIZ, MYLENE L NP	5/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
271504	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
271505	Fee-for-Service	1003896648	1003896648	1	1	REGENTS OF THE UNIV CA	12/22/2003	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
271524	Fee-for-Service	1407961832	1407961832	1	1	ROMO, ELIZABETH A LCSW	6/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
271553	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
271557	Fee-for-Service	1497907455	1497907455	2	1	REDDING RADIATION ONCOLOGIST	6/6/2019	2085R0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TER	963 BUTTE STREET	None	REDDING	CA	96001	0828	45	06089	40.58567535	-122.3853786	Shasta County
271573	Fee-for-Service	1194918920	1194918920	1	1	REGENTS OF UNIVERSITY CA	12/1/1977	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	SFGH FAMILY PLAN PROJECT	1001 POTRERO AVE	# 6D33	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
271581	Fee-for-Service	1346323904	1346323904	1	1	REID, TONY R MD	6/7/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76747	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
271617	Fee-for-Service	1588607766	1588607766	2	1	REHM, KENNETH B DPM	11/19/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1553 GRAND AVENUE	SUITE B	SAN MARCOS	CA	92078	2427	37	06073	33.14507952	-117.1976581	San Diego County
271634	Fee-for-Service	1942361548	1942361548	1	2	ROMERO, ELIOTT MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48383	15	Obstetrics (D.O. only)	0	In state provider	None	999 N TUSTIN AVE	STE 220	SANTA ANA	CA	92705	6506	30	06059	33.754167	-117.834191	Orange County
271637	Fee-for-Service	1720389919	1720389919	1	1	RODRIGUEZ, YVONNE E MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114351	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
271638	Fee-for-Service	1508972191	1508972191	1	1	ROBERTS, JAMES L MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	59945	None	None	0	In state provider	None	2200 W 3RD ST	STE 500	LOS ANGELES	CA	90057	1938	19	06037	34.06329642	-118.2739484	Los Angeles County
271648	Fee-for-Service	1710467113	1710467113	1	1	RUANO, PABLO A PT	9/24/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3889 W STETSON AVE	SUITE 150	HEMET	CA	92545	9686	33	06065	33.72930152	-117.011988	Riverside County
271781	Fee-for-Service	1003896648	1003896648	1	1	REGENTS OF THE UNIV CA	2/15/2019	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
271783	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	11/28/2022	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
271789	Fee-for-Service	1710175278	1710175278	1	1	RAMAN, RAGHAV MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97250	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271827	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
271853	Fee-for-Service	1588744908	1588744908	2	1	RAJKOVIC, ALEKSANDAR, MD	10/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	155309	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271855	Fee-for-Service	1346323904	1346323904	1	1	REID, TONY R MD	6/7/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76747	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
271887	Fee-for-Service	1013976745	1013976745	1	2	RICHARDSON, BRIAN P MD	10/6/2016	207L00000X	NA	Other	026	PHYSICIANS	43896	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
271939	Fee-for-Service	1548397169	1548397169	2	1	RITCHIE, CARRIE A	8/7/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	21263 ERWIN ST	None	WOODLAND HILLS	CA	91367	3715	19	06037	34.18286951	-118.5949215	Los Angeles County
271965	Fee-for-Service	1780734582	1780734582	1	1	ROTAN, EDWARD E JR MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	91946	01	General Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
272015	Fee-for-Service	1881021608	1881021608	1	1	RAM, SHIVANI OD	10/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	58471 29 PALMS HWY	SUITE 203	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
272021	Fee-for-Service	1679101737	1679101737	1	1	REHDER, THOMAS DO	10/23/2023	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	19494	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
272036	Fee-for-Service	1093116766	1093116766	1	1	RAFAEL, SHAUN P DO	7/29/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15077	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
272055	Fee-for-Service	1669617197	1669617197	1	5	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
272060	Fee-for-Service	1063574044	1063574044	1	1	RICHMAN, ERIC I OD	2/27/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	293 WILLOW ST	None	BISHOP	CA	93514	2720	14	06027	37.36287548	-118.3915755	Inyo County
272100	Fee-for-Service	1669617197	1669617197	1	9	RADY CHILDREN'S HOSPITAL SAN	8/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	477 N EL CAMINO REAL	SUITE 302	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
272129	Fee-for-Service	1578729315	1578729315	1	1	REGGIARDO, GINA E MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99646	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
272137	Fee-for-Service	1528131281	1528131281	1	1	ROBERT K PARANGI M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9 YALE CT	None	PARAMUS	NJ	07652	5517	00	None	40.9354833	-74.04990496	Bergen County
272158	Fee-for-Service	1154760940	1154760940	1	1	RONEY, GARRETT S MD	9/17/2018	390200000X	NA	Other	026	PHYSICIANS	157631	05	Anesthesiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
272183	Fee-for-Service	1871509083	1871509083	1	1	REINYS, EMILY E MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77689	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
272197	Fee-for-Service	1932178449	1932178449	1	1	ROBSHAW, CHRISTOPHER L MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154020	40	Pediatrics	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
272200	Fee-for-Service	1427433937	1427433937	1	1	RODA, REX EDWARD MD	7/23/2024	208M00000X	NA	Other	026	PHYSICIANS	186118	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
272225	Fee-for-Service	1871536342	1871536342	1	1	ROSS, WILLIE V MD	12/29/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53544	40	Pediatrics	0	In state provider	None	20101 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
272232	Fee-for-Service	1821194218	1821194218	1	1	RODRIGUEZ, MICHAEL A DC	7/31/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	ENERGY CHIROPRACTIC CTR	3562 ADAMS ST	None	RIVERSIDE	CA	92504	3356	33	06065	33.92912363	-117.4211698	Riverside County
272242	Fee-for-Service	1881747889	1881747889	1	1	REID, GRACE MD	7/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85978	36	Psychiatry	0	In state provider	None	11374 MOUNTAIN VIEW AVE	# A	LOMA LINDA	CA	92354	3830	36	06071	34.0465275	-117.2436991	San Bernardino County
272250	Fee-for-Service	1487064952	1487064952	1	2	RANCHO CORDOVA MEDICAL CLINI	10/8/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C AND URGENT CARE	2890 LA LOMA DR	None	RANCHO CORDOVA	CA	95670	3308	34	06067	38.584512	-121.3140375	Sacramento County
272271	Fee-for-Service	1669478020	1669478020	1	1	ROYAL MAJESTY HOME CARE,	10/31/2003	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3939 ATLANTIC AVE	SUITE 212	LONG BEACH	CA	90807	3536	19	06037	33.830073	-118.1851065	Los Angeles County
272280	Fee-for-Service	1992745574	1992745574	1	1	ROBERTO MURILLO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
272295	Fee-for-Service	1043388267	1043388267	1	1	ROLLER, ALBERT E MD	1/1/1994	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	11992	04	Otology, Laryngology, Rhinology	0	In state provider	None	1095 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65804253	-121.6451894	Monterey County
272299	Fee-for-Service	1528430923	1528430923	1	1	RICHTIGER, KATIE LMFT	9/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	None	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
272310	Fee-for-Service	1174639074	1174639074	1	1	RAFIDI, FUAD F MD	3/2/1987	174400000X	NA	Other	026	PHYSICIANS	38061	02	General Surgery	0	In state provider	None	18372 CLARK ST	STE 218	TARZANA	CA	91356	3579	19	06037	34.16975876	-118.533174	Los Angeles County
272351	Fee-for-Service	1699853713	1699853713	2	1	RADY CHILDRENS HEALTH	7/6/2018	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SERVICES-SAN DIEGO	8291 AERO PLACE	STE 130& 140	SAN DIEGO	CA	92123	2037	37	06073	32.80793485	-117.1471048	San Diego County
272397	Fee-for-Service	1972651297	1972651297	1	2	ROBLA ELEMENTARY SD	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5248 ROSE ST	None	SACRAMENTO	CA	95838	1633	34	06067	38.663262	-121.44699	Sacramento County
272414	Fee-for-Service	1457875643	1457875643	1	1	ROSTAMI, FARIBA LMFT	9/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13525 MIDLAND RD	J	POWAY	CA	92064	4772	37	06073	32.96071787	-117.0362705	San Diego County
272458	Fee-for-Service	1003827346	1003827346	1	1	ROTHMAN, RUTH G MD	2/1/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	38760	01	General Practice	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
272461	Fee-for-Service	1881719433	1881719433	1	1	RIVAS, CINDY E LCSW	8/2/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9040 TELEGRAPH RD	STE 307	DOWNEY	CA	90240	2399	19	06037	33.96022961	-118.1090321	Los Angeles County
272482	Fee-for-Service	1578996278	1578996278	1	1	RODRIGUEZ, ELIESER D	11/14/2016	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12612 SPRINGBROOK DRIVE	UNIT A	SAN DIEGO	CA	92128	5018	37	06073	32.94712845	-117.0852998	San Diego County
272515	Fee-for-Service	1740560044	1740560044	1	1	ROSE, OLGA D MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143536	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
272521	Fee-for-Service	1801031612	1801031612	1	1	RUOFF, CHAD M MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112085	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
272549	Fee-for-Service	1578046959	1578046959	1	1	RI, KATHERINE OT	1/9/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
272554	Fee-for-Service	1679879365	1679879365	1	1	ROSAIA, DEANA	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
272557	Fee-for-Service	1548798812	1548798812	1	1	REED, JACE M MD	7/10/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	192336	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272582	Fee-for-Service	1215963848	1215963848	1	1	RAVINDRANATHAN, MEERA P MD	10/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108963	68	Hematology	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
272598	Fee-for-Service	1144224908	1144224908	1	1	REYES, EVANGELINE A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64361	78	Neoplastic Diseases/Oncology	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
272619	Fee-for-Service	1891194460	1891194460	1	1	RIVERA, JESSICA R LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
272640	Fee-for-Service	1730631045	1730631045	1	1	ROPHETS DIALYSIS LLC	9/24/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	12220 PERRIS BLVD	SUITE A	MORENO VALLEY	CA	92557	7417	33	06065	33.943212	-117.2262935	Riverside County
272672	Fee-for-Service	1679709679	1679709679	1	1	RADIATION ONCOLOGY	11/13/2013	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	PHYSICIANS INC	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
272680	Fee-for-Service	1841551355	1841551355	1	1	RIZVI, ADAM MD	4/3/2020	207RC0200X	NA	Other	026	PHYSICIANS	143097	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
272684	Fee-for-Service	1124237920	1124237920	1	1	RICHARD J CZOSEK	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
272717	Fee-for-Service	1073660890	1073660890	1	1	ROSEN, MICHAEL J MD	8/31/2021	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	173859	None	None	0	In state provider	None	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
272723	Fee-for-Service	1881636058	1881636058	1	1	REEDY, DAVID B MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	73975	66	Emergency Medicine (Urgent Care)	0	In state provider	ALTA EMER. MEDICAL GRP.	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
272734	Fee-for-Service	1396782868	1396782868	1	1	RAVURI, SREENIVAS R MD	4/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
272775	Fee-for-Service	1932380235	1932380235	1	1	ROSENFELD, RACHEL PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
272817	Fee-for-Service	1710287297	1710287297	1	102	REGENTS UNIVERSITY OF CALIFO	9/8/2021	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNIA	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
272840	Fee-for-Service	1992737498	1992737498	1	1	RAUSER, MICHAEL E MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85469	18	Ophthalmology	0	In state provider	None	28083 BRADLEY RD	None	SUN CITY	CA	92586	2207	33	06065	33.71347231	-117.1904328	Riverside County
272848	Fee-for-Service	1457434250	1457434250	1	1	RITTER, CHRISTINA C NP	8/23/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272851	Fee-for-Service	1922044833	1922044833	1	1	RAJARATNAM, RUPERT J MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83675	05	Anesthesiology	0	In state provider	None	43830 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
272853	Fee-for-Service	1215963848	1215963848	1	1	RAVINDRANATHAN, MEERA P MD	10/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108963	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
272854	Fee-for-Service	1013262658	1013262658	1	1	ROLD, OLIVIA A PSYD	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
272869	Fee-for-Service	1144224908	1144224908	1	1	REYES, EVANGELINE A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64361	68	Hematology	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
272932	Fee-for-Service	1710013362	1710013362	1	1	RICCHIOSCHAEFER, ROBIN M NP	11/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43839 N 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
272939	Fee-for-Service	1679709679	1679709679	1	1	RADIATION ONCOLOGY	11/13/2013	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	PHYSICIANS INC	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
272941	Fee-for-Service	1164837183	1164837183	1	1	ROMERO, AL VINCENT D OD INC	4/8/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9496 MAGNOLIA AVE	STE 101	RIVERSIDE	CA	92503	3733	33	06065	33.92047685	-117.4461509	Riverside County
272979	Fee-for-Service	1083664593	1083664593	1	1	RUBINSTEIN, STEVEN W MD	12/11/2002	2080P0201X	NA	Neurology	026	PHYSICIANS	45231	03	Allergy	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
273002	Fee-for-Service	1396782868	1396782868	1	1	RAVURI, SREENIVAS R MD	4/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51238	41	Internal Medicine	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
273039	Fee-for-Service	1649777202	1649777202	1	1	ROYSE, CAITLIN R MD	6/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165374	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
273059	Fee-for-Service	1689634958	1689634958	1	1	RUSSELL, JOHN C MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	25425	41	Internal Medicine	0	In state provider	None	6800 PALM AVE	STE C2	SEBASTOPOL	CA	95472	4251	49	06097	38.39602719	-122.8185446	Sonoma County
273081	Fee-for-Service	1922567726	1922567726	1	1	ROY, KEVIN M	6/16/2023	207L00000X	NA	Other	026	PHYSICIANS	178647	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
273084	Fee-for-Service	1710287297	1710287297	1	123	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	403 W. ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
273086	Fee-for-Service	1942302336	1942302336	1	1	RALEY'S	3/27/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25025 BLUE RAVINE RD	None	FOLSOM	CA	95630	5258	34	06067	38.689236	-121.1224455	Sacramento County
273092	Fee-for-Service	1275866535	1275866535	1	1	RETZLOFF, EILEEN R LCSW	12/5/2018	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
273102	Fee-for-Service	1881809598	1881809598	1	1	RAO, SHWETA S MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	107006	41	Internal Medicine	0	In state provider	None	1114 6TH STREET	None	MODESTO	CA	95304	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
273138	Fee-for-Service	1144224908	1144224908	1	1	REYES, EVANGELINE A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64361	41	Internal Medicine	0	In state provider	None	900 S MAIN ST	STE 202	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
273147	Fee-for-Service	1326055864	1326055864	1	1	RANEY, MICHELLE E MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36853	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
273207	Fee-for-Service	1912900440	1912900440	1	1	RYAN COURTNEY FIELDS MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID CAMPUS	BOX 8109	SAINT LOUIS	MO	63156	8109	00	None	38.63518793	-90.26307576	St. Louis city
273215	Fee-for-Service	1134183734	1134183734	1	1	ROUSSEAU, CAROL A	5/24/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
273236	Fee-for-Service	1427136225	1427136225	1	1	RICH, EDWARD J MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65119	40	Pediatrics	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
273248	Fee-for-Service	1083664593	1083664593	1	1	RUBINSTEIN, STEVEN W MD	12/11/2002	2080P0201X	NA	Neurology	026	PHYSICIANS	45231	40	Pediatrics	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
273298	Fee-for-Service	1043498876	1043498876	1	1	RUAN, JOSEPH H MD	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93995	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
273303	Fee-for-Service	1366712507	1366712507	1	1	RODRIGUEZ, JOSE R LCSW	12/3/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 ABBOTT ST STE 201	STE 201	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
273311	Fee-for-Service	1770511602	1770511602	1	1	REDDY, NAVEEN C MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	75877	41	Internal Medicine	0	In state provider	None	4521 1/2 CESAR E CHAVEZ	None	LOS ANGELES	CA	90022	1116	19	06037	34.04065496	-118.1685332	Los Angeles County
273341	Fee-for-Service	1255301842	1255301842	1	1	REDDY, PRAVEEN K MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142043	20	Orthopedic Surgery	0	In state provider	None	721 RIVER DR	STE B	FORT BRAGG	CA	95437	5403	23	06045	39.43204627	-123.801581	Mendocino County
273348	Fee-for-Service	1568527240	1568527240	1	1	RAO, KAVITHA MD	9/30/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62134	36	Psychiatry	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
273350	Fee-for-Service	1073961108	1073961108	1	1	RDX BIOSCIENCE, INC	8/30/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	629 SPRINGFIELD RD	FIRST FLOOR	KENILWORTH	NJ	07033	1079	00	None	40.68680326	-74.29865155	Union County
273358	Fee-for-Service	1710287297	1710287297	1	102	REGENTS UNIVERSITY OF CALIFO	5/18/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RNIA	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
273361	Fee-for-Service	1235167511	1235167511	1	1	ROBERTSON, LAURA A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84007	40	Pediatrics	0	In state provider	None	2340 CLAY ST	STE 304	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
273388	Fee-for-Service	1730684697	1730684697	1	1	RABBANI, NAVEED MD	9/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173857	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
273408	Fee-for-Service	1689663635	1689663635	1	1	ROBERTS, WENDY MD	11/5/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	57257	07	Dermatology	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
273428	Fee-for-Service	1053339606	1053339606	1	1	ROSE, MELISSA J MD	12/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112131	40	Pediatrics	0	In state provider	None	5173 LONE TREE WAY	None	ANTIOCH	CA	94531	8689	07	06013	37.96178664	-121.7558046	Contra Costa County
273482	Fee-for-Service	1467845909	1467845909	1	1	RODRIGUEZ, CHRISTINA LMFT	8/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	740 G ST STE G	None	REEDLEY	CA	93654	2629	10	06019	36.60007621	-119.4547214	Fresno County
273489	Fee-for-Service	1528172848	1528172848	1	1	REDDY, RAJENDER G MD	8/13/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83062	05	Anesthesiology	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
273500	Fee-for-Service	1912987553	1912987553	1	3	REGENTS OF THE UNIVERSITY OF	11/29/2023	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
273502	Fee-for-Service	1417155318	1417155318	1	1	REEDER, CHERYL J DO	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
273521	Fee-for-Service	1235565516	1235565516	1	1	ROSILES, MAITREYA D LCSW	2/12/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
273523	Fee-for-Service	1316940646	1316940646	3	2	RIVER CITY PHARMACY, INC.	10/1/2019	251F00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3301 C STREET	SUITE 450	SACRAMENTO	CA	95816	3393	34	06067	38.579877	-121.456143	Sacramento County
273546	Fee-for-Service	1245208990	1245208990	2	1	RANCHO PHYSICAL THERAPY, INC	1/13/2021	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25150 HANCOCK AVE	STE 100	MURRIETA	CA	92562	5987	33	06065	33.56635084	-117.1823956	Riverside County
273582	Fee-for-Service	1942284781	1942284781	1	1	RANPARIA, DIPAK J MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54903	None	None	0	In state provider	None	323 N PRAIRIE AVE	STE 114	INGLEWOOD	CA	90301	4503	19	06037	33.966333	-118.3439975	Los Angeles County
273623	Fee-for-Service	1710287297	1710287297	1	123	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	403 W. ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
273630	Fee-for-Service	1235167511	1235167511	1	1	ROBERTSON, LAURA A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84007	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2340 CLAY ST	STE 304	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
273636	Fee-for-Service	1063755882	1063755882	1	1	RACHELLE NICOLAI	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2675 W TAYLORSVILLE BLVD	None	TAYLORSVILLE	UT	84129	2208	00	None	40.65438556	-111.9571398	Salt Lake County
273653	Fee-for-Service	1902984487	1902984487	1	1	RABIN, GREGORY J MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75427	18	Ophthalmology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
273680	Fee-for-Service	1720283286	1720283286	1	1	RAGUCCI, ROBERT P LMFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	37251	-	NOT APPLICABLE	0	In state provider	None	1931 CENTER STREET	None	BERKELEY	CA	94704	1105	01	06001	37.86983853	-122.2717273	Alameda County
273736	Fee-for-Service	1972779338	1972779338	1	1	RAJARAM, KAVITHA MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97309	40	Pediatrics	0	In state provider	None	1320 APPLE AVENUE	STE 102	HAYWARD	CA	94541	1552	01	06001	37.68451068	-122.0927751	Alameda County
273745	Fee-for-Service	1851463723	1851463723	1	4	REGENTS OF THE UNIVERSITY OF	3/16/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	100 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90024	6970	19	06037	34.06544724	-118.4459249	Los Angeles County
273764	Fee-for-Service	1326281718	1326281718	1	1	ROSENTHAL, JENNIFER L MD	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124062	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
273769	Fee-for-Service	1912987553	1912987553	1	3	REGENTS OF THE UNIVERSITY OF	4/25/2023	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
273788	Fee-for-Service	1114060126	1114060126	1	1	RECHNIC, MARK MD INC.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42815	01	General Practice	0	In state provider	None	9834 GENESEE AVE	STE 124	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
273791	Fee-for-Service	1841619756	1841619756	1	1	RANA, NEERVA A MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149476	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
273813	Fee-for-Service	1245208990	1245208990	2	1	RANCHO PHYSICAL THERAPY, INC	1/13/2021	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 100	MURRIETA	CA	92562	5987	33	06065	33.56635084	-117.1823956	Riverside County
273817	Fee-for-Service	1598260291	1598260291	1	1	ROBLES, CHRISTOPHER A MD	6/9/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167218	None	None	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
273846	Fee-for-Service	1730360140	1730360140	1	1	RESNICK, CHARLES T MD INC	1/26/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	625 SOUTH FAIR OAKS AVE	SUITE 250	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
273887	Fee-for-Service	1619427119	1619427119	1	1	ROBERTS, ROSHANDA N LMFT	2/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
273889	Fee-for-Service	1710287297	1710287297	1	123	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	403 W. ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
273898	Fee-for-Service	1235167511	1235167511	1	1	ROBERTSON, LAURA A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84007	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2340 CLAY ST	STE 304	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
273946	Fee-for-Service	1497989347	1497989347	1	1	RELIA, SACHIN MD	7/1/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	119785	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
273950	Fee-for-Service	1205937497	1205937497	1	1	RAMACHANDRAN, SRIDHAR MD	3/18/2015	207R00000X	NA	Other	026	PHYSICIANS	37344	41	Internal Medicine	0	In state provider	None	6850 SEPULVEDA BLVD	STE 207	VAN NUYS	CA	91405	4449	19	06037	34.1955	-118.4661705	Los Angeles County
274034	Fee-for-Service	1912987553	1912987553	1	3	REGENTS OF THE UNIVERSITY OF	4/25/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
274037	Fee-for-Service	1013335033	1013335033	1	1	RAMIREZ, ALISON R LMFT	9/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	400 S. RAMONA AVE	206	CORONA	CA	92879	1440	33	06065	33.87678898	-117.5650086	Riverside County
274104	Fee-for-Service	1053836932	1053836932	1	1	RESARI, KRISTINE PT	6/26/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7900 DISTRICT BLVD	C	BAKERSFIELD	CA	93313	4844	15	06029	35.31318383	-119.0908089	Kern County
274144	Fee-for-Service	1508844341	1508844341	1	1	RAJGURU, DEEPALI S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92811	18	Ophthalmology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
274159	Fee-for-Service	1710287297	1710287297	1	102	REGENTS UNIVERSITY OF CALIFO	8/20/2024	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
274168	Fee-for-Service	1801412507	1801412507	1	1	ROTHLIND, KALIA M NP	5/23/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95020077	-	NOT APPLICABLE	0	In state provider	None	1207 EAST FRUIT STREET	A, B, B2, B3, C, D, E, F	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
274178	Fee-for-Service	1811013766	1811013766	1	1	ROVNER, LEON MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115138	41	Internal Medicine	0	In state provider	None	38485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.59408721	-117.2367937	Riverside County
274208	Fee-for-Service	1700516960	1700516960	1	2	ROOFAN ALSAYEGH SOLE M D PC	2/2/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	7120 CORBIN AVE	None	RESEDA	CA	91335	3618	19	06037	34.20018	-118.5622135	Los Angeles County
274270	Fee-for-Service	1255410262	1255410262	1	1	REVER, BARBARA L MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	30871	45	Nephrology (Renal-Kidney)	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
274284	Fee-for-Service	1821478082	1821478082	1	1	ROMAN, DARWIN L MD	9/1/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	161572	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
274297	Fee-for-Service	1912987553	1912987553	1	3	REGENTS OF THE UNIVERSITY OF	11/8/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
274327	Fee-for-Service	1649362013	1649362013	1	1	ROMAN, MAHER MD	9/11/2018	207R00000X	NA	Other	026	PHYSICIANS	49869	41	Internal Medicine	0	In state provider	None	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
274350	Fee-for-Service	1700280492	1700280492	1	1	REESE, EMILY PHD	10/7/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
274352	Fee-for-Service	1467831388	1467831388	1	1	RIZZA, ELIZABETH R MD	8/18/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	172737	None	None	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
274387	Fee-for-Service	1518526177	1518526177	1	1	ROLL, BRIANNA E MD	12/22/2022	207R00000X	NA	Other	026	PHYSICIANS	176376	None	None	0	In state provider	None	18035 BROOKHURST ST	STE 2100	FOUNTAIN VALLEY	CA	92708	6738	30	06059	33.701184	-117.9544385	Orange County
274398	Fee-for-Service	1992283964	1992283964	1	1	ROMERO, LIDIA L AU	11/16/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
274418	Fee-for-Service	1710287297	1710287297	1	123	REGENTS UNIVERSITY OF CALIFO	12/27/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	403 W. ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
274435	Fee-for-Service	1215111752	1215111752	1	1	RAVULA, SREELAKSHMI MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115618	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
274534	Fee-for-Service	1033397963	1033397963	1	1	RUIZ, RAHEL T MD INC	9/6/2011	207R00000X	NA	Other	026	PHYSICIANS	64304	41	Internal Medicine	0	In state provider	None	4432 JAMES AVENUE	None	CASTRO VALLEY	CA	94546	3533	01	06001	37.70666054	-122.0700438	Alameda County
274536	Fee-for-Service	1255410262	1255410262	1	1	REVER, BARBARA L MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	30871	41	Internal Medicine	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
274539	Fee-for-Service	1366688418	1366688418	1	1	REDWOOD COAST MEDICAL	8/18/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	175 MAIN ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90858254	-123.6924008	Mendocino County
274541	Fee-for-Service	1811420672	1811420672	1	1	RAMIREZ, FERNANDO DO	7/25/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
274547	Fee-for-Service	1780345280	1780345280	1	1	REUS, YUKO CNP	2/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
274568	Fee-for-Service	1033278742	1033278742	1	1	ROSS, HALEY E CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
274592	Fee-for-Service	1275239311	1275239311	1	1	RUPA THACKER MD CORPORATION	2/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	6255 N FRESNO ST	STE 106	FRESNO	CA	93710	5271	10	06019	36.82763799	-119.7814169	Fresno County
274595	Fee-for-Service	1669617197	1669617197	1	2	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SAN DIEGO	25485 MEDICAL CENTER DR	SUITE 100	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
274598	Fee-for-Service	1366904195	1366904195	1	1	RAGHUNATHAN, SNEHA MD	8/3/2022	152WP0200X	NA	Other	026	PHYSICIANS	180081	None	None	0	In state provider	None	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
274619	Fee-for-Service	1447211776	1447211776	1	1	RAYMOND HARRE MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 S GEAR AVE	None	W BURLINGTON	IA	52655	1679	00	None	40.809483	-91.1743785	Des Moines County
274660	Fee-for-Service	1922099829	1922099829	1	1	RHEE, INA P MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105293	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274661	Fee-for-Service	1326173295	1326173295	1	1	RIOS, DONNA J PA	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	10689	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
274670	Fee-for-Service	1669551792	1669551792	1	1	ROMBAKIS, ANDREW S MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41334	18	Ophthalmology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
274673	Fee-for-Service	1891909768	1891909768	1	1	REDDY, SIVAPRIYA T DO	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8674	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
274676	Fee-for-Service	1184662165	1184662165	1	1	RAINA, SURRENDER MD	12/4/1986	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	31110	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	445 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.743354	-121.432495	San Joaquin County
274683	Fee-for-Service	1689622649	1689622649	1	1	RADOW, ARTHUR B MD	5/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89323	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
274709	Fee-for-Service	1861429953	1861429953	1	1	RUAN S FARRER	8/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 ANDERSON DR	None	ABERDEEN	WA	98520	1006	00	None	46.979334	-123.8464165	Grays Harbor County
274717	Fee-for-Service	1407987720	1407987720	1	1	RAEEN, HAYEDE LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 S FAIRFAX AVE	None	LOS ANGELES	CA	90036	3198	19	06037	34.06725156	-118.3614386	Los Angeles County
274729	Fee-for-Service	1841316874	1841316874	1	1	REZA, ALLISON K LMFT	11/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
274745	Fee-for-Service	1457392854	1457392854	1	1	RICCI, ROSEMARY Z CRNA	5/19/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
274752	Fee-for-Service	1154518207	1154518207	1	1	R H VIILLAROSA M D INC	10/15/2003	193400000X	NA	Other	026	PHYSICIANS	50463	41	Internal Medicine	0	In state provider	None	13391 CALIFORNIA ST	STE 3	YUCAIPA	CA	92399	5105	36	06071	34.010847	-117.038842	San Bernardino County
274756	Fee-for-Service	1124555743	1124555743	1	1	ROUGIER, GRACIELA M LCSW	12/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
274765	Fee-for-Service	1700610698	1700610698	1	1	RODRIGUEZ, DANIEL D PT	9/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7311 GREENHAVEN	200	SACRAMENTO	CA	95831	3572	34	06067	38.492622	-121.5219195	Sacramento County
274791	Fee-for-Service	1366688418	1366688418	1	1	REDWOOD COAST MEDICAL	8/18/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	175 MAIN ST	None	POINT ARENA	CA	95468	0000	23	06045	38.90858254	-123.6924008	Mendocino County
274799	Fee-for-Service	1003131350	1003131350	1	1	RIZZUTO, GABRIELLE A MD	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118374	22	Pathology (M.D. only)	0	In state provider	None	1001 POTRERO AVENUE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
274830	Fee-for-Service	1942450069	1942450069	1	1	ROMANYSHYN, JONATHAN C MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120296	02	General Surgery	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
274831	Fee-for-Service	1336243401	1336243401	1	1	REINEKE, CAMILLE S PHD	9/13/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
274860	Fee-for-Service	1669617197	1669617197	1	2	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	SAN DIEGO	25485 MEDICAL CENTER DR	SUITE 100	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
274862	Fee-for-Service	1033376017	1033376017	1	1	RAY, RANJAN MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108532	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
274883	Fee-for-Service	1255358974	1255358974	1	2	ROGALA, CAROL DO	5/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8408	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
274913	Fee-for-Service	1922099829	1922099829	1	1	RHEE, INA P MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105293	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274942	Fee-for-Service	1710146816	1710146816	1	1	REININGA, ERIC J PHD	4/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
274975	Fee-for-Service	1801974308	1801974308	1	1	REYES, VIVIAN M MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77216	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
274992	Fee-for-Service	1043363641	1043363641	1	1	RIVERSIDE-SAN BERNARDINO COU	10/7/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	H CLINIC	66655 MARTINEZ RD	None	THERMAL	CA	92274	9007	33	06065	33.56398663	-116.1545603	Riverside County
275002	Fee-for-Service	1215256300	1215256300	1	1	REACH OUT WEST END	5/6/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	1126 W FOOTHILL BLVD	SUITE 250	UPLAND	CA	91786	3786	36	06071	34.10674652	-117.6680183	San Bernardino County
275014	Fee-for-Service	1588423560	1588423560	1	1	RED SHOE PROJECT INC	6/21/2024	225XM0800X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	301 9TH ST STE 401	None	REDLANDS	CA	92374	4499	36	06071	34.05825	-117.177229	San Bernardino County
275034	Fee-for-Service	1962812925	1962812925	1	1	RO, EVELYN H MSW LCSW	2/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD STE 1	None	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
275105	Fee-for-Service	1326477522	1326477522	1	1	ROMAN, NOEMI LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109184	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PKWY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
275122	Fee-for-Service	1033376017	1033376017	1	1	RAY, RANJAN MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108532	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
275123	Fee-for-Service	1669617197	1669617197	1	2	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN DIEGO	25485 MEDICAL CENTER DR	SUITE 100	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
275172	Fee-for-Service	1912916685	1912916685	1	1	RAJAGOPAL, SUMANTH MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106968	77	Infectious Disease	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94512	3429	48	06095	38.12828446	-122.24821	Solano County
275203	Fee-for-Service	1588364459	1588364459	1	1	RESILIENCE SOCIAL WORK INC.	4/24/2023	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10601 WALKER STREET	SUITE 170 OFFICE 110	CYPRESS	CA	90630	4733	30	06059	33.809724	-118.036976	Orange County
275210	Fee-for-Service	1497931620	1497931620	1	1	RODRIGUEZ, CARLOS S MD	10/1/2002	174400000X	NA	Other	026	PHYSICIANS	39921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	14901 RINALDI ST	STE 202	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
275228	Fee-for-Service	1568922169	1568922169	1	1	RUAN, VICTOR MD	2/26/2024	390200000X	NA	Other	026	PHYSICIANS	191746	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
275231	Fee-for-Service	1265856124	1265856124	1	1	ROHANI, M REZA MD FACS INC	3/6/2015	208600000X	NA	General Surgery	026	PHYSICIANS	108612	None	None	0	In state provider	None	2505 SAMARITAN DRIVE	STE 504	SAN JOSE	CA	95124	4014	43	06085	37.25111447	-121.9483395	Santa Clara County
275253	Fee-for-Service	1043363641	1043363641	1	1	RIVERSIDE-SAN BERNARDINO COU	10/7/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	H CLINIC	66655 MARTINEZ RD	None	THERMAL	CA	92274	9007	33	06065	33.56398663	-116.1545603	Riverside County
275254	Fee-for-Service	1013661040	1013661040	1	1	ROMULO L & NOELIA M GARCIA	6/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2755 THACKER DR	None	CORONA	CA	92881	3634	33	06065	33.84133043	-117.5484704	Riverside County
275261	Fee-for-Service	1164654380	1164654380	1	1	ROOFIAN, SHAWN M MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113626	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
275267	Fee-for-Service	1831415009	1831415009	1	1	RAO, AJAY A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113275	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
275295	Fee-for-Service	1013124288	1013124288	1	1	RABANIPOUR, MORIS MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102679	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
275302	Fee-for-Service	1285017897	1285017897	1	1	RAZ, GUY MD	8/24/2019	207P00000X	NA	Other	026	PHYSICIANS	160733	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
275303	Fee-for-Service	1710031596	1710031596	1	1	REED, RODNEY T LCSW	4/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
275346	Fee-for-Service	1902185218	1902185218	1	1	RAMIREZ, SANDY MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127615	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95350	6594	50	06099	37.653219	-120.975542	Stanislaus County
275353	Fee-for-Service	1922710755	1922710755	1	1	RELIANCE MEDICAL TRANSPORTAT	4/11/2023	231H00000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ION	3036 E BIRCH AVE	None	VISALIA	CA	93292	6823	54	06107	36.335394	-119.258937	Tulare County
275384	Fee-for-Service	1730483918	1730483918	1	1	ROSEN, JULIE A LCSW	9/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30101 AGOURA CT STE 150	None	AGOURA HILLS	CA	91301	4369	19	06037	34.14548993	-118.7770886	Los Angeles County
275402	Fee-for-Service	1700516960	1700516960	1	1	ROOFAN ALSAYEGH SOLE M D PC	2/2/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	623 JUNIPERO ST	None	SANTA BARBARA	CA	93105	4213	42	06083	34.42774896	-119.7271057	Santa Barbara County
275478	Fee-for-Service	1003805490	1003805490	1	1	RXSB INC	11/1/2001	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3605 STATE ST	None	SANTA BARBARA	CA	93105	2521	42	06083	34.44038124	-119.7409349	Santa Barbara County
275511	Fee-for-Service	1851674469	1851674469	1	1	RAHIMZADEH, ALI LMFT	12/23/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87045	-	NOT APPLICABLE	0	In state provider	None	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	37	06073	32.75537928	-117.1416551	San Diego County
275558	Fee-for-Service	1659316412	1659316412	1	1	RAMILO, MARLON G MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78835	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 307	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
275560	Fee-for-Service	1962835132	1962835132	1	1	RUGO, PATRICK J	9/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
275571	Fee-for-Service	1740623883	1740623883	1	1	RAMIREZ, GUILLERMO A MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135768	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
275593	Fee-for-Service	1144371048	1144371048	1	1	RUIZ, MARYBETH PHD	11/24/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
275642	Fee-for-Service	1174598296	1174598296	1	1	REGENTS UNIVERSITY OF CA	9/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
275663	Fee-for-Service	1316206394	1316206394	1	1	REYNARD, TYLER C MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
275714	Fee-for-Service	1013545839	1013545839	1	1	RIVERA, GABRIELLE F MD	10/28/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
275729	Fee-for-Service	1851463723	1851463723	1	9	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	1245 16TH ST	110	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
275747	Fee-for-Service	1437329273	1437329273	1	1	RUBINSTEIN, GENNADY MD INC	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74924	07	Dermatology	0	In state provider	None	3959 LAUREL CANYON BLVD	SUITE F	STUDIO CITY	CA	91604	3711	19	06037	34.14252659	-118.3949222	Los Angeles County
275766	Fee-for-Service	1790257087	1790257087	1	1	ROSSELLA, MARK LMFT	1/28/2025	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
275815	Fee-for-Service	1659316412	1659316412	1	1	RAMILO, MARLON G MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78835	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 307	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
275819	Fee-for-Service	1598822843	1598822843	1	1	RALPHS GROCERY COMPANY	8/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #288	23716 EL TORO RD	None	LAKE FOREST	CA	92630	4711	30	06059	33.618829	-117.7024538	Orange County
275829	Fee-for-Service	1144334608	1144334608	1	1	ROMERO, TOMAS E MD	6/11/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	30887	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	480 4TH AVE	STE 409	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
275836	Fee-for-Service	1871756031	1871756031	1	1	RYAN SCOTT MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	3742	00	None	33.480864	-112.0795155	Maricopa County
275896	Fee-for-Service	1528528197	1528528197	1	1	RILEY, ASHLEY MD	12/20/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187268	None	None	0	In state provider	None	1360 E HERNDON AVE	STE 201	FRESNO	CA	93270	3326	10	06019	36.83744648	-119.7646425	Fresno County
275901	Fee-for-Service	1467609438	1467609438	1	1	RAJEBI, MOHAMMAD MD	11/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134982	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
275926	Fee-for-Service	1215172606	1215172606	1	1	RITTER, ADRIENNE D MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106108	40	Pediatrics	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
275931	Fee-for-Service	1184918393	1184918393	1	1	RODRIGUEZ, FATIMA MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129900	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
275967	Fee-for-Service	1013545839	1013545839	1	1	RIVERA, GABRIELLE F MD	10/28/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
275968	Fee-for-Service	1174554000	1174554000	1	1	ROBBINS, ELIZABETH MD	3/31/1992	2080P0207X	NA	Hematology	026	PHYSICIANS	75533	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
276080	Fee-for-Service	1144334608	1144334608	1	1	ROMERO, TOMAS E MD	6/11/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	30887	66	Emergency Medicine (Urgent Care)	0	In state provider	None	480 4TH AVE	STE 409	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
276087	Fee-for-Service	1710306766	1710306766	1	1	RUBIN, JESSICA B MD	7/15/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	140139	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
276150	Fee-for-Service	1215064589	1215064589	1	1	ROCKCREEK INC	3/26/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	305 ARMSTRONG DR	None	CLAREMONT	CA	91711	1745	19	06037	34.12964372	-117.7180005	Los Angeles County
276154	Fee-for-Service	1326698978	1326698978	1	1	RIN, PATRIZIA M PT	9/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276176	Fee-for-Service	1134314537	1134314537	1	1	RINGGER, CHAD M MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
276179	Fee-for-Service	1871791806	1871791806	1	1	RONNEBERG, MARCY R CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
276184	Fee-for-Service	1184918393	1184918393	1	1	RODRIGUEZ, FATIMA MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129900	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
276195	Fee-for-Service	1033236583	1033236583	1	1	RUBIO, CARMEN MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49796	-	NOT APPLICABLE	0	In state provider	None	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	19	06037	33.92826552	-118.3092091	Los Angeles County
276224	Fee-for-Service	1174554000	1174554000	1	1	ROBBINS, ELIZABETH MD	3/31/1992	2080P0207X	NA	Hematology	026	PHYSICIANS	75533	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
276241	Fee-for-Service	1386780088	1386780088	1	1	RHEE, YOUNG EUN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32462	02	General Surgery	0	In state provider	None	1150 SCOTT BLVD	STE D2	SANTA CLARA	CA	95050	4547	43	06085	37.347003	-121.959449	Santa Clara County
276256	Fee-for-Service	1326332917	1326332917	1	1	RAMACHANDRAN, ARUN MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136393	13	Neurology (M.D. only)	0	In state provider	None	8635 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
276316	Fee-for-Service	1669617197	1669617197	1	14	RADY CHILDREN'S HOSPITAL SAN	3/26/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
276320	Fee-for-Service	1225619521	1225619521	1	1	ROKNSHARIFI, MONA	1/10/2025	207R00000X	NA	Other	026	PHYSICIANS	189182	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
276348	Fee-for-Service	1801931035	1801931035	1	1	RICHARDS, JAMES M INC	10/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8610 S SEPULVEDA BLVD	STE 102	LOS ANGELES	CA	90045	4009	19	06037	33.959448	-118.396202	Los Angeles County
276365	Fee-for-Service	1205154747	1205154747	1	1	REINEKE, ANKE PHD	9/29/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
276422	Fee-for-Service	1265779979	1265779979	1	1	ROONEY, JACLYN M	12/19/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
276424	Fee-for-Service	1518077916	1518077916	1	1	RAUN, RANDALL S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42238	08	Family Practice	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
276493	Fee-for-Service	1386780088	1386780088	1	1	RHEE, YOUNG EUN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32462	01	General Practice	0	In state provider	None	1150 SCOTT BLVD	STE D2	SANTA CLARA	CA	95050	4547	43	06085	37.347003	-121.959449	Santa Clara County
276547	Fee-for-Service	1568724417	1568724417	1	1	REDDY, MADHUMITHA C DO	7/3/2017	208800000X	NA	Other	026	PHYSICIANS	15373	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
276564	Fee-for-Service	1669617197	1669617197	1	14	RADY CHILDREN'S HOSPITAL SAN	3/26/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF SAN DIEGO, A MEDICAL	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
276610	Fee-for-Service	1649298670	1649298670	1	3	RETINA CONSULTANTS	3/22/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	OF LOS ANGELES INC	7320 WOODLAKE AVE	STE 360	WEST HILLS	CA	91307	1472	19	06037	34.20245266	-118.6321273	Los Angeles County
276649	Fee-for-Service	1831240126	1831240126	1	1	ROSEMEAD SCHOOL DISTRICT	1/10/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3907 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1984	19	06037	34.07877813	-118.0732428	Los Angeles County
276666	Fee-for-Service	1780789834	1780789834	1	1	RAMOS, SUSANNE L MD	11/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55641	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5333 HOLLISTER AVE	STE 239	SANTA BARBARA	CA	93111	3327	42	06083	34.43491982	-119.8105484	Santa Barbara County
276668	Fee-for-Service	1568521276	1568521276	1	1	ROSE, THOMAS A OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
276672	Fee-for-Service	1518077916	1518077916	1	1	RAUN, RANDALL S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
276687	Fee-for-Service	1245388289	1245388289	1	1	RASHTIAN AFSHIN MD	1/2/2008	2085R0001X	NA	Other	026	PHYSICIANS	87539	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNST BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
276693	Fee-for-Service	1548548498	1548548498	1	1	ROUTRAY, CHITTARANJAN MD	9/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
276700	Fee-for-Service	1487226452	1487226452	1	1	RAPHAEL, EVA NP	2/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
276746	Fee-for-Service	1326573775	1326573775	1	1	REEVES, RUSSELL A MD	4/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184507	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
276771	Fee-for-Service	1538904917	1538904917	1	1	ROCKLIN ACADEMY FAMILY OF	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOLS	2204 PLAZA DRIVE	SUITE 200	ROCKLIN	CA	95765	4413	31	06061	38.79448621	-121.2699671	Placer County
276775	Fee-for-Service	1659802387	1659802387	1	1	RAMAKRISHNAN, MEERA MD	7/22/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	186915	None	None	0	In state provider	None	1680 E ROSEVILLE PKWY	STE 140	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
276786	Fee-for-Service	1164149621	1164149621	1	1	REVELES, MARY ANN NP	4/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
276802	Fee-for-Service	1083855464	1083855464	1	1	RA, SEONG H MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94085	22	Pathology (M.D. only)	0	In state provider	None	4077 5TH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
276807	Fee-for-Service	1124029020	1124029020	1	1	RIOUX, DOREEN M DO	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5249	01	General Practice	0	In state provider	None	5475 E LA PALMA AVE	STE 200	ANAHEIM	CA	92807	2075	30	06059	33.85997926	-117.7958236	Orange County
276812	Fee-for-Service	1669617197	1669617197	1	14	RADY CHILDREN'S HOSPITAL SAN	5/29/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
276839	Fee-for-Service	1669617197	1669617197	1	11	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	SAN DIEGO	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	37	06073	32.80027449	-117.153846	San Diego County
276850	Fee-for-Service	1811594955	1811594955	1	1	RIVERA, ADRIENNE M NP	2/23/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	232 WEST F STREET	None	OAKDALE	CA	95361	3844	50	06099	37.76493274	-120.8512261	Stanislaus County
276862	Fee-for-Service	1417456609	1417456609	1	1	ROBISON, JOHN F LCSW	10/7/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16944 VENTURA BLVD	None	ENCINO	CA	91316	4124	19	06037	34.15959142	-118.5027242	Los Angeles County
276874	Fee-for-Service	1033614722	1033614722	1	1	ROH, ELAINE M MD	3/24/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164766	None	None	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
276889	Fee-for-Service	1316915952	1316915952	1	1	REVENAUGH, JAMES R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
276901	Fee-for-Service	1417972282	1417972282	2	1	REEDLEY COMMUNITY HOSPITAL	9/18/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	155 S NEWMARK AVE	None	PARLIER	CA	93648	2531	10	06019	36.60675722	-119.5299369	Fresno County
276934	Fee-for-Service	1104241470	1104241470	1	2	RICO, EDGAR LCSW	9/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
276957	Fee-for-Service	1013906973	1013906973	1	2	REGENTS OF THE UNIV OF CA	4/3/2020	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
276973	Fee-for-Service	1700313996	1700313996	1	1	RAO, RAMESHWAR MD	6/4/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	167423	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
276981	Fee-for-Service	1487212577	1487212577	1	1	RENNELS, CAROLYN F MD	8/1/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	187397	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
277007	Fee-for-Service	1346444221	1346444221	1	1	RANKIN-MARTINEZ, ALLYN E	6/27/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11750 DUBLIN BLVD	SUITE 104	DUBLIN	CA	94568	2820	01	06001	37.70096071	-121.9396397	Alameda County
277029	Fee-for-Service	1437366622	1437366622	1	1	ROBERT G. SALAZAR, M.D., INC	1/27/2020	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	.	7152 N SHARON AVE	102	FRESNO	CA	93720	3361	10	06019	36.83995087	-119.7594391	Fresno County
277039	Fee-for-Service	1043362403	1043362403	1	1	RIAZI, JALIL MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	41050	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
277056	Fee-for-Service	1124029020	1124029020	1	1	RIOUX, DOREEN M DO	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5249	08	Family Practice	0	In state provider	None	5475 E LA PALMA AVE	STE 200	ANAHEIM	CA	92807	2075	30	06059	33.85997926	-117.7958236	Orange County
277060	Fee-for-Service	1669617197	1669617197	1	14	RADY CHILDREN'S HOSPITAL SAN	5/19/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
277076	Fee-for-Service	1871579292	1871579292	1	1	RABINOWITZ, CHAD B MD	7/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	111052	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
277089	Fee-for-Service	1669617197	1669617197	1	11	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	37	06073	32.80027449	-117.153846	San Diego County
277118	Fee-for-Service	1083677405	1083677405	2	1	RAZAVI, HOSSEIN	6/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	70810	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.74248474	-121.8493369	Butte County
277146	Fee-for-Service	1417972282	1417972282	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	155 S NEWMARK AVE	None	PARLIER	CA	93648	2531	10	06019	36.60675722	-119.5299369	Fresno County
277148	Fee-for-Service	1033649579	1033649579	1	1	ROTH, ROBERT M MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	169310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
277157	Fee-for-Service	1104404201	1104404201	1	1	RUIZ, CAROLINA OD	6/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	SUITE 101	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
277175	Fee-for-Service	1801994850	1801994850	1	1	ROCCO, MICHAEL G LCSW	11/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
277184	Fee-for-Service	1376168575	1376168575	1	1	REACH AIR MEDICAL SERVICES	10/3/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	LLC	2500 ROCKY MOUNTAIN AVE	None	LOVELAND	CO	80538	9004	00	None	40.415778	-104.99715	Larimer County
277195	Fee-for-Service	1396744918	1396744918	1	1	REDBROOK HEALTHCARE	8/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, LLC	105 TERRACINA BLVD	None	REDLANDS	CA	92373	4845	36	06071	34.04382827	-117.2115866	San Bernardino County
277198	Fee-for-Service	1790766087	1790766087	1	1	REDMOND, GREGORY S. M.D.	11/7/1994	207R00000X	NA	Other	026	PHYSICIANS	77054	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
277202	Fee-for-Service	1073587358	1073587358	1	1	RODARTE, JOHN G MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55748	01	General Practice	0	In state provider	None	1346 FOOTHILL BLVD	STE 210	LA CANADA	CA	91011	2122	19	06037	34.20780552	-118.2076252	Los Angeles County
277208	Fee-for-Service	1013906973	1013906973	1	2	REGENTS OF THE UNIV OF CA	5/1/1999	207VM0101X	NA	Obstetrics & Gynecology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
277260	Fee-for-Service	1053735043	1053735043	1	2	ROND, LUKE DO	1/10/2024	207P00000X	NA	Other	026	PHYSICIANS	15194	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
277273	Fee-for-Service	1235424706	1235424706	1	1	ROTTLER, NICHOLAS P MD	3/21/2020	2086S0127X	NA	General Surgery	026	PHYSICIANS	156069	89	Surgery-Traumatic	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
277281	Fee-for-Service	1669676714	1669676714	1	1	REDDY, MEERA A MD	1/14/2008	207RR0500X	NA	Other	026	PHYSICIANS	97397	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
277297	Fee-for-Service	1326446816	1326446816	1	1	ROLLINS, CHRISTINE L LMFT	3/9/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43066	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
277337	Fee-for-Service	1669617197	1669617197	1	11	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	SAN DIEGO	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	37	06073	32.80027449	-117.153846	San Diego County
277362	Fee-for-Service	1083677405	1083677405	2	1	RAZAVI, HOSSEIN	6/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	70810	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.74248474	-121.8493369	Butte County
277394	Fee-for-Service	1417972282	1417972282	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	155 S NEWMARK AVE	None	PARLIER	CA	93648	2531	10	06019	36.60675722	-119.5299369	Fresno County
277397	Fee-for-Service	1881755429	1881755429	1	1	REDDY, KARTHIK MD	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134870	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2220 GLADSTONE DRIVE	SUITE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
277427	Fee-for-Service	1225034556	1225034556	1	1	REDDY, ARUNA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80478	08	Family Practice	0	In state provider	None	1001 MAIN ST	None	DELANO	CA	93215	1731	15	06029	35.76932624	-119.245737	Kern County
277478	Fee-for-Service	1912941485	1912941485	1	1	REBURN, MICHAEL A MD	4/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	146743	None	None	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
277554	Fee-for-Service	1811147887	1811147887	1	1	RAMAKRISHNAN, PRASUN MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137015	41	Internal Medicine	0	In state provider	None	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3028	19	06037	34.07803211	-117.74833	Los Angeles County
277641	Fee-for-Service	1417972282	1417972282	2	1	REEDLEY COMMUNITY HOSPITAL	1/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	155 S NEWMARK AVE	None	PARLIER	CA	93648	2531	10	06019	36.60675722	-119.5299369	Fresno County
277653	Fee-for-Service	1841470960	1841470960	1	1	ROJAS-MARTINEZ, GABRIELA LC	12/2/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
277681	Fee-for-Service	1376577411	1376577411	2	1	RUBIN, ROY M MD	6/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	78753	20	Orthopedic Surgery	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	7684	34	06067	38.568402	-121.418019	Sacramento County
277683	Fee-for-Service	1114592136	1114592136	1	1	RIEDLE, KRISTEN G PHD	11/4/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4631 TELLER AVE	100	NEWPORT BEACH	CA	92660	8105	30	06059	33.66641504	-117.857408	Orange County
277698	Fee-for-Service	1740437367	1740437367	1	1	RUBY, MARIESA S	5/30/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
277721	Fee-for-Service	1649371220	1649371220	1	1	RONAGHI, NADER MD	2/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89178	05	Anesthesiology	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
277740	Fee-for-Service	1225356678	1225356678	1	1	REED, MATTHEW J MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121080	41	Internal Medicine	0	In state provider	None	4600 BROADWAY	SUITE 1100	SACRAMENTO	CA	95820	1527	34	06067	38.546127	-121.452669	Sacramento County
277754	Fee-for-Service	1649629155	1649629155	1	1	ROSS, JASON B MD	6/10/2024	2085R0001X	NA	Other	026	PHYSICIANS	153164	32	Radiation Therapy (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277768	Fee-for-Service	1831639715	1831639715	1	1	RYAN, CANDICE S PSY	4/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
277781	Fee-for-Service	1982645131	1982645131	1	1	ROSE, JUDITH G MD	6/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	36279	42	Nuclear Medicine	0	In state provider	None	465 N ROXBURY DR	STE 101	BEVERLY HILLS	CA	90210	4230	19	06037	34.06832918	-118.4072114	Los Angeles County
277797	Fee-for-Service	1356341507	1356341507	1	1	RICHARD S VAUGHAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	GUADALUPE REGIONAL MD	1215 EAST COURT STREET	None	SEGUIN	TX	78155	5129	00	None	29.569055	-97.94688981	Guadalupe County
277806	Fee-for-Service	1346675154	1346675154	1	1	RICHARDSON, ERIN A	1/29/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 N ROSE AVENUE	SUITE 460	OXNARD	CA	93030	3790	56	06111	34.21746	-119.155545	Ventura County
277811	Fee-for-Service	1689616617	1689616617	1	1	ROSENGARTEN, GARY G PHD	6/1/1999	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	444 S SAN VICENTE BLVD	STE 1101	LOS ANGELES	CA	90048	4170	19	06037	34.06999878	-118.3755119	Los Angeles County
277859	Fee-for-Service	1144288523	1144288523	1	1	REECE, RONALD E MD	12/31/1984	207N00000X	NA	Dermatology	026	PHYSICIANS	45548	07	Dermatology	0	In state provider	None	2701 OLD EUREKA WAY	STE 2A	REDDING	CA	96001	0848	45	06089	40.58555878	-122.4101367	Shasta County
277914	Fee-for-Service	1235159427	1235159427	1	1	ROTH, MICHAEL MD	1/1/1988	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53992	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
277948	Fee-for-Service	1982670220	1982670220	1	1	ROBERTS, GERALD S MD	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	26452	None	None	0	In state provider	None	2186 GEARY BLVD	STE 314	SAN FRANCISCO	CA	94115	3457	38	06075	37.78343395	-122.4392245	San Francisco County
277977	Fee-for-Service	1992751440	1992751440	1	1	ROSHDIEH, BABAK MD CORP	1/24/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	76333	07	Dermatology	0	In state provider	None	770 MAGNOLIA AVE	STE 2G	CORONA	CA	92879	3120	33	06065	33.85936872	-117.5534605	Riverside County
277988	Fee-for-Service	1841297207	1841297207	1	1	ROSENBERG, ANDREW G MD	8/1/1989	208800000X	NA	Other	026	PHYSICIANS	66599	34	Urology and Urological Surgery	0	In state provider	None	1750 EL CAMINO REAL	STE 307	BURLINGAME	CA	94010	3216	41	06081	37.59392355	-122.3819595	San Mateo County
278022	Fee-for-Service	1427497916	1427497916	1	1	RAUSCHECKER, ANDREAS M MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155842	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278069	Fee-for-Service	1740447267	1740447267	1	1	RAO, LATHA B MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127286	68	Hematology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
278076	Fee-for-Service	1356765739	1356765739	1	1	REZAIE, ALI MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127168	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
278101	Fee-for-Service	1144288523	1144288523	1	1	REECE, RONALD E MD	12/31/1984	207N00000X	NA	Dermatology	026	PHYSICIANS	45548	01	General Practice	0	In state provider	None	2701 OLD EUREKA WAY	STE 2A	REDDING	CA	96001	0848	45	06089	40.58555878	-122.4101367	Shasta County
278115	Fee-for-Service	1669908612	1669908612	1	1	ROBINSON, SAMUEL MD	8/1/2020	390200000X	NA	Other	026	PHYSICIANS	161519	41	Internal Medicine	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
278117	Fee-for-Service	1972799252	1972799252	1	1	RAMACHANDRAN, KAVAN MD	11/22/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
278145	Fee-for-Service	1073654083	1073654083	1	1	ROSENMAN, JOHN E. MD	7/1/1984	208600000X	NA	General Surgery	026	PHYSICIANS	49400	02	General Surgery	0	In state provider	None	117 N SAN MATEO DR	None	SAN MATEO	CA	94401	2708	41	06081	37.56866767	-122.3286434	San Mateo County
278158	Fee-for-Service	1285744946	1285744946	1	1	RALEYS	3/12/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	781 SOUTH HIGHWAY 49	None	JACKSON	CA	95642	2621	03	06005	38.34132284	-120.7652671	Amador County
278163	Fee-for-Service	1841406840	1841406840	1	1	REED, KRIS A PHD	6/6/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	219 N INDIAN HILL BLVD	SUITE 205	CLAREMONT	CA	91711	4644	19	06037	34.09604729	-117.71934	Los Angeles County
278166	Fee-for-Service	1346604519	1346604519	1	1	ROSNER, JACK J MD	12/11/2020	207L00000X	NA	Other	026	PHYSICIANS	155706	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
278181	Fee-for-Service	1750506689	1750506689	1	2	RAIMEL Y. PEREZ-PASILIAO, MD	8/27/2020	152WP0200X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	, INC.	12574 CENTRAL AVE	None	CHINO	CA	91710	3507	36	06071	34.024617	-117.6894775	San Bernardino County
278183	Fee-for-Service	1871584359	1871584359	1	1	RHM INC	9/15/1994	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	130 FORD ST	None	UKIAH	CA	95482	4012	23	06045	39.15680164	-123.2067215	Mendocino County
278211	Fee-for-Service	1023691433	1023691433	1	1	RUSHTON, SPENCER DO	5/24/2024	207P00000X	NA	Other	026	PHYSICIANS	22550	66	Emergency Medicine (Urgent Care)	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
278232	Fee-for-Service	1285814467	1285814467	1	1	RODRIGUEZ, LUIS LCSW	5/17/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
278243	Fee-for-Service	1215908702	1215908702	1	1	RIZZO, MARIO W DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15 W PORTAL AVE	None	SAN FRANCISCO	CA	94127	1303	38	06075	37.74069661	-122.465948	San Francisco County
278252	Fee-for-Service	1225007396	1225007396	1	1	REDFERN, CHARLES H MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52733	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
278311	Fee-for-Service	1740447267	1740447267	1	1	RAO, LATHA B MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127286	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
278339	Fee-for-Service	1275731176	1275731176	1	1	ROWE, EILEEN T	9/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
278347	Fee-for-Service	1306152244	1306152244	1	1	RIFKIND AUDIOLOGY INC	9/8/2010	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	25425 ORCHARD VILLAGE RO	SUITE 220	SANTA CLARITA	CA	91355	2959	19	06037	34.39014682	-118.5481743	Los Angeles County
278447	Fee-for-Service	1073792446	1073792446	1	1	RAIKHEL, MARINA MD	2/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49056	08	Family Practice	0	In state provider	None	25043 NARBONNE AVE	None	LOMITA	CA	90717	2101	19	06037	33.796863	-118.3199875	Los Angeles County
278451	Fee-for-Service	1386746097	1386746097	1	1	ROCHESTER, MARIANNE G MD	4/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45939	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
278515	Fee-for-Service	1346375094	1346375094	1	1	RAIA, JULIE D MFT	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41143	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
278552	Fee-for-Service	1740447267	1740447267	1	1	RAO, LATHA B MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127286	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
278578	Fee-for-Service	1265168397	1265168397	1	1	RAMIREZ, MELANIE OT	3/4/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6133 BRISTOL PKWY	STE 200	CULVER CITY	CA	90230	6670	19	06037	33.98472747	-118.3891179	Los Angeles County
278648	Fee-for-Service	1457360950	1457360950	1	1	REDDY, RAM T	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50362	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1360 W 6TH ST	STE 200	SAN PEDRO	CA	90732	3561	19	06037	33.73886546	-118.3075065	Los Angeles County
278659	Fee-for-Service	1821493768	1821493768	1	1	REANEY, NOREEN NP	5/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
278690	Fee-for-Service	1386746097	1386746097	1	1	ROCHESTER, MARIANNE G MD	4/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45939	34	Urology and Urological Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
278691	Fee-for-Service	1457882482	1457882482	1	1	RANGWALA, SHIVANI D MD	1/5/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	159676	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
278737	Fee-for-Service	1083099873	1083099873	1	1	REGAR, ARI A	9/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	78370 HIGHWAY 111	215	LA QUINTA	CA	92253	2618	33	06065	33.71596576	-116.2966509	Riverside County
278761	Fee-for-Service	1942361548	1942361548	1	3	ROMERO, ELIOTT MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48383	01	General Practice	0	In state provider	None	11180 WARNER AVE	STE 253	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
278779	Fee-for-Service	1124356829	1124356829	1	1	RAMIREZ, JOEL F MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109791	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
278828	Fee-for-Service	1851936728	1851936728	1	1	REDDING PAIN MEDICINE	8/16/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2111 AIRPARK DR	None	REDDING	CA	96001	2433	45	06089	40.57502348	-122.4048036	Shasta County
278849	Fee-for-Service	1205022241	1205022241	1	1	RYLAN EAST PAC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY ROOM ASSOCIATE	1601 W ST MARY RD	None	TUCSON	AZ	85745	0000	00	None	32.228199	-111.0000825	Pima County
278863	Fee-for-Service	1033295316	1033295316	1	1	RUHL, PHILLIP N DO	9/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	4881	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
278867	Fee-for-Service	1003893223	1003893223	1	1	RAHAL, PARAMVIR	12/31/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51282	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
278869	Fee-for-Service	1942728159	1942728159	1	1	RUELAS, NICOLETTE K LMFT	11/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
278971	Fee-for-Service	1699419309	1699419309	1	1	RESTART HOME HEALTH CARE INC	11/26/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3959 FOOTHILL BLVD	SUITE 305	LA CRESCENTA	CA	91214	1664	19	06037	34.24025956	-118.2658392	Los Angeles County
278972	Fee-for-Service	1295120855	1295120855	1	1	RUSSELL-SWETEK, AUBREY T NP	10/27/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
278978	Fee-for-Service	1811912413	1811912413	1	1	RALPHS GROCERY COMPANY	8/14/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #680	100 W CARRILLO ST	None	SANTA BARBARA	CA	93101	3215	42	06083	34.41973978	-119.7037725	Santa Barbara County
278992	Fee-for-Service	1275902074	1275902074	1	1	RICHARDS, DIANE R NP	3/18/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	146256	-	NOT APPLICABLE	0	In state provider	None	159 BRENTWOOD DRIVE	None	GRASS VALLEY	CA	95945	5768	29	06057	39.23230278	-121.0486552	Nevada County
278998	Fee-for-Service	1942361548	1942361548	1	3	ROMERO, ELIOTT MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48383	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11180 WARNER AVE	STE 253	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
279035	Fee-for-Service	1043880750	1043880750	1	1	REECE, CHARLA C CNP	12/1/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
279117	Fee-for-Service	1770005936	1770005936	1	1	RUBIN, ELIZABETH MD	6/7/2021	207P00000X	NA	Other	026	PHYSICIANS	171566	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
279136	Fee-for-Service	1144706060	1144706060	1	1	RODRIGUES, ASHLEY C CSW	3/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
279149	Fee-for-Service	1659893485	1659893485	1	1	RAU, BECKY I LCSW	8/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	70411	-	NOT APPLICABLE	0	In state provider	None	844 PICO BOULEVARD	None	SANTA MONICA	CA	90405	1325	19	06037	34.01263151	-118.4813759	Los Angeles County
279181	Fee-for-Service	1417033374	1417033374	1	1	RAYMUNDO DE VERA, CARMELITA	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	55746	40	Pediatrics	0	In state provider	A MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
279212	Fee-for-Service	1518176460	1518176460	1	1	REPKO, MICHAEL S MD	2/8/2015	207ZP0102X	NA	Other	026	PHYSICIANS	25554	22	Pathology (M.D. only)	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
279234	Fee-for-Service	1821142555	1821142555	1	1	RUIZ, BLANCA E NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3401 SOUTH HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
279312	Fee-for-Service	1235395799	1235395799	1	1	RABADI, MUNIF Y MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104966	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
279355	Fee-for-Service	1184722779	1184722779	1	1	REGENTS OF THE UNIV CA	7/1/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER-SAN DIEGO	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
279370	Fee-for-Service	1568675569	1568675569	1	1	RAPA, KATARZYNA W MD	2/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93625	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
279395	Fee-for-Service	1306145982	1306145982	1	1	ROGERS, TIMOTHY M MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130552	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
279413	Fee-for-Service	1922024405	1922024405	1	1	REINGOLD, WARREN J MD	3/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	A MEDICAL CORPORTATION	12139 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3832	19	06037	34.15763747	-118.3980195	Los Angeles County
279418	Fee-for-Service	1124166012	1124166012	1	1	REDDY, GIRIDHAR G MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78870	36	Psychiatry	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
279435	Fee-for-Service	1497833289	1497833289	1	1	ROTH, KATHLEEN L MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54430	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
279441	Fee-for-Service	1174503767	1174503767	1	1	REGENTS OF THE UNIV CA	1/1/1999	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	1370 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9554	34	06067	38.65493608	-121.1686756	Sacramento County
279472	Fee-for-Service	1710287297	1710287297	1	135	REGENTS UNIVERSITY OF CALIFO	4/15/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RNIA	862 AEROVISTA PL	100	SAN LUIS OBISPO	CA	93401	8758	40	06079	35.24253261	-120.6410999	San Luis Obispo County
279477	Fee-for-Service	1699859488	1699859488	1	1	RHEE, ELIZABETH U MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145923	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
279487	Fee-for-Service	1417082249	1417082249	1	1	RACHMAN, BONNIE R MD	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74955	40	Pediatrics	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2047	19	06037	33.83155851	-118.2920625	Los Angeles County
279497	Fee-for-Service	1376367870	1376367870	1	1	RAYA HEALTH, INC.	1/1/2025	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
279499	Fee-for-Service	1487721361	1487721361	1	1	RAKAB, AMINE M MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79499	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
279519	Fee-for-Service	1588009286	1588009286	1	1	RICHARDS, EVAN J MD	11/10/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
279538	Fee-for-Service	1912039124	1912039124	1	1	RUELAS, GILDA LMFT	7/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 S IMPERIAL HWY	None	ANAHEIM	CA	92807	3943	30	06059	33.85001282	-117.7903584	Orange County
279560	Fee-for-Service	1366962391	1366962391	1	1	RAMIREZ, CAMILLE M LPCC	1/9/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
279562	Fee-for-Service	1649212309	1649212309	1	1	REDERICH, GEORGE J MD	1/1/1982	207RS0012X	NA	Other	026	PHYSICIANS	36414	01	General Practice	0	In state provider	None	4455 W 117TH ST	None	HAWTHORNE	CA	90250	2241	19	06037	33.92825048	-118.3539285	Los Angeles County
279576	Fee-for-Service	1194802033	1194802033	1	1	REED, CATHERINE, MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80530	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
279624	Fee-for-Service	1093130676	1093130676	1	1	REYES, PAMELA CCC-SLP	9/13/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	31205 PAUBA ROAD	103	TEMECULA	CA	92592	6220	33	06065	33.49739729	-117.1169062	Riverside County
279628	Fee-for-Service	1881793693	1881793693	1	1	RODRIGUEZ, ROBERTO MD	10/31/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	60334	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
279634	Fee-for-Service	1912369208	1912369208	1	1	RIVERA, MARISA MD	11/25/2019	207R00000X	NA	Other	026	PHYSICIANS	151235	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
279639	Fee-for-Service	1538324645	1538324645	1	2	RAMIN ASHTIANI, MD A PROFESS	11/3/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	IONAL CORPORATION	13024 HESPERIA ROAD	STE 103	VICTORVILLE	CA	92395	8303	36	06071	34.48893153	-117.29123	San Bernardino County
279644	Fee-for-Service	1770976987	1770976987	1	1	RETINA INSTITUTE OF CALIFORN	10/8/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6906 BROCKTON AVE	6	RIVERSIDE	CA	92506	4027	33	06065	33.948306	-117.396721	Riverside County
279661	Fee-for-Service	1639340235	1639340235	1	1	ROSE, CHADRON M MD	3/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133207	05	Anesthesiology	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
279667	Fee-for-Service	1497833289	1497833289	1	1	ROTH, KATHLEEN L MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54430	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
279703	Fee-for-Service	1710287297	1710287297	1	135	REGENTS UNIVERSITY OF CALIFO	4/15/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	RNIA	862 AEROVISTA PL	100	SAN LUIS OBISPO	CA	93401	8758	40	06079	35.24253261	-120.6410999	San Luis Obispo County
279717	Fee-for-Service	1639219165	1639219165	1	1	REEVES III, JOHN D MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45076	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
279738	Fee-for-Service	1679640064	1679640064	1	1	REGEV, LISA G PHD	2/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
279771	Fee-for-Service	1932548609	1932548609	1	1	READ, NATHANAEL	5/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1650 OREGON ST	STE 216	REDDING	CA	96001	1757	45	06089	40.58198408	-122.3937903	Shasta County
279777	Fee-for-Service	1184026833	1184026833	1	1	ROSTAMI, MOHAMMADREZA MD	12/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135686	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
279791	Fee-for-Service	1467747543	1467747543	1	1	RIOS-ALBA, TONATIUH MD	10/10/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
279793	Fee-for-Service	1598958449	1598958449	1	1	ROGGE, SHANNON E LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9060 GRATON RD	None	GRATON	CA	95444	9364	49	06097	38.43631887	-122.8695445	Sonoma County
279795	Fee-for-Service	1346636602	1346636602	1	1	ROSE, SUSANNAH M MD	6/12/2020	208600000X	NA	General Surgery	026	PHYSICIANS	151776	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
279801	Fee-for-Service	1043408453	1043408453	1	1	RAFAAT, ZOE G MD	4/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104478	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
279824	Fee-for-Service	1033370333	1033370333	1	1	RICHARDS, KRISTIN L MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120017	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
279860	Fee-for-Service	1881793693	1881793693	1	1	RODRIGUEZ, ROBERTO MD	10/31/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	60334	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
279875	Fee-for-Service	1770976987	1770976987	1	1	RETINA INSTITUTE OF CALIFORN	10/8/2021	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6906 BROCKTON AVE	6	RIVERSIDE	CA	92506	4027	33	06065	33.948306	-117.396721	Riverside County
279896	Fee-for-Service	1073193413	1073193413	1	1	REN, JUSTIN L MD	8/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
279903	Fee-for-Service	1023437761	1023437761	1	1	ROSS, JUSTIN S DPM	7/9/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
279932	Fee-for-Service	1437134319	1437134319	1	1	RAHIM, NAZIR AHMAD MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77214	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
279934	Fee-for-Service	1710287297	1710287297	1	135	REGENTS UNIVERSITY OF CALIFO	4/15/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	862 AEROVISTA PL	100	SAN LUIS OBISPO	CA	93401	8758	40	06079	35.24253261	-120.6410999	San Luis Obispo County
279936	Fee-for-Service	1306138433	1306138433	1	1	RAJ, KRISTIN S MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122098	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
279942	Fee-for-Service	1689615015	1689615015	1	1	ROSS-CAMMOCK, CHERYL E	4/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78872	40	Pediatrics	0	In state provider	MD	110833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06391926	-118.4418606	Los Angeles County
279950	Fee-for-Service	1639219165	1639219165	1	1	REEVES III, JOHN D MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45076	05	Anesthesiology	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
279956	Fee-for-Service	1669617197	1669617197	1	16	RADY CHILDREN'S HOSPITAL SAN	4/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF SAN DIEGO, A MEDICAL	3605 VISTA WAY	STE 172	OCEANSIDE	CA	92056	4546	37	06073	33.1818929	-117.3104591	San Diego County
279997	Fee-for-Service	1093431603	1093431603	1	1	RAINBOW INVESTMENTS GROUP	12/8/2022	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	LLC	1525 S GROVE AVE	10	ONTARIO	CA	91762	4587	36	06071	34.046406	-117.6280695	San Bernardino County
280012	Fee-for-Service	1831933100	1831933100	1	1	ROQUE, RUDY NP	12/3/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1101 CALIFORNIA AVE	STE 100-18	CORONA	CA	92881	6470	33	06065	33.86171794	-117.5440764	Riverside County
280024	Fee-for-Service	1235375395	1235375395	1	1	RAPARIA, KIRTEE MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148542	22	Pathology (M.D. only)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
280039	Fee-for-Service	1750896387	1750896387	1	1	RODRIGUEZ, MARITRINI LCSW	10/22/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
280040	Fee-for-Service	1750914719	1750914719	1	1	REDDY, AMIT G MD	3/25/2025	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
280048	Fee-for-Service	1659364685	1659364685	1	1	REGENTS/UCDPBG/SUR GI	7/12/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
280098	Fee-for-Service	1518937838	1518937838	1	1	RICHA, ELIE M MD	4/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55015	None	None	0	In state provider	None	2710 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
280110	Fee-for-Service	1609955731	1609955731	1	1	RAMPAUL, REGINALD C MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80067	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
280154	Fee-for-Service	1144531773	1144531773	1	1	ROBY, JAY P MD	11/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103741	None	None	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91203	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
280168	Fee-for-Service	1689615015	1689615015	1	1	ROSS-CAMMOCK, CHERYL E	4/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78872	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	110833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06391926	-118.4418606	Los Angeles County
280179	Fee-for-Service	1205041779	1205041779	1	1	RAJAGOPALAN, SHOBITA MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51072	77	Infectious Disease	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
280216	Fee-for-Service	1568079762	1568079762	1	1	REAL CARE HOSPICE INC	3/25/2025	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4730 WOODMAN AVE	SUITE 302	SHERMAN OAKS	CA	91423	2400	19	06037	34.156701	-118.4312045	Los Angeles County
280238	Fee-for-Service	1275915985	1275915985	1	1	RIVERA MELARA, LUIS F MD	8/2/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	156579	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
280283	Fee-for-Service	1881731370	1881731370	1	1	RAHMAN-ABDEL, KHALED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 N DIVISION ST	STE 404	AUBURN	WA	98001	4939	00	None	47.308698	-122.2297715	King County
280310	Fee-for-Service	1457697807	1457697807	1	1	ROSENBERG, NICHOLAS D LCSW	7/20/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2140 SHATTUCK AVE	1104	BERKELEY	CA	94704	1210	01	06001	37.87056737	-122.2682364	Alameda County
280342	Fee-for-Service	1144670217	1144670217	1	1	RAMOS, COURTNEY DO	2/7/2020	207R00000X	NA	Other	026	PHYSICIANS	16200	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
280385	Fee-for-Service	1922077890	1922077890	1	1	RODWELL, GRAHAM E MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76385	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
280395	Fee-for-Service	1992012306	1992012306	1	9	ROLLING HILLS CLINIC	4/28/2023	261QP2300X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	2526 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
280403	Fee-for-Service	1609948231	1609948231	1	1	ROSENTHAL, ELLEN G MD	3/6/1996	207R00000X	NA	Other	026	PHYSICIANS	82191	41	Internal Medicine	0	In state provider	None	100 S ELLSWORTH AVE	STE 308	SAN MATEO	CA	94401	3931	41	06081	37.56665635	-122.3247743	San Mateo County
280457	Fee-for-Service	1710046842	1710046842	1	1	RETINA CONSULTANTS OF	11/20/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOUTHERN CALIFORNIA INC	9041 MAGNOLIA AVE	SUITE 207	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
280515	Fee-for-Service	1528130671	1528130671	1	1	RAU, JAMES E MD	11/30/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	24244	41	Internal Medicine	0	In state provider	None	6201 BRISTOL PKWY	None	CULVER CITY	CA	90230	6903	19	06037	33.98320609	-118.3910955	Los Angeles County
280522	Fee-for-Service	1477133627	1477133627	1	1	RAHMAN, ARIFEEN MD	2/22/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
280538	Fee-for-Service	1467065086	1467065086	1	1	RAITH, TIFFANY DC	9/2/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	12561 PALM DR	E	DESERT HOT SPRING	CA	92240	4521	33	06065	33.95736	-116.501348	Riverside County
280617	Fee-for-Service	1992012306	1992012306	1	9	ROLLING HILLS CLINIC	4/28/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2526 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
280647	Fee-for-Service	1295885630	1295885630	1	1	ROSENBERG, FREDRIC R MD	12/8/1972	No Taxonomy Provided	NA	None	026	PHYSICIANS	21402	None	None	0	In state provider	None	3650 SOUTH ST	STE 306	LAKEWOOD	CA	90712	1516	19	06037	33.86019847	-118.149255	Los Angeles County
280654	Fee-for-Service	1033596614	1033596614	1	1	ROSZCZYNIALSKI, KELLY N MD	8/13/2019	207PE0004X	NA	Other	026	PHYSICIANS	162806	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280690	Fee-for-Service	1568539484	1568539484	1	1	ROSANDICH, PAUL C MD	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80886	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
280732	Fee-for-Service	1134424005	1134424005	2	2	REONO BERTAGNOLLI, A MEDICAL	7/8/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FORNIA	10948 BIGGE STREET	None	SAN LEANDRO	CA	94577	1121	01	06001	37.72586136	-122.1862649	Alameda County
280736	Fee-for-Service	1528130671	1528130671	1	1	RAU, JAMES E MD	11/30/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	24244	77	Infectious Disease	0	In state provider	None	6201 BRISTOL PKWY	None	CULVER CITY	CA	90230	6903	19	06037	33.98320609	-118.3910955	Los Angeles County
280745	Fee-for-Service	1730375841	1730375841	1	1	RIVERA, MERCEDES Y MD	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109441	41	Internal Medicine	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6253	07	06013	37.98252	-121.8030615	Contra Costa County
280813	Fee-for-Service	1598720666	1598720666	1	1	REMPEL, DAVID MD	11/30/1994	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	51242	41	Internal Medicine	0	In state provider	None	1515 SCOTT ST	STE 1	SAN FRANCISCO	CA	94115	3511	38	06075	37.78406999	-122.4379366	San Francisco County
280895	Fee-for-Service	1538236427	1538236427	1	1	ROSENBAUM, DAVID A MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59059	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
280896	Fee-for-Service	1053670174	1053670174	1	1	RAJKANAN, NEHA	1/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127895	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
280938	Fee-for-Service	1487698585	1487698585	1	1	RATILAL, JAY P MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66236	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
280940	Fee-for-Service	1497783021	1497783021	1	1	RYU, JOHN J MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	51686	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
281006	Fee-for-Service	1720084999	1720084999	1	1	REHOBOTH MCKINLEY CHRISTIAN	12/27/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CARE SERVICES	1901 REDROCK DR	None	GALLUP	NM	87301	5683	00	None	35.50662903	-108.7272069	McKinley County
281024	Fee-for-Service	1598759151	1598759151	1	1	RICHARDSON, PATTI H MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43313	22	Pathology (M.D. only)	0	In state provider	None	19951 MARINER AVE	STE 150	TORRANCE	CA	90503	1738	19	06037	33.85129396	-118.3504889	Los Angeles County
281044	Fee-for-Service	1730756974	1730756974	1	1	RAI, MONICA PT	2/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26700 TOWNE CENTER DRIVE	SUITE 110	FOOTHILL RANCH	CA	92610	2844	30	06059	33.67455886	-117.6639195	Orange County
281047	Fee-for-Service	1851619407	1851619407	1	1	REZAEI ABBASSI, NIMA MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131669	18	Ophthalmology	0	In state provider	None	1360 W 6TH STREET	NORTH BLDG, SUITE 125	SAN PEDRO	CA	90732	3559	19	06037	33.73886546	-118.3075065	Los Angeles County
281052	Fee-for-Service	1154837300	1154837300	1	1	REYNOLDS, KRISTINA M PSYD	10/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
281060	Fee-for-Service	1871568097	1871568097	1	1	RAMSINGHANI, VEENA MD	3/29/2005	2085R0001X	NA	Other	026	PHYSICIANS	34356	30	Radiology	0	In state provider	None	1443 W 7TH ST	None	HANFORD	CA	93230	4937	16	06031	36.32550091	-119.6678789	Kings County
281075	Fee-for-Service	1215509393	1215509393	1	3	RECOVER MEDICAL GROUP P.C.	6/22/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	13101 W WASHINGTON BLVD	233	LOS ANGELES	CA	90066	5131	19	06037	33.99397583	-118.440813	Los Angeles County
281099	Fee-for-Service	1306092465	1306092465	1	1	RUIZ, ERICA M MD	5/20/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104555	01	General Practice	0	In state provider	None	47110 WASHINGTON ST	STE 203	LA QUINTA	CA	92253	2186	33	06065	33.70698194	-116.2929821	Riverside County
281115	Fee-for-Service	1538236427	1538236427	1	1	ROSENBAUM, DAVID A MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59059	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
281116	Fee-for-Service	1609900562	1609900562	1	1	ROMERO, ERIN E LCSW	9/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23955	-	NOT APPLICABLE	0	In state provider	None	151 W MISSION ST	STE A1 WING A	SAN JOSE	CA	95110	1713	43	06085	37.3498901	-121.9035777	Santa Clara County
281117	Fee-for-Service	1255362919	1255362919	1	2	ROACHE, PAUL B MD	3/1/2019	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	48445	None	None	0	In state provider	None	45 CASTRO STREET	337	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
281126	Fee-for-Service	1528146388	1528146388	1	1	ROZYCKI, GREGORY A MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88022	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
281156	Fee-for-Service	1487698585	1487698585	1	1	RATILAL, JAY P MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66236	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
281168	Fee-for-Service	1982846325	1982846325	1	1	ROSARIO, JASPER M DO	8/18/2014	207L00000X	NA	Other	026	PHYSICIANS	12489	05	Anesthesiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
281199	Fee-for-Service	1205928520	1205928520	1	1	ROBINSON, FRANCIS J	5/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
281213	Fee-for-Service	1518214808	1518214808	1	1	REYNOLDS, JENNIFER M LMFT	1/2/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7225 RAINBOW DR	None	SAN JOSE	CA	95129	4552	43	06085	37.30146258	-122.0315034	Santa Clara County
281225	Fee-for-Service	1720084999	1720084999	1	1	REHOBOTH MCKINLEY CHRISTIAN	12/27/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CARE SERVICES	1901 REDROCK DR	None	GALLUP	NM	87301	5683	00	None	35.50662903	-108.7272069	McKinley County
281309	Fee-for-Service	1851463723	1851463723	1	10	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	1250 LA VENTA DR	211	WESTLAKE VILLAGE	CA	91361	3702	56	06111	34.14827603	-118.8227637	Ventura County
281313	Fee-for-Service	1306092465	1306092465	1	1	RUIZ, ERICA M MD	5/20/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104555	08	Family Practice	0	In state provider	None	47110 WASHINGTON ST	STE 203	LA QUINTA	CA	92253	2186	33	06065	33.70698194	-116.2929821	Riverside County
281352	Fee-for-Service	1447283429	1447283429	1	1	RABECK, MELVIN J PHD	3/3/1997	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10843 MINETTE DR	None	CUPERTINO	CA	95014	3681	43	06085	37.31097826	-122.0036718	Santa Clara County
281368	Fee-for-Service	1225333545	1225333545	1	1	REEVES, ELIZABETH I	6/18/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
281374	Fee-for-Service	1205896370	1205896370	1	1	ROGERS, CHRISTOPHER J MD	8/1/1998	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	84249	25	Physical Medicine and Rehabilitation	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
281380	Fee-for-Service	1447349089	1447349089	1	1	ROSEN, NORMAN J MD	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48673	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
281382	Fee-for-Service	1700084753	1700084753	1	1	RICHARDS, MARTHA J NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
281407	Fee-for-Service	1922325588	1922325588	1	1	RAMIREZ, NOEL E MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110539	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
281457	Fee-for-Service	1205885878	1205885878	1	1	ROBY P. JOYCE M.D.	6/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12315 JUSDSON RD	STE 114	SAN ANTONIO	TX	78233	0000	00	None	29.55130253	-98.3462474	Bexar County
281519	Fee-for-Service	1083659155	1083659155	1	1	ROSONKE, STEVEN L MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
281534	Fee-for-Service	1750489241	1750489241	1	1	RUCH, STUART W MD	11/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78806	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
281546	Fee-for-Service	1699974329	1699974329	1	2	RN HOME HEALTH CARE INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6047 TAMPA AVE	SUITE 306	TARZANA	CA	91356	1174	19	06037	34.180812	-118.553488	Los Angeles County
281585	Fee-for-Service	1205896370	1205896370	1	1	ROGERS, CHRISTOPHER J MD	8/1/1998	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	84249	20	Orthopedic Surgery	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
281589	Fee-for-Service	1669577334	1669577334	1	1	ROSAL, CARLA J MD	3/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68599	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
281672	Fee-for-Service	1174798581	1174798581	1	1	RANA, MANDEEP MD	11/3/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	173319	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
281674	Fee-for-Service	1518145846	1518145846	1	1	RIVERA-ORTIZ, WM MD	9/30/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18484 OUTER HWY 18	STE 225	APPLE VALLEY	CA	92307	2319	36	06071	34.53974182	-117.2611347	San Bernardino County
281720	Fee-for-Service	1497965768	1497965768	1	1	RYAN KIRWAN	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
281721	Fee-for-Service	1053798090	1053798090	1	1	RAHIM, SHELLEY A	5/6/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
281739	Fee-for-Service	1801029921	1801029921	1	1	ROHANI, PAYAM MD	12/12/2014	207R00000X	NA	Other	026	PHYSICIANS	117919	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
281761	Fee-for-Service	1437154697	1437154697	1	1	RENAISSANCE RADIOLOGY	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	9041 MAGNOLIA AVE	STE 101	RIVERSIDE	CA	92503	3942	33	06065	33.92541585	-117.4378266	Riverside County
281773	Fee-for-Service	1326508508	1326508508	1	1	RANKIN, HOLLY MD	9/5/2023	390200000X	NA	Other	026	PHYSICIANS	184085	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
281802	Fee-for-Service	1053051813	1053051813	1	1	REED, VANESSA LCSW	1/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1620 E ROSEVILLE PARKWAY	200	ROSEVILLE	CA	95661	3303	31	06061	38.74929858	-121.2417037	Placer County
281815	Fee-for-Service	1992348460	1992348460	1	1	RSCR CALIFORNIA INC	12/10/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5940 LOS ANGELES WAY	None	BUENA PARK	CA	90620	2723	30	06059	33.84140604	-118.0313617	Orange County
281829	Fee-for-Service	1902231467	1902231467	1	1	ROTH, MELISSA N LCSW	8/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
281865	Fee-for-Service	1851816599	1851816599	3	1	REBECCA ZENER, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
281894	Fee-for-Service	1639660202	1639660202	1	1	RIPA, VALERIA MD	4/25/2023	204F00000X	NA	General Surgery	026	PHYSICIANS	185572	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
281901	Fee-for-Service	1710321062	1710321062	1	1	ROSE, CHRISTIAN C MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133608	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281936	Fee-for-Service	1164861803	1164861803	1	1	RAJPUT, ANUJ K MD	6/28/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	154360	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
281940	Fee-for-Service	1659398089	1659398089	1	1	RAVURI, SUMAN MD	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
281977	Fee-for-Service	1487183307	1487183307	1	1	RABIZADEH, FARIBA MARRIAGE	7/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPIST A PROF	12304 SANTA MONICA BLVD	STE 314	LOS ANGELES	CA	90025	2593	19	06037	34.03948285	-118.4656304	Los Angeles County
281980	Fee-for-Service	1518491158	1518491158	1	1	RYU, CHRISTINA N MD	7/20/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	159726	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
282003	Fee-for-Service	1780160796	1780160796	1	1	RUSHING, MARIKO C NP	2/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
282078	Fee-for-Service	1861417461	1861417461	1	1	RALPHS GROCERY COMPANY	5/29/1999	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #120	1413 HAWTHORNE BLVD	None	REDONDO BEACH	CA	90278	3923	19	06037	33.866982	-118.352739	Los Angeles County
282080	Fee-for-Service	1992788897	1992788897	1	1	RUDD, STEVEN M MD	3/31/1995	207P00000X	NA	Other	026	PHYSICIANS	76265	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
282114	Fee-for-Service	1700845278	1700845278	1	1	RENAL TREATMENT CTRS-CA	8/1/2002	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4345 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2318	19	06037	33.93082074	-118.1841897	Los Angeles County
282153	Fee-for-Service	1629657168	1629657168	1	1	RAINER, CAMILLE R MD	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10100 CULVER BLVD	STE A	CULVER CITY	CA	90232	3175	19	06037	34.01935201	-118.3979919	Los Angeles County
282182	Fee-for-Service	1689072670	1689072670	1	1	RESTORE MEDICAL INC	4/5/2016	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	24 ANTELOPE BLVD	None	RED BLUFF	CA	96080	2807	52	06103	40.17871238	-122.2296851	Tehama County
282249	Fee-for-Service	1457345621	1457345621	1	1	ROBIN, MARCO S DO	2/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8835	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
282269	Fee-for-Service	1083613897	1083613897	1	1	RO, KYOO S MD INC	2/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	26079	14	Neurological Surgery	0	In state provider	None	435 ARDEN AVE	STE 380	GLENDALE	CA	91203	1147	19	06037	34.15848148	-118.2628845	Los Angeles County
282279	Fee-for-Service	1518045368	1518045368	1	1	RAMPAL, RAJESH MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84367	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
282316	Fee-for-Service	1295235380	1295235380	1	1	RAINVILLE, ANNA M LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
282318	Fee-for-Service	1891416558	1891416558	1	1	RANDOLPH SENINING CORP	1/16/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7702 MEANY AVE	SUITE 101	BAKERSFIELD	CA	93308	5199	15	06029	35.3942865	-119.087946	Kern County
282357	Fee-for-Service	1225300346	1225300346	1	1	ROHRER, REBECCA	1/27/2024	2085B0100X	NA	MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
282393	Fee-for-Service	1366532905	1366532905	1	1	RYAN, TIMOTHY M MD AMC	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72433	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
282394	Fee-for-Service	1477783264	1477783264	1	1	ROWAN, CHRISTOPHER J MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	1500 E 2ND STREET	SUITE 400	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
282409	Fee-for-Service	1508842683	1508842683	1	1	ROWEN, DAVID W CRNA	12/1/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
282442	Fee-for-Service	1578793808	1578793808	1	1	REZA, MOHAMMAD S MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117572	08	Family Practice	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
282450	Fee-for-Service	1205046182	1205046182	1	1	RANA, SHAUNAK V MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117404	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	405	LA MESA	CA	91942	3198	37	06073	32.78189749	-117.0075062	San Diego County
282510	Fee-for-Service	1366590762	1366590762	1	1	REGENTS OF THE UNIVERSITY OF	12/7/2018	207QA0000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LY MEDICINE	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
282535	Fee-for-Service	1285747139	1285747139	1	1	REIS, KIM S DO	6/28/2010	207L00000X	NA	Other	026	PHYSICIANS	7595	05	Anesthesiology	0	In state provider	None	3350 W BALL ROAD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
282567	Fee-for-Service	1558561498	1558561498	1	1	REYES MERIN, MELISSA A MD	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100703	07	Dermatology	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
282612	Fee-for-Service	1497739296	1497739296	1	1	RICHMAN, DAVID P MD	4/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	25987	13	Neurology (M.D. only)	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
282639	Fee-for-Service	1699862102	1699862102	1	1	ROSENBLIT, PAUL D MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39224	41	Internal Medicine	0	In state provider	None	18821 DELAWARE ST	STE 202	HUNTINGTON BEACH	CA	92648	1936	30	06059	33.68906927	-117.9932048	Orange County
282654	Fee-for-Service	1205046182	1205046182	1	1	RANA, SHAUNAK V MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117404	45	Nephrology (Renal-Kidney)	0	In state provider	None	8851 CENTER DR	405	LA MESA	CA	91942	3198	37	06073	32.78189749	-117.0075062	San Diego County
282657	Fee-for-Service	1205397510	1205397510	1	1	ROBBINS, ANN L MD	5/20/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	182561	13	Neurology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282701	Fee-for-Service	1366590762	1366590762	1	1	REGENTS OF THE UNIVERSITY OF	5/13/2020	207QA0000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LY MEDICINE	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
282723	Fee-for-Service	1912071564	1912071564	1	1	RAI CARE CTRS SO CA II	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	RAI-CENTINELA-INGLEWOOD	1416 CENTINELA AVE	None	INGLEWOOD	CA	90302	1142	19	06037	33.97689302	-118.3649641	Los Angeles County
282837	Fee-for-Service	1922889682	1922889682	1	1	ROYAL LAKE VIEW LLC	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	35940 TIERRA SUBIDA AVE	None	PALMDALE	CA	93551	8002	19	06037	34.53550225	-118.1348697	Los Angeles County
282849	Fee-for-Service	1831758622	1831758622	1	1	RAPID CARE HOSPICE	2/5/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	SUITE 228	RESEDA	CA	91335	4055	19	06037	34.2011975	-118.5419835	Los Angeles County
282854	Fee-for-Service	1912704552	1912704552	1	1	RESCUE-A-LIFE FOUNDATION	3/3/2025	261QC1500X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	24328 VERMONT AVE	STE.316	HARBOR CITY	CA	90710	2320	19	06037	33.80332668	-118.2902866	Los Angeles County
282899	Fee-for-Service	1851478481	1851478481	1	1	REYNARD, MICHAEL MD	1/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40986	18	Ophthalmology	0	In state provider	None	1301 20TH ST	STE 260	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
282901	Fee-for-Service	1366590762	1366590762	1	1	REGENTS OF THE UNIVERSITY OF	3/16/2007	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	LY MEDICINE	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
282903	Fee-for-Service	1710970736	1710970736	1	1	REGENTS/UCDPBG/IM NEPHR	1/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
282919	Fee-for-Service	1881153153	1881153153	1	1	ROSS, ALEXANDRA L DO	6/29/2022	208M00000X	NA	Other	026	PHYSICIANS	19724	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
282933	Fee-for-Service	1427086842	1427086842	1	1	RAJALA, WILLIAM P	12/31/1987	207R00000X	NA	Other	026	PHYSICIANS	62173	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
282947	Fee-for-Service	1154679173	1154679173	1	1	ROUNGTHIP, BACCAM MFT	12/29/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1545 SAINT MARKS PLAZA	STE 5	STOCKTON	CA	95207	6411	39	06077	37.98892524	-121.3254177	San Joaquin County
282948	Fee-for-Service	1881190767	1881190767	1	1	RASUL, LAILA MD	10/24/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	184970	None	None	0	In state provider	None	321 E ST	None	CHULA VISTA	CA	91910	2667	37	06073	32.64457385	-117.0820661	San Diego County
282980	Fee-for-Service	1932253952	1932253952	1	1	ROTHI, BRIAN D MD	7/31/1989	174400000X	NA	Other	026	PHYSICIANS	34821	20	Orthopedic Surgery	0	In state provider	None	12612 183RD ST	None	CERRITOS	CA	90703	8531	19	06037	33.86576147	-118.0633327	Los Angeles County
282984	Fee-for-Service	1073573903	1073573903	1	1	REDDY, JAYAPAL A MD	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81459	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
282989	Fee-for-Service	1659811859	1659811859	1	1	ROBERTSON, ABBY E NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283004	Fee-for-Service	1124041744	1124041744	1	1	RIESEN, SHARON K MD	10/1/2021	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 CAMPUS ST	COLEMAN PAV ROOM A-11120	LOMA LINDA	CA	92350	1700	36	06071	34.049547	-117.2656245	San Bernardino County
283042	Fee-for-Service	1831758622	1831758622	1	1	RAPID CARE HOSPICE	2/5/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18747 SHERMAN WAY	SUITE 228	RESEDA	CA	91335	4055	19	06037	34.2011975	-118.5419835	Los Angeles County
283077	Fee-for-Service	1316315146	1316315146	1	1	REGINALDO-ROXAS, RITA	3/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2166 BOCA RATON ST	None	HAYWARD	CA	94545	3534	01	06001	37.63420448	-122.0973284	Alameda County
283093	Fee-for-Service	1780752683	1780752683	1	1	ROBERTS, JENNA C MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86373	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
283161	Fee-for-Service	1750768784	1750768784	1	1	RODRIGUEZ, JONIER R MD	2/24/2019	207R00000X	NA	Other	026	PHYSICIANS	153852	41	Internal Medicine	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
283174	Fee-for-Service	1134150998	1134150998	1	1	RICHARDSON, ROSALIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 E PARK CENTER BLVD	None	BOISE	ID	83706	6528	00	None	43.58988807	-116.1750146	Ada County
283179	Fee-for-Service	1073573903	1073573903	1	1	REDDY, JAYAPAL A MD	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81459	41	Internal Medicine	0	In state provider	None	1330 SAN BERNARDINO RD	STE L	UPLAND	CA	91786	4980	36	06071	34.10294486	-117.6325059	San Bernardino County
283198	Fee-for-Service	1124041744	1124041744	1	1	RIESEN, SHARON K MD	6/8/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51060	40	Pediatrics	0	In state provider	None	11175 CAMPUS ST	COLEMAN PAV ROOM A-11120	LOMA LINDA	CA	92350	1700	36	06071	34.049547	-117.2656245	San Bernardino County
283220	Fee-for-Service	1629061643	1629061643	1	2	REGENTS/UCDPBG/IM HEMOTO	6/5/2020	207RH0000X	NA	Hematology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
283244	Fee-for-Service	1275642910	1275642910	1	1	RENNER, ELISABETH H MD	11/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66708	01	General Practice	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3191	07	06013	37.95582533	-121.967442	Contra Costa County
283259	Fee-for-Service	1811576192	1811576192	1	1	RIDENOUR, JOSEPH OD	7/24/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2650 ELM AVE	108	LONG BEACH	CA	90806	1651	19	06037	33.805521	-118.1882945	Los Angeles County
283311	Fee-for-Service	1134415011	1134415011	1	1	ROHATGI, PRAGATI MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135665	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283313	Fee-for-Service	1427001346	1427001346	1	1	RIOS & PIERCE MEDICAL CORP	9/15/2006	261QR1300X	NA	Rural Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	148 E KINGS ST	None	AVENAL	CA	93204	1529	16	06031	36.00249425	-120.1366109	Kings County
283333	Fee-for-Service	1205927316	1205927316	1	1	RAUL P CONSING MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 S COLUMBIA RD	None	GRAND FORKS	ND	58201	4036	00	None	47.910609	-97.06647551	Grand Forks County
283339	Fee-for-Service	1447214812	1447214812	1	1	RENAL TREATMENT CTRS INC	3/28/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	2	Out of state provider	ST LOUIS PARK DIALYSIS	3505 LOUISIANA AVE S	None	ST LOUIS PARK	MN	55426	4121	00	None	44.93948797	-93.3698735	Hennepin County
283346	Fee-for-Service	1689075749	1689075749	1	1	RODRIGUEZ, CINDY	6/19/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	STE 137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
283359	Fee-for-Service	1730114133	1730114133	1	1	ROSEN, ELAINE L MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50232	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
283394	Fee-for-Service	1891560959	1891560959	1	1	RADER, DIANA D LMFT	12/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
283404	Fee-for-Service	1942449442	1942449442	1	2	RUIZ, RUBEN M III MD INC	10/17/2012	193400000X	NA	Other	026	PHYSICIANS	78287	01	General Practice	0	In state provider	None	3342 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2206	19	06037	34.02803057	-118.2015948	Los Angeles County
283409	Fee-for-Service	1629061643	1629061643	1	2	REGENTS/UCDPBG/IM HEMOTO	5/1/1999	207RH0000X	NA	Hematology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
283410	Fee-for-Service	1386635878	1386635878	1	1	RICHARD HALTERMAN	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1750 E KEN PRATT BLVD	None	LONGMONT	CO	80504	5311	00	None	40.16034936	-105.0585093	Boulder County
283424	Fee-for-Service	1659830545	1659830545	1	1	ROSTAMI, BENJAMIN MD	5/26/2022	207R00000X	NA	Other	026	PHYSICIANS	176597	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
283427	Fee-for-Service	1720217235	1720217235	1	1	RAMOS, MANFRED L DO	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12169	01	General Practice	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
283429	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	9/27/2022	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
283437	Fee-for-Service	1770520884	1770520884	1	1	RENNKE, STEPHANIE MD	12/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90616	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
283450	Fee-for-Service	1275526337	1275526337	1	1	REGENTS/UCDPBG/SUR PLAST	1/16/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
283451	Fee-for-Service	1487132403	1487132403	1	1	RICKENBACH, LYNNE RCP	8/27/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
283459	Fee-for-Service	1457748840	1457748840	1	1	REDDY, PAVAN MD	5/29/2019	207R00000X	NA	Other	026	PHYSICIANS	146837	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
283497	Fee-for-Service	1508390063	1508390063	1	1	ROBINS, DENNIS MD	11/4/2022	208800000X	NA	Other	026	PHYSICIANS	178476	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
283546	Fee-for-Service	1588869382	1588869382	1	1	RAGHUWANSHI, NAISHADH N MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102238	41	Internal Medicine	0	In state provider	None	25485 MEDICAL CENTER DR	STE 104	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
283562	Fee-for-Service	1164402434	1164402434	1	1	RHO, TAE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
283589	Fee-for-Service	1265988943	1265988943	1	1	RAJANALA, ALEKYA MD	6/7/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
283614	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	10/27/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
283629	Fee-for-Service	1215661434	1215661434	1	1	RENTERIA, ERNESTO	9/27/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 GOSFORD RD	SUITE G	BAKERSFIELD	CA	93309	7694	15	06029	35.320932	-119.092064	Kern County
283639	Fee-for-Service	1275526337	1275526337	1	1	REGENTS/UCDPBG/SUR PLAST	5/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
283730	Fee-for-Service	1588869382	1588869382	1	1	RAGHUWANSHI, NAISHADH N MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102238	10	Gastroenterology (M.D. only)	0	In state provider	None	25485 MEDICAL CENTER DR	STE 104	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
283736	Fee-for-Service	1487213500	1487213500	1	1	RAMIREZ, NICOLE A CRNA	4/7/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283766	Fee-for-Service	1881984409	1881984409	1	1	RESLER, BRIAN L MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124681	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
283798	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	8/15/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
283812	Fee-for-Service	1275556607	1275556607	1	17	REDWOOD REGIONAL MEDICAL	12/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
283872	Fee-for-Service	1659788107	1659788107	1	1	ROY, DAVID C MD	8/18/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	160710	46	Hand Surgery	0	In state provider	None	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	27	06053	36.66192801	-121.6413283	Monterey County
283884	Fee-for-Service	1356546568	1356546568	1	1	RALPHS GROCERY COMPANY	10/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS PHARMACY #110	3455 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2606	19	06037	33.828075	-118.345635	Los Angeles County
283903	Fee-for-Service	1811042179	1811042179	1	1	RABKIN, JOHN M MD	2/20/2004	208600000X	NA	General Surgery	026	PHYSICIANS	51241	02	General Surgery	0	In state provider	None	2340 CLAY ST	FL 4	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
283904	Fee-for-Service	1720247612	1720247612	1	1	RICHARDS, LISA M NP	1/26/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283916	Fee-for-Service	1528479300	1528479300	1	1	ROBERTSON, MONIQUE N LMFT	11/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
283929	Fee-for-Service	1518048628	1518048628	1	1	RATENER, MICHAEL C MD	12/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42147	36	Psychiatry	0	In state provider	None	3131 BROWNS VALLEY RD	None	NAPA	CA	94558	5422	28	06055	38.30367773	-122.3214694	Napa County
283938	Fee-for-Service	1043384324	1043384324	1	1	RAI CARE CENTERS OF	10/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIF II LLC	7200 BANCROFT AVE	STE 220	OAKLAND	CA	94605	2414	01	06001	37.768221	-122.17608	Alameda County
283941	Fee-for-Service	1841789328	1841789328	1	1	RAYAN, SUNIL MD INC	10/2/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	87655	02	General Surgery	0	In state provider	None	320 SANTA FE	STE 212	ENCINITAS	CA	92024	5139	37	06073	33.038847	-117.285579	San Diego County
283954	Fee-for-Service	1194766782	1194766782	1	1	ROBERT D ARMSTRONG MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	159 N MAIN ST	None	MANTI	UT	84642	1257	00	None	39.26773507	-111.6370559	Sanpete County
283968	Fee-for-Service	1699271965	1699271965	1	1	RADHAKRISHNAN, VIVEK MD	12/22/2021	207R00000X	NA	Other	026	PHYSICIANS	174503	None	None	0	In state provider	None	5400 ALDRIN	None	BAKERSFIELD	CA	93313	2103	15	06029	35.31652652	-119.062791	Kern County
283978	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	10/27/2021	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
283989	Fee-for-Service	1871250019	1871250019	1	1	RETANA, JENNIFER AU	12/7/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284003	Fee-for-Service	1003340944	1003340944	1	1	RILEY, HOLLYANN E OT	8/16/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
284006	Fee-for-Service	1356578959	1356578959	1	1	REDDING SPINE & SPORTS MED	12/9/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	1255 EAST STREET	SUITE 201	REDDING	CA	96001	0800	45	06089	40.58763719	-122.3893695	Shasta County
284031	Fee-for-Service	1417035213	1417035213	1	1	ROSSMAN, LORCA MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
284054	Fee-for-Service	1659788107	1659788107	1	1	ROY, DAVID C MD	8/18/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	160710	20	Orthopedic Surgery	0	In state provider	None	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	27	06053	36.66192801	-121.6413283	Monterey County
284161	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	2/14/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
284163	Fee-for-Service	1275556607	1275556607	1	4	REDWOOD REGIONAL MEDICAL	6/2/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
284186	Fee-for-Service	1760779953	1760779953	1	1	ROSS, JENNIFER L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
284213	Fee-for-Service	1538365325	1538365325	1	1	RAVEN, RAMIN A	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119240	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
284262	Fee-for-Service	1124474606	1124474606	1	1	RAYMUNDO M. GARCIA LORA MD I	5/23/2016	261QP2300X	NA	Other	026	PHYSICIANS	137841	None	None	0	In state provider	INC	459 N. TUSTIN ST	None	ORANGE	CA	92867	7778	30	06059	33.79438889	-117.8356736	Orange County
284275	Fee-for-Service	1376668293	1376668293	1	1	REBER, SHAWN M LMFT	9/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
284289	Fee-for-Service	1902861453	1902861453	1	1	ROSA, GREGORY P MD	10/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6800 PALM AVE	STE C1	SEBASTOPOL	CA	95472	4251	49	06097	38.39602719	-122.8185446	Sonoma County
284307	Fee-for-Service	1336671908	1336671908	1	1	ROBERTSON, ELSIE M MD	8/17/2022	208600000X	NA	General Surgery	026	PHYSICIANS	157907	None	None	0	In state provider	None	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
284309	Fee-for-Service	1497884506	1497884506	1	1	ROY MITCHELL COLVEN MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
284330	Fee-for-Service	1164421012	1164421012	1	1	REMINGTON BOONE, LEE MD	3/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77690	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 200	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
284337	Fee-for-Service	1669617197	1669617197	1	12	RADY CHILDREN'S HOSPITAL SAN	5/17/2024	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
284358	Fee-for-Service	1629198676	1629198676	1	1	RAMOS, CORINE D LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
284371	Fee-for-Service	1972691228	1972691228	1	1	RIVERSIDE PSYCHIATRIC MEDICA	3/17/2021	261QM0801X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	L GROUP	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
284403	Fee-for-Service	1437751492	1437751492	1	1	RASLOWSKY, BRANDON J PT	1/14/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
284428	Fee-for-Service	1669617197	1669617197	1	8	RADY CHILDREN'S HOSPITAL SAN	8/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
284437	Fee-for-Service	1386823888	1386823888	1	1	RIDE ON TIME LLC	11/16/2007	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5220 4TH ST	STE 18	IRWINDALE	CA	91706	6600	19	06037	34.1074203	-117.9385093	Los Angeles County
284460	Fee-for-Service	1093885824	1093885824	1	1	RICH, JEREMY MD	10/12/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	151780	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
284462	Fee-for-Service	1902861453	1902861453	1	1	ROSA, GREGORY P MD	10/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35981	08	Family Practice	0	In state provider	None	6800 PALM AVE	STE C1	SEBASTOPOL	CA	95472	4251	49	06097	38.39602719	-122.8185446	Sonoma County
284478	Fee-for-Service	1023299740	1023299740	2	1	R&C QUALITY CARE	5/16/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1040 S BUBBLING WELL RD	None	WEST COVINA	CA	91790	5001	19	06037	34.05628059	-117.9352081	Los Angeles County
284542	Fee-for-Service	1972691228	1972691228	1	1	RIVERSIDE PSYCHIATRIC MEDICA	3/17/2021	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	L GROUP	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
284590	Fee-for-Service	1013264951	1013264951	1	1	RONDINONE, SARA J CRNA	12/17/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
284599	Fee-for-Service	1669617197	1669617197	1	8	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SAN DIEGO	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
284600	Fee-for-Service	1700301603	1700301603	1	1	ROSE MEADOW ASSISTED LIVING,	10/31/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	5627 N BOND STREET	None	FRESNO	CA	93710	6315	10	06019	36.81992574	-119.7671979	Fresno County
284630	Fee-for-Service	1073526430	1073526430	1	1	ROSS, PETER S MD	10/14/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	161346	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284639	Fee-for-Service	1578619649	1578619649	1	1	RUSH, AURILLA N MD	7/31/1988	207P00000X	NA	Other	026	PHYSICIANS	61071	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
284662	Fee-for-Service	1093324279	1093324279	1	1	ROYAL HOLLYWOOD HEALTHCARE	3/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	5068 HOLLYWOOD BLVD	STE A	LOS ANGELES	CA	90027	6139	19	06037	34.10173003	-118.3002721	Los Angeles County
284681	Fee-for-Service	1669512059	1669512059	1	1	REDLANDS UNIF SCHOOL DIS	11/30/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	33 W LUGONIA AVE	None	REDLANDS	CA	92374	2233	36	06071	34.0700109	-117.1832005	San Bernardino County
284713	Fee-for-Service	1972691228	1972691228	1	1	RIVERSIDE PSYCHIATRIC MEDICA	9/13/2021	261QM0801X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	L GROUP	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
284716	Fee-for-Service	1518941087	1518941087	1	1	ROGER, ALLEN L	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 10TH ST SE	None	CEDAR RAPIDS	IA	52403	0000	00	None	41.97807	-91.6557795	Linn County
284741	Fee-for-Service	1992184329	1992184329	1	1	REYES PEREYRA, JESUS M MD	7/16/2021	390200000X	NA	Other	026	PHYSICIANS	172668	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
284768	Fee-for-Service	1669617197	1669617197	1	8	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	SAN DIEGO	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
284795	Fee-for-Service	1104936756	1104936756	1	1	RACHELEFSKY, GARY S MD	1/1/1982	207KI0005X	NA	Other	026	PHYSICIANS	22339	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
284799	Fee-for-Service	1073526430	1073526430	1	1	ROSS, PETER S MD	10/14/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	161346	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284867	Fee-for-Service	1952418758	1952418758	1	1	RALEYS	2/11/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39 LINCOLN BOULEVARD	None	LINCOLN	CA	95648	9390	31	06061	38.87276359	-121.2980416	Placer County
284877	Fee-for-Service	1588687255	1588687255	1	1	ROSEN, IVAN W MD	1/1/1982	2085B0100X	NA	MRI Provider	026	PHYSICIANS	24928	30	Radiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
284882	Fee-for-Service	1407494180	1407494180	1	1	RECOVERY ROAD HOME HEALTH	10/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14545 FRIAR ST	SUITE 162	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
284886	Fee-for-Service	1972691228	1972691228	1	1	RIVERSIDE PSYCHIATRIC MEDICA	7/23/2021	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	L GROUP	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
284933	Fee-for-Service	1669617197	1669617197	1	8	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
284942	Fee-for-Service	1437398591	1437398591	1	1	RAZZAQUE, SAQIB MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127157	78	Neoplastic Diseases/Oncology	0	In state provider	None	1410 S LA BRUCHERIE RD	SUITE A	EL CENTRO	CA	92243	9676	13	06025	32.78048827	-115.578488	Imperial County
285010	Fee-for-Service	1396709077	1396709077	1	1	RIVERSIDE MEDICAL CLINIC SUR	6/3/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	GERY CENTER	7160 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94273905	-117.3941945	Riverside County
285021	Fee-for-Service	1851639405	1851639405	1	1	ROSE GARDEN RESIDENTIAL	2/3/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OPERATOR, LLC	1350 WABASH AVE	None	MENTONE	CA	92359	1124	36	06071	34.073694	-117.1388045	San Bernardino County
285080	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285097	Fee-for-Service	1669617197	1669617197	1	8	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	SAN DIEGO	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
285139	Fee-for-Service	1679602163	1679602163	1	1	ROUX, JOAN W MD	9/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79291	40	Pediatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
285159	Fee-for-Service	1881970903	1881970903	1	1	RIMULAR, LLEWY CRNA	9/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
285162	Fee-for-Service	1194837518	1194837518	1	1	ROGECE A PROFESSIONAL	10/12/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76791	08	Family Practice	0	In state provider	MEDICAL CORPORATION	18433 ROSCOE BLVD	SUITE 103	NORTHRIDGE	CA	91325	4126	19	06037	34.22076747	-118.534725	Los Angeles County
285164	Fee-for-Service	1184221301	1184221301	1	1	RELAXED HOME HOSPICE CARE	9/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6303 OWENSMOUTH AVE	STE 1069	WOODLAND HILLS	CA	91367	2264	19	06037	34.18490848	-118.6015408	Los Angeles County
285176	Fee-for-Service	1972662617	1972662617	1	1	ROPER, JONATHAN G MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78585	20	Orthopedic Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
285180	Fee-for-Service	1760466395	1760466395	1	1	RUDA, JOSEPH F MD	9/16/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32463	18	Ophthalmology	0	In state provider	None	1360 E HERNDON AVE	STE 201	FRESNO	CA	93270	3326	10	06019	36.83744648	-119.7646425	Fresno County
285184	Fee-for-Service	1245631365	1245631365	1	1	REGALADO, GERARDO A NP	10/22/2018	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
285185	Fee-for-Service	1992012306	1992012306	1	8	ROLLING HILLS CLINIC	4/21/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	705 EAST ST	None	CORNING	CA	96021	2252	52	06103	39.92879035	-122.1757125	Tehama County
285192	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	4/3/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285219	Fee-for-Service	1043461247	1043461247	1	1	RYAN PAGANELLI M.D.	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
285221	Fee-for-Service	1275661506	1275661506	1	1	RENAL TREATMENT CTRS CA	10/23/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	14400 OLYMPIC DR	None	CLEARLAKE	CA	95422	8809	17	06033	38.96189261	-122.6416049	Lake County
285224	Fee-for-Service	1215320429	1215320429	1	1	RETINA INSTITUTE OF CALIFORN	1/18/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1801 E. TAHQUITZ CANYON	200 & 201	PALM SPRINGS	CA	92262	7123	33	06065	33.82303451	-116.5265775	Riverside County
285227	Fee-for-Service	1699709048	1699709048	1	1	ROTH, BRADLEY J MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84133	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
285230	Fee-for-Service	1871587535	1871587535	1	1	RUCCIONE, JOSEPH S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52295	05	Anesthesiology	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
285244	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285315	Fee-for-Service	1356491161	1356491161	1	1	ROSENBLATT, SOLON L MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65801	20	Orthopedic Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
285325	Fee-for-Service	1184221301	1184221301	1	1	RELAXED HOME HOSPICE CARE	9/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6303 OWENSMOUTH AVE	STE 1069	WOODLAND HILLS	CA	91367	2264	19	06037	34.18490848	-118.6015408	Los Angeles County
285345	Fee-for-Service	1255594420	1255594420	1	1	RAZI SYED MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 CHERRY ST	STE 1400	TOLEDO	OH	43608	2669	00	None	41.66865567	-83.5418674	Lucas County
285346	Fee-for-Service	1992012306	1992012306	1	8	ROLLING HILLS CLINIC	4/21/2023	2084P0800X	NA	Psychiatry	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	705 EAST ST	None	CORNING	CA	96021	2252	52	06103	39.92879035	-122.1757125	Tehama County
285354	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285384	Fee-for-Service	1215320429	1215320429	1	1	RETINA INSTITUTE OF CALIFORN	1/18/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1801 E. TAHQUITZ CANYON	200 & 201	PALM SPRINGS	CA	92262	7123	33	06065	33.82303451	-116.5265775	Riverside County
285395	Fee-for-Service	1326500679	1326500679	1	1	RAMOS, YESENIA MD	8/29/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	179078	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
285399	Fee-for-Service	1174072896	1174072896	1	1	RYAN, JOCELYN A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
285407	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	10/11/2012	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285460	Fee-for-Service	1922297415	1922297415	1	1	RAHBAN, SAID MD INC	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	26769	10	Gastroenterology (M.D. only)	0	In state provider	None	6333 WILSHIRE BLVD	STE 414	LOS ANGELES	CA	90048	5722	19	06037	34.06355697	-118.366413	Los Angeles County
285471	Fee-for-Service	1679659171	1679659171	1	1	RACHAMALLU, HARITHA MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56500	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
285479	Fee-for-Service	1215509393	1215509393	1	2	RECOVER MEDICAL GROUP P.C.	5/12/2022	207QA0401X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
285484	Fee-for-Service	1740268960	1740268960	1	1	ROBERT A KETROSER	12/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 E NICOLLET BLVD	None	BURNSVILLE	MN	55337	5714	00	None	44.749107	-93.2733135	Dakota County
285518	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285527	Fee-for-Service	1053653493	1053653493	1	1	REDDY, RAJIV D MD	6/18/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	147522	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285533	Fee-for-Service	1972565786	1972565786	1	1	RHODES DONALD BO	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3753 CHURN CREEK RD	None	REDDING	CA	96002	2923	45	06089	40.551534	-122.352893	Shasta County
285561	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	4/7/2021	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285572	Fee-for-Service	1114911880	1114911880	1	1	ROBERTS, ANTOINE MD INC	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39726	20	Orthopedic Surgery	0	In state provider	None	4644 LINCOLN BLVD	STE 101	MARINA DEL REY	CA	90292	6374	19	06037	33.98210351	-118.4405172	Los Angeles County
285608	Fee-for-Service	1710514526	1710514526	1	1	RUSSO, SAMANTHA K MD	2/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183868	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
285620	Fee-for-Service	1578699724	1578699724	1	1	ROBINSON, CHARLES A MD	1/1/1982	207K00000X	NA	Other	026	PHYSICIANS	24257	83	Rheumatology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
285637	Fee-for-Service	1215509393	1215509393	1	2	RECOVER MEDICAL GROUP P.C.	8/13/2024	207QA0401X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
285648	Fee-for-Service	1639150832	1639150832	1	1	RAILSBACK,CHARLES H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 HOSPITAL PKWY	STE 210	BEBFORD	TX	76022	0000	00	None	32.83531148	-97.12538031	Tarrant County
285659	Fee-for-Service	1174684815	1174684815	1	1	RAMASWAMY, DHARMARAJAN MD	6/10/2020	207RR0500X	NA	Other	026	PHYSICIANS	66364	83	Rheumatology	0	In state provider	None	29798 HAUN RD	SUITE 301	MENIFEE	CA	92586	6542	33	06065	33.68787713	-117.1748638	Riverside County
285669	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285689	Fee-for-Service	1407096944	1407096944	1	1	REISS, MATTHEW J MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82444	24	Plastic Surgery	0	In state provider	None	317 ROSECRANS AVE	None	MANHATTAN BEACH	CA	90266	0000	19	06037	33.90124824	-118.4173142	Los Angeles County
285708	Fee-for-Service	1497514848	1497514848	1	1	RODGERS, JACOB S	6/18/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9924 SNIKTAW LN	None	FORT JONES	CA	96032	9745	47	06093	41.59687928	-122.9892816	Siskiyou County
285718	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285743	Fee-for-Service	1861424665	1861424665	2	1	ROSTKOWSKI, JOHN R	11/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	24111	None	None	0	In state provider	None	130 LA CASA VIA	SUITE 213	WALNUT CREEK	CA	94598	3078	07	06013	37.91175467	-122.0414101	Contra Costa County
285748	Fee-for-Service	1609098003	1609098003	1	1	RENAL MEDICAL ASSOCIATES	11/1/1994	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3625 MARTIN LUTHER KING	STE 2	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
285762	Fee-for-Service	1386061067	1386061067	1	1	REMY E KASLON	12/26/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
285777	Fee-for-Service	1578699724	1578699724	1	1	ROBINSON, CHARLES A MD	1/1/1982	207K00000X	NA	Other	026	PHYSICIANS	24257	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
285801	Fee-for-Service	1508041575	1508041575	2	1	REHM, KENNETH B DPM	8/5/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1553 GRAND AVE	#B	SAN MARCOS	CA	92078	2427	37	06073	33.14507952	-117.1976581	San Diego County
285802	Fee-for-Service	1215509393	1215509393	1	2	RECOVER MEDICAL GROUP P.C.	10/7/2021	207QA0401X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
285826	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	12/11/2023	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285874	Fee-for-Service	1669617197	1669617197	1	4	RADY CHILDREN'S HOSPITAL SAN	6/20/2014	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
285907	Fee-for-Service	1609098003	1609098003	1	1	RENAL MEDICAL ASSOCIATES	11/1/1994	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	3625 MARTIN LUTHER KING	STE 2	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
285912	Fee-for-Service	1447306600	1447306600	1	1	RAY-DATTA, ISHANI MD	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153405	40	Pediatrics	0	In state provider	None	1700 KEYSTONE PACIFIC PK	UNIT B	PATTERSON	CA	95363	8874	50	06099	37.47600952	-121.160718	Stanislaus County
285930	Fee-for-Service	1710220777	1710220777	1	1	RAISDANA, AISAN MD	7/27/2017	207L00000X	NA	Other	026	PHYSICIANS	148429	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
285944	Fee-for-Service	1093281438	1093281438	1	1	RELIEVE PAIN CENTER, INC.	5/21/2019	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	3969 4TH AVE	STE 208	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
285961	Fee-for-Service	1609295773	1609295773	1	1	RABBANI, ROBBIN CRNA	4/10/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
285979	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	9/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
285992	Fee-for-Service	1376920793	1376920793	1	1	RAMASAMY, VAISHALI S MD	8/26/2019	207R00000X	NA	Other	026	PHYSICIANS	156747	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
286019	Fee-for-Service	1801889829	1801889829	1	1	REGENTS/UCDPBG/PED NEPHR	5/1/1983	2080P0210X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
286036	Fee-for-Service	1346348562	1346348562	1	1	ROSEMARIE ANEITA ANDERSON M.	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 17TH AVE	None	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
286048	Fee-for-Service	1700818093	1700818093	1	1	RICHARDS, JOSHUA C MD	3/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78751	20	Orthopedic Surgery	0	In state provider	None	1133 E STANLEY BLVD	STE 111	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
286110	Fee-for-Service	1083799746	1083799746	1	1	ROCK, JAMEY J MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79068	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
286130	Fee-for-Service	1669617197	1669617197	1	3	RADY CHILDREN'S HOSPITAL SAN	12/29/2023	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
286169	Fee-for-Service	1780870899	1780870899	1	1	REGENTS OF THE UNIV OF	5/1/1995	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
286194	Fee-for-Service	1023204468	1023204468	1	1	RUIZ, PEDRO J MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84199	83	Rheumatology	0	In state provider	None	2235 HAYES ST	5TH FL	SAN FRANCISCO	CA	94117	1082	38	06075	37.77302045	-122.4529717	San Francisco County
286202	Fee-for-Service	1205808714	1205808714	1	1	RODARTE, ELLEN B MD	2/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76932	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
286256	Fee-for-Service	1316272107	1316272107	1	1	ROGES, OCTAVIANO A MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106623	41	Internal Medicine	0	In state provider	None	480 FOURTH AVE	#202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
286280	Fee-for-Service	1871829606	1871829606	1	1	RUTMAN, MICHAEL N DO A	10/12/2010	207R00000X	NA	Other	026	PHYSICIANS	4641	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	2355 SO MELROSE DR	None	VISTA	CA	92081	8788	37	06073	33.14409946	-117.2417711	San Diego County
286286	Fee-for-Service	1023134939	1023134939	1	1	REDLIN, DAVID P MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95271	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
286296	Fee-for-Service	1215509393	1215509393	1	6	RECOVER MEDICAL GROUP P.C.	12/31/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3730 ATHERTON RD	None	ROCKLIN	CA	95765	3717	31	06061	38.81575175	-121.2939002	Placer County
286321	Fee-for-Service	1780870899	1780870899	1	1	REGENTS OF THE UNIV OF	5/1/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
286324	Fee-for-Service	1659364685	1659364685	1	2	REGENTS/UCDPBG/SUR GI	9/3/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
286341	Fee-for-Service	1578677951	1578677951	1	1	ROBERTS, MICHAEL A MD	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78949	05	Anesthesiology	0	In state provider	None	2500 OVERLAND AVE	None	LOS ANGELES	CA	90064	3333	19	06037	34.04024551	-118.4235883	Los Angeles County
286351	Fee-for-Service	1073921045	1073921045	1	1	RASOOL, NAILYN MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159933	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
286358	Fee-for-Service	1013959097	1013959097	2	1	ROSENBERG, DAVID A MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	42241	13	Neurology (M.D. only)	0	In state provider	None	3771 KATELLA AVE	STE 201	LOS ALAMITOS	CA	90720	3116	30	06059	33.80319153	-118.067274	Orange County
286385	Fee-for-Service	1013093533	1013093533	1	1	ROWEN, STEPHANIE K MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75046	24	Plastic Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
286404	Fee-for-Service	1538694708	1538694708	1	1	REMINGTON, LISA ANN K MD	7/15/2021	207P00000X	NA	Other	026	PHYSICIANS	162643	None	None	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
286416	Fee-for-Service	1548318579	1548318579	1	1	RAPAE, ANTHONY T MD	1/4/2008	2085R0204X	NA	Other	026	PHYSICIANS	78058	30	Radiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
286429	Fee-for-Service	1871829606	1871829606	1	1	RUTMAN, MICHAEL N DO A	8/5/2011	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CORPORATION	2355 SO MELROSE DR	None	VISTA	CA	92081	8788	37	06073	33.14409946	-117.2417711	San Diego County
286463	Fee-for-Service	1811063951	1811063951	1	1	RIATE, ANNE MARIE L	6/27/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	855 N LARK ELLEN AVE	SUITE J	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
286466	Fee-for-Service	1780870899	1780870899	1	1	REGENTS OF THE UNIV OF	5/24/2016	207P00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	CALIFORNIA	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
286472	Fee-for-Service	1659364685	1659364685	1	2	REGENTS/UCDPBG/SUR GI	5/1/1999	208600000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
286474	Fee-for-Service	1932110012	1932110012	1	1	ROSENBLATT, ANDREW MD	12/14/1977	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	26142	None	None	0	In state provider	None	350 PARNASSUS AVE	STE 71	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
286491	Fee-for-Service	1952718652	1952718652	1	1	REDDY, ABISHEK P MD	8/19/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161599	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
286523	Fee-for-Service	1043280407	1043280407	1	1	ROSHAN, BIJAN MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52724	45	Nephrology (Renal-Kidney)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
286562	Fee-for-Service	1235747189	1235747189	1	1	ROCHA, IZBIETA PHD	9/13/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
286595	Fee-for-Service	1477550614	1477550614	1	1	REESE, LEROY A MD	4/1/1976	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	24668	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1710 BROOKLYN AVE	STE 12	LOS ANGELES	CA	90033	2439	19	06037	34.040502	-118.191954	Los Angeles County
286614	Fee-for-Service	1851821441	1851821441	1	1	ROJAS-ASHE, ELSA E	9/8/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
286615	Fee-for-Service	1407804289	1407804289	1	1	RUDERMAN, JEANNE W MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	40371	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
286620	Fee-for-Service	1598749921	1598749921	1	1	RENAISSANCE RADIOLOGY	10/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
286634	Fee-for-Service	1609530039	1609530039	1	1	REDONDO, KAREN NP	2/3/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
286670	Fee-for-Service	1467555474	1467555474	1	1	ROSENBAUM, LAWRENCE C MD	2/10/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79252	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 411	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
286692	Fee-for-Service	1992758478	1992758478	1	1	RAMSAY, BEATTY H JR MD	5/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40918	67	Endocrinology	0	In state provider	None	100 S ELLSWORTH AVE	STE 308	SAN MATEO	CA	94401	3931	41	06081	37.56665635	-122.3247743	San Mateo County
286708	Fee-for-Service	1588712285	1588712285	1	1	REGENTS OF THE UNIVERSITY OF	6/1/1999	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CA	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
286751	Fee-for-Service	1780729236	1780729236	1	1	RAHMANY, KHALIL R PHD	9/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39675 CEDAR BLVD	STE 240A	NEWARK	CA	94560	5489	01	06001	37.52050519	-121.9962032	Alameda County
286763	Fee-for-Service	1346387636	1346387636	1	1	REECE, THOMAS B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
286768	Fee-for-Service	1295340420	1295340420	1	1	RED ROSE HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18425 BURBANK BLVD	STE 402	TARZANA	CA	91356	3455	19	06037	34.17226853	-118.5348151	Los Angeles County
286790	Fee-for-Service	1114464096	1114464096	1	1	RODRIGUEZ, ALLISON LMFT	11/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
286820	Fee-for-Service	1437254596	1437254596	1	1	RUBAII, JAZIM I MD	3/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71778	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
286835	Fee-for-Service	1992758478	1992758478	1	1	RAMSAY, BEATTY H JR MD	5/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40918	41	Internal Medicine	0	In state provider	None	100 S ELLSWORTH AVE	STE 308	SAN MATEO	CA	94401	3931	41	06081	37.56665635	-122.3247743	San Mateo County
286845	Fee-for-Service	1427391325	1427391325	1	1	RODRIGUEZ DIAZ, MARIA F LMFT	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6205 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91606	3210	19	06037	34.183314	-118.3965585	Los Angeles County
286910	Fee-for-Service	1295340420	1295340420	1	1	RED ROSE HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18425 BURBANK BLVD	STE 402	TARZANA	CA	91356	3455	19	06037	34.17226853	-118.5348151	Los Angeles County
286939	Fee-for-Service	1053610493	1053610493	1	1	RIAZ, MUHAMMAD MD	6/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127480	01	General Practice	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
286962	Fee-for-Service	1437254596	1437254596	1	1	RUBAII, JAZIM I MD	3/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
286990	Fee-for-Service	1811928641	1811928641	1	1	REGENTS OF THE UNIVERSITY OF	2/14/2019	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	MICHIGAN	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
286991	Fee-for-Service	1598786576	1598786576	1	1	REGENTS OF THE UNIVERSITY OF	8/3/1993	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA-UCSD MEDICAL	200 W ARBOR DR	RM I317	SAN DIEGO	CA	92103	8765	37	06073	32.7537975	-117.1658298	San Diego County
287003	Fee-for-Service	1194095927	1194095927	1	1	RAFAELLA HOME HEALTH CARE	10/23/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14328 VICTORY BLVD	SUITE 209	VAN NUYS	CA	91401	6513	19	06037	34.1866137	-118.4454117	Los Angeles County
287033	Fee-for-Service	1982377412	1982377412	1	1	ROBINSON, EVEREST LPCC	8/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
287127	Fee-for-Service	1174607857	1174607857	1	1	RASSOLI, AMIR DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 GARTH RD	None	BAYTOWN	TX	77521	2122	00	None	29.76910842	-94.97759843	Harris County
287129	Fee-for-Service	1346311305	1346311305	1	1	RAMOS, XAVIER MD	11/17/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59146	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287133	Fee-for-Service	1255358974	1255358974	1	1	ROGALA, CAROL A DO	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8408	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
287175	Fee-for-Service	1871799528	1871799528	1	1	ROBINSON, COLE W MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112840	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
287213	Fee-for-Service	1023850351	1023850351	1	1	REDA, MICHAEL A PSYD	7/25/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25050 AVENUE KEARNY	SUITE 203	VALENCIA	CA	91355	1255	19	06037	34.43517857	-118.5722781	Los Angeles County
287246	Fee-for-Service	1427055839	1427055839	1	1	REGENTS UNIVERSITY OF	7/1/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CA HEALTH SCIENCES	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
287260	Fee-for-Service	1760945935	1760945935	1	1	RAI, SONAM	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
287266	Fee-for-Service	1346311305	1346311305	1	1	RAMOS, XAVIER MD	11/17/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59146	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287286	Fee-for-Service	1073654331	1073654331	1	1	RAGUSKUS, BROOK LEE	12/21/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 ALAMEDA DE LAS PULG	STE 100	MENLO PARK	CA	94025	6509	41	06081	37.43203515	-122.2019218	San Mateo County
287287	Fee-for-Service	1689790768	1689790768	1	1	RANDALL, AMANDA LCSW	3/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
287347	Fee-for-Service	1144409699	1144409699	1	1	RUPPE, ERIN N NP	11/21/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
287381	Fee-for-Service	1427055839	1427055839	1	1	REGENTS UNIVERSITY OF	7/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CA HEALTH SCIENCES	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
287398	Fee-for-Service	1497303499	1497303499	1	1	RAMIREZ, SAMANTHA M AU	5/18/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
287474	Fee-for-Service	1013215219	1013215219	1	1	RHEE, JENNIFER Y DO	1/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11179	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
287545	Fee-for-Service	1407896046	1407896046	1	1	RAUCH, MARTIN W MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74148	30	Radiology	0	In state provider	None	23101 SHERMAN PL	STE 407	WEST HILLS	CA	91307	2032	19	06037	34.20099112	-118.6297991	Los Angeles County
287577	Fee-for-Service	1477502342	1477502342	1	1	REDDING, ROSS B OD	4/13/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 SYLVAN AVE	STE C	MODESTO	CA	95350	1693	50	06099	37.68896459	-120.979468	Stanislaus County
287601	Fee-for-Service	1861401309	1861401309	1	1	RELIANT MEDICAL SUPPLIES &	1/28/2013	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS, INC	5855 VENICE BLVD	None	LOS ANGELES	CA	90019	5021	19	06037	34.04176195	-118.3666104	Los Angeles County
287607	Fee-for-Service	1710970736	1710970736	1	2	REGENTS/UCDPBG/IM NEPHR	8/11/2022	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
287636	Fee-for-Service	1912078957	1912078957	1	1	REDDY, VIJAYANTI K MD	2/21/1995	207R00000X	NA	Other	026	PHYSICIANS	53752	41	Internal Medicine	0	In state provider	None	23961 CALLE DE MAGDELENA	#51-A	LAGUNA HILLS	CA	92653	0000	30	06059	33.60918911	-117.7104355	Orange County
287666	Fee-for-Service	1558555722	1558555722	1	1	ROEDER, HARRIET W MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80780	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
287695	Fee-for-Service	1679641104	1679641104	1	1	REDDY, ARCHANA P MD	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54793	01	General Practice	0	In state provider	None	20130 LAKE CHABOT RD	#201	CASTRO VALLEY	CA	94546	4055	01	06001	37.69738066	-122.087041	Alameda County
287735	Fee-for-Service	1710970736	1710970736	1	2	REGENTS/UCDPBG/IM NEPHR	5/1/1999	207RN0300X	NA	Nephrology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
287749	Fee-for-Service	1124080916	1124080916	1	1	REMBERT, JAMES MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81527	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
287775	Fee-for-Service	1821253758	1821253758	1	1	REID, JON D	4/15/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
287791	Fee-for-Service	1386116077	1386116077	1	1	REID, SUSAN C NP	5/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287794	Fee-for-Service	1669578811	1669578811	1	1	RAMIREZ, LYNN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38362	08	Family Practice	0	In state provider	None	303 S GLENOAKS BLVD	STE 4	BURBANK	CA	91502	1193	19	06037	34.18156737	-118.3040137	Los Angeles County
287808	Fee-for-Service	1578706164	1578706164	1	1	RLK ANESTHESIA, INC	7/1/2009	207L00000X	NA	Other	026	PHYSICIANS	63330	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
287817	Fee-for-Service	1730436114	1730436114	1	1	REVUELTA, HERIBERTO	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
287859	Fee-for-Service	1619105327	1619105327	1	1	REYES, ROSEMARY D DO	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13461	01	General Practice	0	In state provider	None	2237 W BALL ROAD	None	ANAHEIM	CA	92804	5314	30	06059	33.817798	-117.9610599	Orange County
287878	Fee-for-Service	1942498159	1942498159	1	1	RAHIMI, SUSAN M MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130678	01	General Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
287891	Fee-for-Service	1134708498	1134708498	1	2	RIDE WITH US TRANSPORTATION	5/4/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	6356 VAN NUYS BLVD	209	VAN NUYS	CA	91401	2627	19	06037	34.185861	-118.4487045	Los Angeles County
287918	Fee-for-Service	1366468514	1366468514	1	1	R&J MEDICAL SALES INC	12/13/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	R&J MEDICAL SALES INC	15 RAILROAD AVE	None	SYOSSET	NY	11791	3718	00	None	40.823064	-73.50309	Nassau County
287945	Fee-for-Service	1972008696	1972008696	1	1	ROVIRA, MIGUEL A	10/2/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
287965	Fee-for-Service	1124149653	1124149653	1	1	RILEY, TIMOTHY B MD	7/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33037	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4045 3RD AVE	STE 301	SAN DIEGO	CA	92103	2132	37	06073	32.75080807	-117.162721	San Diego County
287977	Fee-for-Service	1215509393	1215509393	1	5	RECOVER MEDICAL GROUP P.C.	12/31/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	301 NORTH PRAIRIE AVE	301	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
288009	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	6/19/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288058	Fee-for-Service	1831266741	1831266741	1	1	RAHMAN, SOPHIA MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85649	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288089	Fee-for-Service	1124149653	1124149653	1	1	RILEY, TIMOTHY B MD	7/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33037	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4045 3RD AVE	STE 301	SAN DIEGO	CA	92103	2132	37	06073	32.75080807	-117.162721	San Diego County
288100	Fee-for-Service	1538309067	1538309067	1	1	RECALDE, FRANCISCO J MD	3/9/2018	174400000X	NA	Other	026	PHYSICIANS	41872	01	General Practice	0	In state provider	None	3811 EL CAJON BLVD	None	SAN DIEGO	CA	92105	1020	37	06073	32.75512069	-117.1114152	San Diego County
288115	Fee-for-Service	1588608475	1588608475	1	1	RICHLEY, SUNNY R MD	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77361	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
288128	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	5/18/2017	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288155	Fee-for-Service	1306866736	1306866736	1	1	RAJESH BAGAI	2/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13677 W MCDOWELL RD	None	GOODYEAR	AZ	85395	2635	00	None	33.461982	-112.3535475	Maricopa County
288198	Fee-for-Service	1992728570	1992728570	1	1	ROSS, ALAN B MD	3/5/1992	207L00000X	NA	Other	026	PHYSICIANS	43273	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
288207	Fee-for-Service	1164810107	1164810107	1	1	ROSELAND ELEMENTARY SCHOOL	7/1/2014	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ATTN: DISTRICT	1691 BURBANK AVE	None	SANTA ROSA	CA	95407	5903	49	06097	38.420703	-122.735142	Sonoma County
288225	Fee-for-Service	1497895882	1497895882	1	1	RIVERA, JOSETTE A MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99590	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288227	Fee-for-Service	1477582781	1477582781	1	1	RODRIGUES, DARRYL J MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74969	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1798 N GEARY AVE	None	POMONA	CA	91767	2918	19	06037	0	0	None
288239	Fee-for-Service	1558432500	1558432500	1	1	RAGAB, MEDHAT M MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44701	01	General Practice	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
288246	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	5/16/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288315	Fee-for-Service	1902959794	1902959794	1	1	ROBERT SCHWANER, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8268 164TH ST	None	JAMAICA	NY	11432	1121	00	None	40.717917	-73.804086	Queens County
288362	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288364	Fee-for-Service	1568792646	1568792646	1	1	RODRIGUEZ-GUTIERREZ, MARICEL	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108278	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MD	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288408	Fee-for-Service	1114306982	1114306982	1	1	ROBICHAUD, MATTHEW D MD	2/12/2024	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
288455	Fee-for-Service	1396036588	1396036588	1	1	REID, BRADLEY M MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123555	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
288479	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	4/9/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288485	Fee-for-Service	1306421391	1306421391	1	1	RODRIGUEZ, CHRISTINE M LCSW	4/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
288499	Fee-for-Service	1609977164	1609977164	1	1	RADING, FAIZA A MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85957	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
288510	Fee-for-Service	1871663047	1871663047	1	1	RAGHAVENDER, BHUPALA MD	6/30/1990	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	45746	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
288570	Fee-for-Service	1962581918	1962581918	1	1	ROMERO, LISA R LCSW	1/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
288571	Fee-for-Service	1740254713	1740254713	1	1	ROUEL, WADI R MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55979	41	Internal Medicine	0	In state provider	None	860 JAMACHA ROAD	STE 107	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
288592	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	4/9/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288628	Fee-for-Service	1760063234	1760063234	1	1	RODRIGUEZ, BRIEANA H MD	6/27/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288636	Fee-for-Service	1578958674	1578958674	1	1	ROFAEL, MARTIN MD	6/25/2018	207R00000X	NA	Other	026	PHYSICIANS	146455	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
288694	Fee-for-Service	1770591372	1770591372	1	1	RILEY, BRENDAN M DPM	11/18/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
288697	Fee-for-Service	1396789228	1396789228	1	1	RINAUDO, PAOLO F MD	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87718	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
288711	Fee-for-Service	1578672184	1578672184	1	1	REGENTS OF THE UNIVERSITY OF	1/25/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288719	Fee-for-Service	1962525428	1962525428	1	1	ROBBINS, ROBERT S MD	4/30/1991	207R00000X	NA	Other	026	PHYSICIANS	42621	41	Internal Medicine	0	In state provider	None	44530 SAN PABLO AVE	STE 204	PALM DESERT	CA	92260	3596	33	06065	33.72495692	-116.3825032	Riverside County
288752	Fee-for-Service	1114535937	1114535937	1	1	ROSSO, ASHLEY E NP	11/27/2022	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
288753	Fee-for-Service	1336585603	1336585603	1	1	RANA, SUNNY MD	4/16/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
288777	Fee-for-Service	1548503121	1548503121	1	1	RUIZ, CLAUDIA MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136343	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
288833	Fee-for-Service	1609849520	1609849520	1	1	ROSTON, RICHARD R MD	4/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	78666	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
288866	Fee-for-Service	1851463723	1851463723	1	5	REGENTS OF THE UNIVERSITY OF	2/4/2021	207UN0903X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP	27235 TOURNEY RD	1500	VALENCIA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
288879	Fee-for-Service	1407889132	1407889132	1	1	RAKHLIN, NINA MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87284	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
288897	Fee-for-Service	1295955763	1295955763	1	1	RABBANI, KAMRAN C MD	5/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70167	41	Internal Medicine	0	In state provider	None	5363 BALBOA BLVD	STE 542	ENCINO	CA	91316	2853	19	06037	34.169058	-118.5011265	Los Angeles County
288937	Fee-for-Service	1831114438	1831114438	1	1	RALPHS GROCERY COMPANY	4/3/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RALPHS STORE #756	710 N ROSE DR	None	PLACENTIA	CA	92870	7520	30	06059	33.87731188	-117.8433267	Orange County
288960	Fee-for-Service	1700849031	1700849031	1	1	RAMIREZ, JORGE A MD	4/25/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87367	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
288976	Fee-for-Service	1285724948	1285724948	1	1	RAINES,ALYSSA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
288996	Fee-for-Service	1497048672	1497048672	1	1	RAAKESH, LATHIKA MD	1/14/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	125715	45	Nephrology (Renal-Kidney)	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
289003	Fee-for-Service	1881795458	1881795458	1	1	ROSOVE, SHERMAN P MD APC	1/31/1989	193400000X	NA	Other	026	PHYSICIANS	25993	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7080 HOLLYWOOD BLVD	STE 301	LOS ANGELES	CA	90028	6930	19	06037	34.10143074	-118.3445888	Los Angeles County
289067	Fee-for-Service	1548216138	1548216138	1	1	RANDELL BLANE MILTON	6/4/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
289076	Fee-for-Service	1245478791	1245478791	1	1	RAMSINGHANI PRAKASH N MD	10/26/2010	390200000X	NA	Other	026	PHYSICIANS	112127	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
289107	Fee-for-Service	1881795458	1881795458	1	1	ROSOVE, SHERMAN P MD APC	1/31/1989	193400000X	NA	Other	026	PHYSICIANS	25993	41	Internal Medicine	0	In state provider	None	7080 HOLLYWOOD BLVD	STE 301	LOS ANGELES	CA	90028	6930	19	06037	34.10143074	-118.3445888	Los Angeles County
289114	Fee-for-Service	1467603241	1467603241	1	1	REDDICK, AMARA LCSW	3/24/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
289167	Fee-for-Service	1295363018	1295363018	1	1	ROTSTEIN, MIKE A MD	7/7/2023	207P00000X	NA	Other	026	PHYSICIANS	184751	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
289228	Fee-for-Service	1962485839	1962485839	1	1	REGUERA, TIFFANY L NP	1/25/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3082 MCMURRAY	None	ANDERSON	CA	96007	3544	45	06089	40.45499506	-122.2929002	Shasta County
289259	Fee-for-Service	1659037950	1659037950	1	1	RUSSO, NICHOLAS	1/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
289297	Fee-for-Service	1124323779	1124323779	1	1	RENSBERGER, FELICITY C CRNA	5/17/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
289321	Fee-for-Service	1770610438	1770610438	1	1	RESCARE, INC	10/1/1999	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8268 LA ALMENDRA WAY	None	SACRAMENTO	CA	95823	5649	34	06067	38.457225	-121.432644	Sacramento County
289364	Fee-for-Service	1316027568	1316027568	1	1	RAWLES, JODY M MD	7/15/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	72658	36	Psychiatry	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
289376	Fee-for-Service	1538641857	1538641857	1	1	RELIVE YOU CENTER FOR ADVANC	10/3/2018	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ED PAIN MANAGEMENT	8901 ACTIVITY RD	100	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
289388	Fee-for-Service	1689664385	1689664385	1	1	REID, JOHN B MD	10/21/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	168664	20	Orthopedic Surgery	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
289439	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	5/24/2017	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289447	Fee-for-Service	1902929193	1902929193	1	1	RUH, STEVEN F MD	9/22/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	41583	-	NOT APPLICABLE	0	In state provider	None	117 E HARRY BRIDGE BLVD	None	WILMINGTON	CA	90744	5825	19	06037	33.77134876	-118.261036	Los Angeles County
289468	Fee-for-Service	1811063811	1811063811	1	1	ROOP, JONATHAN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
289469	Fee-for-Service	1588091300	1588091300	1	1	RYAN, MAUREEN A NP	11/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289510	Fee-for-Service	1477623023	1477623023	1	1	RIMSZA, LISA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
289524	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	7/1/1966	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289549	Fee-for-Service	1376611483	1376611483	1	1	RODRIGUEZ-SOTO, JORGE MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77056	22	Pathology (M.D. only)	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
289573	Fee-for-Service	1902812191	1902812191	1	1	RICE, SUSAN J PHD	11/30/1992	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SUITE 300	150 N SANTA ANITA AVE	None	ARCADIA	CA	91006	3113	19	06037	34.14186	-118.0314005	Los Angeles County
289598	Fee-for-Service	1275997223	1275997223	1	1	RIVERA-CALONJE, FRANCHESCA M	8/1/2022	207L00000X	NA	Other	026	PHYSICIANS	156587	None	None	0	In state provider	MD	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
289600	Fee-for-Service	1740592757	1740592757	1	1	RENGARAJAN, HARISH K MD	10/5/2023	207R00000X	NA	Other	026	PHYSICIANS	188146	None	None	0	In state provider	None	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
289602	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	4/10/2017	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289613	Fee-for-Service	1639477367	1639477367	1	1	RAMOS, JULIA LMFT	11/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
289632	Fee-for-Service	1467455063	1467455063	1	1	RIGGIO, DAVID W. MD	7/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 E 2ND ST	STE 118	SCOTTSDALE	AZ	85251	5610	00	None	33.491178	-111.92427	Maricopa County
289681	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	12/4/2019	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289692	Fee-for-Service	1376720367	1376720367	1	1	RAGAB, HASSAN MD INC	12/17/2007	207R00000X	NA	Other	026	PHYSICIANS	48982	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
289694	Fee-for-Service	1003975665	1003975665	1	1	RUDEK, ROBERT L MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62966	02	General Surgery	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
289695	Fee-for-Service	1619073806	1619073806	1	1	RHEE, INSOOK A MD	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25957	40	Pediatrics	0	In state provider	None	4220 W 3RD ST	STE 205	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
289707	Fee-for-Service	1013175918	1013175918	1	1	RONCALLI, LUCIA D MD	2/10/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	110937	08	Family Practice	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
289735	Fee-for-Service	1275612038	1275612038	1	1	ROUSSOS, PAMELA M T DO	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	8409	01	General Practice	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
289759	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	4/5/2017	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289792	Fee-for-Service	1497881486	1497881486	1	1	ROSEN, REBECCA L MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67987	08	Family Practice	0	In state provider	None	1414 S GRAND AVE	FL 2	LOS ANGELES	CA	90015	3067	19	06037	34.03661142	-118.2657227	Los Angeles County
289814	Fee-for-Service	1902878978	1902878978	1	1	RANGI, JAIWANT K MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92729	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
289826	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	4/5/2017	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289854	Fee-for-Service	1487034807	1487034807	1	1	RHEE, ALICE H MD	8/3/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167723	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
289895	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	7/1/1986	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289901	Fee-for-Service	1902868201	1902868201	1	1	ROTH, JEFFREY C DO	7/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
289913	Fee-for-Service	1073527412	1073527412	1	1	ROMO, RICHARD	7/1/1996	174400000X	NA	Other	026	PHYSICIANS	76841	None	None	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
289922	Fee-for-Service	1437442746	1437442746	1	1	REYES, JEANETTE AU	7/25/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1135 E ROUTE 66	STE 111	GLENDORA	CA	91740	3778	19	06037	34.12888853	-117.845127	Los Angeles County
289923	Fee-for-Service	1003269242	1003269242	1	1	RIVELIS, YULIA MD	9/20/2022	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	180148	None	None	0	In state provider	None	3883 AIRWAY DR	202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
289962	Fee-for-Service	1508968751	1508968751	1	1	REGENTS OF THE UNIVERSITY OF	4/27/2023	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289973	Fee-for-Service	1144277120	1144277120	1	1	RUSCHER, ADAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
289980	Fee-for-Service	1710268206	1710268206	1	1	ROSS, JONATHAN M OD	9/15/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	360 SIERRA COLLEGE DR	STE 100	GRASS VALLEY	CA	95945	7735	29	06057	39.23622963	-121.0549676	Nevada County
289998	Fee-for-Service	1356071369	1356071369	1	1	RUBIO-HOYT, ERIKA M LPCC	3/10/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24401 ALTA VISTA DR	None	DANA POINT	CA	92629	1703	30	06059	33.47417201	-117.7037735	Orange County
290000	Fee-for-Service	1033382213	1033382213	1	1	RIDDELL, GWENDOLYN R	10/8/2009	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	751 LOMBARDI COURT	SUITE B	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
290002	Fee-for-Service	1235358797	1235358797	1	1	ROGERS, PAMELA M LCSW	8/27/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 ABBOTT ST	STE 201	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
290013	Fee-for-Service	1295049328	1295049328	1	1	RYBURN, LACY T PSYD	2/20/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1171 HOMESTEAD RD	STE 220	SANTA CLARA	CA	95050	5478	43	06085	37.34826707	-121.94579	Santa Clara County
290072	Fee-for-Service	1992012306	1992012306	1	7	ROLLING HILLS CLINIC	12/10/2018	261QP2300X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	706 PEACH ST	None	CORNING	CA	96021	3355	52	06103	39.928689	-122.174397	Tehama County
290096	Fee-for-Service	1215436928	1215436928	1	1	ROSS, ANTHONY D LCSW	8/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
290103	Fee-for-Service	1588680987	1588680987	1	1	RUBIN, ROY M MD INC	1/31/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
290124	Fee-for-Service	1992012306	1992012306	1	7	ROLLING HILLS CLINIC	12/10/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	706 PEACH ST	None	CORNING	CA	96021	3355	52	06103	39.928689	-122.174397	Tehama County
290154	Fee-for-Service	1184811028	1184811028	1	1	RAMIREZ, AMEE T CRNA	11/16/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	90054	0330	30	06059	33.78674051	-117.8888713	Orange County
290155	Fee-for-Service	1962702662	1962702662	1	1	RAMIREZ, GILBERT H MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
290156	Fee-for-Service	1477915932	1477915932	1	1	ROGAN, BRIANNA L DO	10/6/2020	207R00000X	NA	Other	026	PHYSICIANS	16629	41	Internal Medicine	0	In state provider	None	350 TERRACINA	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
290159	Fee-for-Service	1588680987	1588680987	1	1	RUBIN, ROY M MD INC	1/31/2013	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
290209	Fee-for-Service	1669617197	1669617197	1	13	RADY CHILDREN'S HOSPITAL SAN	3/14/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF SAN DIEGO, A MEDICAL	386 EAST H ST	STE 202	CHULA VISTA	CA	91910	7486	37	06073	32.63995805	-117.0482026	San Diego County
290213	Fee-for-Service	1588680987	1588680987	1	1	RUBIN, ROY M MD INC	1/31/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
290216	Fee-for-Service	1497022156	1497022156	1	1	RELIEF HOSPICE INC	8/17/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8081 STANTON AVE	SUITE 305	BUENA PARK	CA	90620	3227	30	06059	33.84561815	-117.9937247	Orange County
290224	Fee-for-Service	1497907455	1497907455	2	3	REDDING RADIATION ONCOLOGIST	2/27/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	310 HARTNELL AVE	None	REDDING	CA	96002	1800	45	06089	40.56670901	-122.3688887	Shasta County
290267	Fee-for-Service	1841395951	1841395951	1	1	ROGOLSKY, EUGENE H MD	4/22/1976	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28747	01	General Practice	0	In state provider	None	12626 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3420	19	06037	34.15758449	-118.408131	Los Angeles County
290270	Fee-for-Service	1497022156	1497022156	1	1	RELIEF HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8081 STANTON AVE	SUITE 305	BUENA PARK	CA	90620	3227	30	06059	33.84561815	-117.9937247	Orange County
290277	Fee-for-Service	1396804076	1396804076	1	1	RIFENBURG, THERESA M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
290288	Fee-for-Service	1760658504	1760658504	1	1	RIVERA, ANGELA M LCSW	9/25/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
290295	Fee-for-Service	1770584328	1770584328	1	1	ROYALE HEALTH CARE CTR	7/1/1994	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	30	06059	33.71597598	-117.8819134	Orange County
290300	Fee-for-Service	1679749683	1679749683	1	1	RAPTIS, DERRICK N MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117405	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	#202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
290314	Fee-for-Service	1114929809	1114929809	1	1	ROBERTS, RANDALL F MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60385	02	General Surgery	0	In state provider	None	1510 S CENTRAL AVE	STE 530	GLENDALE	CA	91204	2542	19	06037	34.12709764	-118.2577911	Los Angeles County
290325	Fee-for-Service	1952495624	1952495624	2	1	RAMIREZ-OCHOA, IGNACIO J	4/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	47768	01	General Practice	0	In state provider	MD	3024 N PARK WAY	None	SAN DIEGO	CA	92104	3626	37	06073	32.7474303	-117.1292991	San Diego County
290352	Fee-for-Service	1801811641	1801811641	1	1	RUNDLE, HERMAN L MD INC	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	9113	18	Ophthalmology	0	In state provider	None	1031 W CHAPMAN AVE	STE 203	ORANGE	CA	92868	2826	30	06059	33.78791049	-117.8632755	Orange County
290359	Fee-for-Service	1962432732	1962432732	1	1	RHYNER, PATRICIA A MD	12/13/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46215	30	Radiology	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
290364	Fee-for-Service	1114929809	1114929809	1	1	ROBERTS, RANDALL F MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60385	33	Thoracic Surgery	0	In state provider	None	1510 S CENTRAL AVE	STE 530	GLENDALE	CA	91204	2542	19	06037	34.12709764	-118.2577911	Los Angeles County
290368	Fee-for-Service	1700022464	1700022464	1	1	RIZVI, S M HAMMAD MD INC	6/28/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96440	08	Family Practice	0	In state provider	GROUP	901 SAN BERNARDINO	SUITE 104	UPLAND	CA	91786	4912	36	06071	34.10050176	-117.6382066	San Bernardino County
290453	Fee-for-Service	1922150150	1922150150	1	1	REDING, TERRENCE P MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44625	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
290493	Fee-for-Service	1154442945	1154442945	1	1	RHO, BONG HO CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5001 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90036	6104	19	06037	34.06216453	-118.339128	Los Angeles County
290496	Fee-for-Service	1922150150	1922150150	1	1	REDING, TERRENCE P MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44625	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
290533	Fee-for-Service	1881214526	1881214526	1	1	RAO, KAMINI MD	3/11/2024	207R00000X	NA	Other	026	PHYSICIANS	184574	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
290534	Fee-for-Service	1396944872	1396944872	1	1	RALEY'S	8/21/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3020 FLOYD AVE	None	MODESTO	CA	95355	9654	50	06099	37.676241	-120.9391515	Stanislaus County
290553	Fee-for-Service	1215509393	1215509393	1	1	RECOVER MEDICAL GROUP P.C.	8/2/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
290573	Fee-for-Service	1215509393	1215509393	1	4	RECOVER MEDICAL GROUP P.C.	5/15/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8150 SIERRA COLLEGE BLVD	STE. 250	ROSEVILLE	CA	95661	9414	31	06061	38.7463157	-121.2263794	Placer County
290602	Fee-for-Service	1124007067	1124007067	1	1	RAPOFF, CHRISTOPHER A DC	9/20/2007	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC WORKS	140 N LURING DR	STE D	PALM SPRINGS	CA	92262	6841	33	06065	33.823737	-116.5270635	Riverside County
290627	Fee-for-Service	1528335577	1528335577	1	1	RODRIQUEZ, CARLOS R MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117610	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
290636	Fee-for-Service	1225059488	1225059488	1	1	RICKLES, DAVID J MD	3/31/1987	2085R0001X	NA	Other	026	PHYSICIANS	56693	09	Gynecology (D.O. only)	0	In state provider	None	14608 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	1521	19	06037	33.898932	-118.352374	Los Angeles County
290647	Fee-for-Service	1396814356	1396814356	1	1	RAGHURAMAN, SANGEETHA MD	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78175	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2468	43	06085	37.31105733	-121.937923	Santa Clara County
290668	Fee-for-Service	1225059488	1225059488	1	1	RICKLES, DAVID J MD	3/31/1987	2085R0001X	NA	Other	026	PHYSICIANS	56693	30	Radiology	0	In state provider	None	14608 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	1521	19	06037	33.898932	-118.352374	Los Angeles County
290672	Fee-for-Service	1194403642	1194403642	1	1	ROCKET DOCTOR PRACTICE GROUP	4/12/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	, P.C.	20311 SW ACACIA ST	UNIT 140	NEWPORT BEACH	CA	92660	1733	30	06059	33.65825868	-117.8791294	Orange County
290687	Fee-for-Service	1255726253	1255726253	1	1	RHEE, ALEXANDRA DO	9/13/2022	207L00000X	NA	Other	026	PHYSICIANS	18405	None	None	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
290696	Fee-for-Service	1194797357	1194797357	1	1	REYNOLDS, JAMES B MD	1/1/1982	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	18657	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
290703	Fee-for-Service	1194403642	1194403642	1	1	ROCKET DOCTOR PRACTICE GROUP	4/12/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	, P.C.	20311 SW ACACIA ST	UNIT 140	NEWPORT BEACH	CA	92660	1733	30	06059	33.65825868	-117.8791294	Orange County
290716	Fee-for-Service	1114488145	1114488145	1	1	RAMIREZ, FAUSTINE D MD	5/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176665	None	None	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
290717	Fee-for-Service	1467657809	1467657809	1	1	ROCCO, MARLENE D	6/3/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
290744	Fee-for-Service	1194403642	1194403642	1	1	ROCKET DOCTOR PRACTICE GROUP	4/12/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	, P.C.	20311 SW ACACIA ST	UNIT 140	NEWPORT BEACH	CA	92660	1733	30	06059	33.65825868	-117.8791294	Orange County
290774	Fee-for-Service	1548358062	1548358062	1	1	REDDY, ANTHONY B MD	5/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43010	34	Urology and Urological Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 502	ANAHEIM	CA	92801	2812	30	06059	33.84718298	-117.933758	Orange County
290780	Fee-for-Service	1497085757	1497085757	1	1	ROSS, MICKI L LCSW	2/1/2011	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	23461 S POINTE DR	STE 190	LAGUNA HILLS	CA	92653	1538	30	06059	33.62535142	-117.7206568	Orange County
290796	Fee-for-Service	1922071539	1922071539	1	1	REODICA, JENNIFER C MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	89673	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4490	38	06075	37.7479947	-122.4209132	San Francisco County
290802	Fee-for-Service	1851463723	1851463723	1	1	REGENTS OF THE UNIVERSITY OF	10/23/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10833 LE CONTE AVE	BLDG AR130	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
290850	Fee-for-Service	1427105014	1427105014	1	1	RANKIN, CAROLINE E OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
290864	Fee-for-Service	1346924420	1346924420	1	1	ROY ELEVAZO & ASSOCIATES, IN	8/4/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C.	5220 CLARK AVE	400	LAKEWOOD	CA	90712	2618	19	06037	33.8527092	-118.1337623	Los Angeles County
290893	Fee-for-Service	1346924420	1346924420	1	1	ROY ELEVAZO & ASSOCIATES, IN	8/4/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	C.	5220 CLARK AVE	400	LAKEWOOD	CA	90712	2618	19	06037	33.8527092	-118.1337623	Los Angeles County
290908	Fee-for-Service	1295474823	1295474823	1	1	RAPID DOC, INC.	11/15/2024	261QU0200X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5600 WILSHIRE BLVD	STE A	LOS ANGELES	CA	90036	3797	19	06037	34.06233427	-118.3512599	Los Angeles County
290916	Fee-for-Service	1346344397	1346344397	2	1	ROSENBERG, STUART M MD	2/19/2020	208800000X	NA	Other	026	PHYSICIANS	51185	34	Urology and Urological Surgery	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
290989	Fee-for-Service	1316098999	1316098999	1	1	REYES, LORNA M OD	6/26/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 110B	SAN DIMAS	CA	91773	2543	19	06037	34.10669347	-117.814932	Los Angeles County
291019	Fee-for-Service	1962163816	1962163816	1	1	RIVERA, MARITZA	6/18/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
291047	Fee-for-Service	1669481594	1669481594	1	1	RIFAT, RIFAT B MD	11/30/1982	193400000X	NA	Other	026	PHYSICIANS	49369	08	Family Practice	0	In state provider	None	13950 MILTON AVE	STE 404	WESTMINSTER	CA	92683	2939	30	06059	33.75987547	-118.0203975	Orange County
291094	Fee-for-Service	1992012306	1992012306	1	1	ROLLING HILLS CLINIC	3/18/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	740 SOLANO ST	None	CORNING	CA	96021	0908	52	06103	39.92792649	-122.175513	Tehama County
291097	Fee-for-Service	1528372034	1528372034	1	1	RASHTI, PEDRAM MD	10/26/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113049	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
291114	Fee-for-Service	1992012306	1992012306	1	1	ROLLING HILLS CLINIC	3/18/2011	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	740 SOLANO ST	None	CORNING	CA	96021	0908	52	06103	39.92792649	-122.175513	Tehama County
291124	Fee-for-Service	1336651223	1336651223	1	1	ROCHA, RENEE NP	1/27/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4821 PANAMA LN	STE A-C	BAKERSFIELD	CA	93313	3480	15	06029	35.29587848	-119.056005	Kern County
291129	Fee-for-Service	1497956445	1497956445	1	1	RHOADES, TORRE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
291140	Fee-for-Service	1649678087	1649678087	1	1	RUIZ, ANA LMFT	3/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10445 LAKEWOOD BLVD	SUITE 104	DOWNEY	CA	90241	2782	19	06037	33.94365444	-118.1193843	Los Angeles County
291159	Fee-for-Service	1295837342	1295837342	1	1	ROUHE, RICHARD L MD INC	7/1/1996	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	12642	20	Orthopedic Surgery	0	In state provider	None	802 MAGNOLIA AVE	STE 106	CORONA	CA	92879	3125	33	06065	33.8596449	-117.5529774	Riverside County
291213	Fee-for-Service	1174724637	1174724637	1	1	RIVERSIDE-SAN BERNARDINO	4/23/2018	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	COUNTY INDIAN HEALTH INC	11980 MT VERNON AVE	None	GRAND TERRACE	CA	92313	5172	36	06071	34.036353	-117.3136565	San Bernardino County
291218	Fee-for-Service	1598767717	1598767717	1	1	REDDY, NARENDRANATH A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31701	41	Internal Medicine	0	In state provider	None	301 W HUNTINGTON DR	STE 327	ARCADIA	CA	91007	1501	19	06037	34.13481053	-118.0425638	Los Angeles County
291250	Fee-for-Service	1669617197	1669617197	1	15	RADY CHILDREN'S HOSPITAL SAN	4/2/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OF SAN DIEGO, A MEDICAL	2125 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11901958	-117.1202863	San Diego County
291261	Fee-for-Service	1669617197	1669617197	1	15	RADY CHILDREN'S HOSPITAL SAN	4/2/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF SAN DIEGO, A MEDICAL	2125 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11901958	-117.1202863	San Diego County
291278	Fee-for-Service	1790273894	1790273894	1	1	ROMANI, SARA MD	11/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164359	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
291293	Fee-for-Service	1720009913	1720009913	1	1	ROESKE, RICHMOND E MD	10/28/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	64048	18	Ophthalmology	0	In state provider	None	41877 ENTERPRISE CIR N	STE 110	TEMECULA	CA	92590	5628	33	06065	33.51705818	-117.169463	Riverside County
291314	Fee-for-Service	1568567949	1568567949	1	1	RALEYS #293	3/10/1988	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	692 FREEMAN LN	None	GRASS VALLEY	CA	95949	9616	29	06057	39.20195627	-121.0635127	Nevada County
291326	Fee-for-Service	1821176579	1821176579	1	1	RAMIN, FARZAD MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64974	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
291330	Fee-for-Service	1922418466	1922418466	1	1	ROSALES-VONG, GHE S MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138493	01	General Practice	0	In state provider	None	1212 W 17TH ST	None	SANTA ANA	CA	92706	3418	30	06059	33.75995152	-117.883521	Orange County
291344	Fee-for-Service	1912987553	1912987553	1	1	REGENTS OF THE UNIVERSITY OF	1/27/2023	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
291350	Fee-for-Service	1912987553	1912987553	1	1	REGENTS OF THE UNIVERSITY OF	7/5/2018	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
291356	Fee-for-Service	1912987553	1912987553	1	1	REGENTS OF THE UNIVERSITY OF	11/3/2021	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	UC DAVIS MEDICAL GROUP	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
291365	Fee-for-Service	1912987553	1912987553	1	1	REGENTS OF THE UNIVERSITY OF	4/26/2023	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	UC DAVIS MEDICAL GROUP	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
291372	Fee-for-Service	1912987553	1912987553	1	1	REGENTS OF THE UNIVERSITY OF	12/1/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	UC DAVIS MEDICAL GROUP	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
291377	Fee-for-Service	1366509226	1366509226	1	1	RUTTER, MICHAEL J MD	2/8/2015	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	-	04	Otology, Laryngology, Rhinology	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
291432	Fee-for-Service	1811490758	1811490758	1	1	REDMAN, TAMESIA LMFT	11/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
291440	Fee-for-Service	1831651231	1831651231	1	1	RIGBY, ROBERT E DO	12/27/2022	207P00000X	NA	Other	026	PHYSICIANS	19607	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
291464	Fee-for-Service	1407628266	1407628266	1	1	RAE HILL GROUP, LLC	11/28/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1265 SALVADOR DR. E	None	PLACENTIA	CA	92870	3923	30	06059	33.88442923	-117.8408996	Orange County
291480	Fee-for-Service	1932220589	1932220589	1	1	ROVERE, ANN M LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	120 MADRID ST	None	SAN FRANCISCO	CA	94112	2009	38	06075	37.72745262	-122.4284282	San Francisco County
291538	Non-Physician Medical Practitioner	None	1366788283	0	0	ROWE, NICOLE M NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
291550	Non-Physician Medical Practitioner	None	1942477575	0	0	ROSENCRANS WELLS, WENDY L	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1004 FOWLER WAY	STE 4	PLACERVILLE	CA	95667	5746	00	06000	38.72683597	-120.7921028	El Dorado County
291581	Non-Physician Medical Practitioner	None	1871839027	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 S MADERA AVE	SUITE 201	KERMAN	CA	93630	1403	00	06000	36.73165922	-120.0602617	Fresno County
291591	Non-Physician Medical Practitioner	None	1417625187	0	0	RIVERA, STACY M NP	11/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	00	06000	32.70706919	-117.0850896	San Diego County
291593	Non-Physician Medical Practitioner	None	1316948235	0	0	RUNYON, THERESA K	2/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3183 CORDOVA WAY	None	LAFAYETTE	CA	94549	5627	00	06000	37.85882559	-122.0970869	Contra Costa County
291603	Non-Physician Medical Practitioner	None	1801061221	0	0	RIGOR, MARILEAH D NP	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	00	06000	33.78236048	-117.8664975	Orange County
291615	Non-Physician Medical Practitioner	None	1144554205	0	0	ROWE, LETRICA	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2503 S AVENUE A STE 1	None	YUMA	AZ	85364	7174	00	06000	32.681889	-114.632802	Yuma County
291664	Non-Physician Medical Practitioner	None	1114043361	0	0	RIGMAIDEN, LEONARD H	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7248 WEST 91ST ST	None	WESTCHESTER	CA	90045	3449	00	06000	33.95464171	-118.4214035	Los Angeles County
291683	Non-Physician Medical Practitioner	None	1326021320	0	0	ROCHE, ELLEN M NP	4/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	537 ROSEDALE AVENUE	None	SANTA ROSA	CA	95405	4538	00	06000	38.443599	-122.695434	Sonoma County
291697	Non-Physician Medical Practitioner	None	1194416917	0	0	REALI, MEGAN PA-C	2/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291751	Non-Physician Medical Practitioner	None	1225195407	0	0	RAZAIE, NAJIA	1/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
291787	Non-Physician Medical Practitioner	None	1053408401	0	0	RICHARDSON, KARRAINE	4/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
291808	Non-Physician Medical Practitioner	None	1568715282	0	0	ROTH, ALICIA	1/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
291811	Non-Physician Medical Practitioner	None	1215929914	0	0	RHOADES, BARBARA A	8/24/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	00	06000	38.00403417	-121.8422798	Contra Costa County
291818	Non-Physician Medical Practitioner	None	1699952879	0	0	RODRIGUEZ, ANGELA NP	4/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
291888	Non-Physician Medical Practitioner	None	1073259214	0	0	ROGERS, GRACE NP	11/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41250 12TH ST W	SUITE B	PALMDALE	CA	93551	1444	00	06000	34.63265063	-118.1517391	Los Angeles County
291897	Non-Physician Medical Practitioner	None	1588993927	0	0	ROMERO, WHITNEY L NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
291905	Non-Physician Medical Practitioner	None	1245874767	0	0	RAMIREZ, ANDREA E PA	6/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
291923	Non-Physician Medical Practitioner	None	1508064791	0	0	RABKIN, JESSICIAH M NP	5/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31052 E SUNSET DR N	None	REDLANDS	CA	92373	7453	00	06000	34.02309554	-117.1261195	San Bernardino County
291942	Non-Physician Medical Practitioner	None	1639778012	0	0	ROGERS, NICHOLE NP	8/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18200 YORBA LINDA BLVD	SUITE 250	YORBA LINDA	CA	92886	4044	00	06000	33.88842824	-117.8154698	Orange County
292024	Non-Physician Medical Practitioner	None	1780733691	0	0	RATHBUN, SHANNON MICHELLE	2/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
292067	Non-Physician Medical Practitioner	None	1710529219	0	0	RICHARDS, KATHRYN P NP	5/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
292076	Non-Physician Medical Practitioner	None	1780296350	0	0	REID, ASHLEY P NP	4/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	00	06000	37.24572659	-121.957997	Santa Clara County
292083	Non-Physician Medical Practitioner	None	1811444961	0	0	ROTHMAN, ALANA L NP	10/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20087 SUMMERGLEN PL	None	CASTRO VALLEY	CA	94552	5341	00	06000	37.71904062	-122.0220726	Alameda County
292098	Non-Physician Medical Practitioner	None	1093351751	0	0	ROS, DENISE M PA-C	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 S SAN MATEO DR	SUITE 120	SAN MATEO	CA	94401	3857	00	06000	37.56634141	-122.3261145	San Mateo County
292104	Non-Physician Medical Practitioner	None	1568431385	0	0	ROHRER, PAMELA L	6/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	00	06000	38.568402	-121.418019	Sacramento County
292189	Non-Physician Medical Practitioner	None	1295888634	0	0	RAGSDALE, SUZANNE LYDIA	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BICENTENNIAL WAY	KAISER MEDICAL CENTER	SANTA ROSA	CA	95403	0000	00	06000	38.47017844	-122.7236628	Sonoma County
292215	Non-Physician Medical Practitioner	None	1053982165	0	0	RISMILLER, SARA PA	8/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81800 DR. CARREON BLVD	SUITE A	INDIO	CA	92201	5595	00	06000	33.70743053	-116.2372995	Riverside County
292251	Non-Physician Medical Practitioner	None	1205326261	0	0	RICO, ASHLEY N NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4420	00	06000	38.7294585	-121.2763095	Placer County
292264	Non-Physician Medical Practitioner	None	1639559917	0	0	ROOT, JODI L	3/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
292270	Non-Physician Medical Practitioner	None	1790457349	0	0	RAFANAN, AASHIKA D NP	8/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10610 OWENSMOUTH	None	CHATSWORTH	CA	91311	2151	00	06000	34.26314853	-118.6017056	Los Angeles County
292288	Non-Physician Medical Practitioner	None	1578002135	0	0	ROY, SELINAMMA NP	7/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6850 SEPULVEDA BLVD	SUITE 217	VAN NUYS	CA	91405	4444	00	06000	34.1955	-118.4661705	Los Angeles County
292302	Non-Physician Medical Practitioner	None	1588695480	0	0	REGAN, KARENA F	12/22/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25881 SKYLINE DRIVE	None	TEHACHAPI	CA	93561	9610	00	06000	35.14506541	-118.6071999	Kern County
292320	Non-Physician Medical Practitioner	None	1164070371	0	0	RAMOS-PAMPLONA, GABRIELA NP	2/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
292373	Non-Physician Medical Practitioner	None	1356797963	0	0	RODRIGUEZ, JOHN J	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1424 HEATHERWOOD AVE	None	CHULA VISTA	CA	91913	2972	00	06000	32.62534815	-116.9828462	San Diego County
292376	Non-Physician Medical Practitioner	None	1356464333	0	0	ROFKAHR, JENIFER L NP	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 ROSE CIRCLE	None	NAPA	CA	94558	2118	00	06000	38.3251323	-122.269272	Napa County
292390	Non-Physician Medical Practitioner	None	1235463019	0	0	RULL, SONNY C PA	10/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3614 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	00	06000	33.95782946	-117.390044	Riverside County
292552	Non-Physician Medical Practitioner	None	1740052471	0	0	RIVERA, STEPHANIE NP	4/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19742 MACARTHUR BLVD	SUITE 100	IRVINE	CA	92612	2408	00	06000	33.65738766	-117.8625556	Orange County
292565	Non-Physician Medical Practitioner	None	1992991863	0	0	RACHEL, DUBRIA M	10/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5953 ATLANTIC BLVD	None	MAYWOOD	CA	90270	3133	00	06000	33.98590138	-118.1858597	Los Angeles County
292612	Non-Physician Medical Practitioner	None	1427067727	0	0	ROBYN, BODECKER	10/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	00	06000	32.72663119	-117.1611714	San Diego County
292632	Non-Physician Medical Practitioner	None	1598973828	0	0	RENDON, CARLOS O	12/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4301 S FIGUEROA ST	# F	LOS ANGELES	CA	90037	2660	00	06000	34.005132	-118.282769	Los Angeles County
292638	Non-Physician Medical Practitioner	None	1346612546	0	0	RANA, GUNBIR K PA-C	10/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
292666	Non-Physician Medical Practitioner	None	1881677292	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 HANNA AVENUE	None	CORCORAN	CA	93212	2334	00	06000	36.09974853	-119.56293	Kings County
292672	Non-Physician Medical Practitioner	None	1235911132	0	0	RIVERA, THALIA	8/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5405 W HILLSDALE AVE	None	VISALIA	CA	93291	5156	00	06000	36.329364	-119.3510385	Tulare County
292682	Non-Physician Medical Practitioner	None	1578548806	0	0	RICKMAN PATRICK, SHERI NP	1/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1355 FLORIN ROAD	SUITE 10	SACRAMENTO	CA	95822	4200	00	06000	38.496114	-121.5042525	Sacramento County
292696	Non-Physician Medical Practitioner	None	1205232808	0	0	ROBINSON, ALTHEA L NP	8/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1114 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63901905	-121.0057149	Stanislaus County
292751	Non-Physician Medical Practitioner	None	1811054315	0	0	RAMOS, BARBARA P NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	55-480 RUE MARNE	None	THERMAL	CA	92274	9456	00	06000	33.64689272	-116.2123391	Riverside County
292759	Non-Physician Medical Practitioner	None	1063450625	0	0	ROMAN, ELIZABETH D	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	691 LAKEHAVEN DRIVE	None	SUNNYVALE	CA	94089	2548	00	06000	37.39597559	-122.0065757	Santa Clara County
292770	Non-Physician Medical Practitioner	None	1538932280	0	0	RAY, COURTNEY NP	1/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	00	06000	35.366706	-119.0959425	Kern County
292848	Non-Physician Medical Practitioner	None	1700445640	0	0	RO, HANNA PA-C	3/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	408 S BEACH BLVD	STE 211	ANAHEIM	CA	92804	1853	00	06000	33.82709101	-117.9932293	Orange County
292851	Non-Physician Medical Practitioner	None	1417383159	0	0	ROTH, SHIRA R	1/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	439 GUERRERO ST	None	SAN FRANCISCO	CA	94110	1021	00	06000	37.76414742	-122.424015	San Francisco County
292861	Non-Physician Medical Practitioner	None	1326706417	0	0	REJCEK, EMILY G PA-C	2/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
292906	Non-Physician Medical Practitioner	None	1457538662	0	0	RHODES, LANA R	5/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10770 HOLE AVE	118	RIVERSIDE	CA	92505	2873	00	06000	33.91784126	-117.480413	Riverside County
292954	Non-Physician Medical Practitioner	None	1760703136	0	0	REPPENHAGEN, DENISE M NP	9/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
292972	Non-Physician Medical Practitioner	None	1740927250	0	0	ROCES, NOREEN NP	4/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	06000	36.28701289	-115.2877045	Clark County
292995	Non-Physician Medical Practitioner	None	1629008644	0	0	REYES, ROCHELLE ANN	3/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DR	CLINIC A	STANFORD	CA	94305	2200	00	06000	37.43562782	-122.1766097	Santa Clara County
292996	Non-Physician Medical Practitioner	None	1821242991	0	0	RIOS, ANA	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1003 N STATE ST	None	HEMET	CA	92543	1474	00	06000	33.76422692	-116.9719003	Riverside County
293009	Non-Physician Medical Practitioner	None	1346503117	0	0	REINERTSON, LISA N	11/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	450 E MESQUITE AVE	APT 2	APACHE JUNCTION	AZ	85119	7741	00	06000	33.398361	-111.5411535	Pinal County
293031	Non-Physician Medical Practitioner	None	1316174063	0	0	ROBERTSON, KARI DAWN	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6802 W RIO GRANDE AVE ST	None	KENNEWICK	WA	99336	7684	00	06000	46.22150964	-119.2109959	Benton County
293049	Non-Physician Medical Practitioner	None	1972769933	0	0	ROBINSON, KIM A NP	7/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2318 DEL MAR RD	None	MONTROSE	CA	91020	1404	00	06000	34.21097002	-118.2288378	Los Angeles County
293055	Non-Physician Medical Practitioner	None	1083323133	0	0	ROWELL, NICHOLAS A NP	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
293067	Non-Physician Medical Practitioner	None	1437366002	0	0	REYNOLDS, BROOKE L PA-C	6/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE STE 3	None	SAN BERNARDINO	CA	92404	3830	00	06000	34.1358627	-117.2757778	San Bernardino County
293071	Non-Physician Medical Practitioner	None	1518504299	0	0	ROMERO, SHIRLEY NP	1/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13820 SAN ANTONIO DRIVE	None	NORWALK	CA	90650	4033	00	06000	33.90534381	-118.0790912	Los Angeles County
293084	Non-Physician Medical Practitioner	None	1851352355	0	0	RUBIN, HOPE S PA	9/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	00	06000	37.91229899	-122.0423696	Contra Costa County
293095	Non-Physician Medical Practitioner	None	1154950616	0	0	ROBERTS, MICHELLE PA-C	8/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8101 NEWMAN AVE	STE B	HUNTINGTON BEACH	CA	92647	7042	00	06000	33.70483151	-117.987264	Orange County
293117	Non-Physician Medical Practitioner	None	1891393732	0	0	REYES, CARLO NP	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
293120	Non-Physician Medical Practitioner	None	1194253377	0	0	RHEE, PAUL S	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2060 TIERRA LOMA DR	None	DIAMOND BAR	CA	91765	3135	00	06000	33.984999	-117.8349605	Los Angeles County
293237	Non-Physician Medical Practitioner	None	1417168527	0	0	RHEE, MICHELLE M	8/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1603 S CRESTHILL DR	None	SPOKANE	WA	99203	3551	00	06000	47.640852	-117.398628	Spokane County
293238	Non-Physician Medical Practitioner	None	1568702009	0	0	ROBKER, AMY L	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3171 RABBIT CREEK DR	None	LAS VEGAS	NV	89120	3162	00	06000	36.05413653	-115.105347	Clark County
293292	Non-Physician Medical Practitioner	None	1518006600	0	0	RAMIREZ, ADRIANA Y	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
293295	Non-Physician Medical Practitioner	None	1972586386	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	155 S 5TH STREET	None	COALINA	CA	93210	1903	00	06000	36.13845412	-120.3582671	Fresno County
293298	Non-Physician Medical Practitioner	None	1609196625	0	0	ROSENTHAL, PAMELA ANN	12/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5396	00	06000	38.83760761	-121.2972372	Placer County
293313	Non-Physician Medical Practitioner	None	1477390870	0	0	ROMASANTA, ROSANA NP	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11868 ROSECRANS AVE	None	NORWALK	CA	90650	3081	00	06000	33.90212153	-118.080252	Los Angeles County
293317	Non-Physician Medical Practitioner	None	1477745768	0	0	RUIZ-FLORES, ROSE M PA-C	6/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	425 DIAMOND DRIVE	SUITE 104-105	LAKE ELSINORE	CA	92530	4495	00	06000	33.65802263	-117.3002985	Riverside County
293355	Non-Physician Medical Practitioner	None	1598814923	0	0	RUNNER, JEANNE MARIE	8/26/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
293368	Non-Physician Medical Practitioner	None	1699737361	0	0	REISING, MICHAEL PATRICK	8/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3424 TRIO LN	None	SACRAMENTO	CA	95817	2071	00	06000	38.559294	-121.46589	Sacramento County
293370	Non-Physician Medical Practitioner	None	1326516717	0	0	RAMIREZ, RUEL D PA-C	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	00	06000	33.87557796	-118.0725386	Los Angeles County
293380	Non-Physician Medical Practitioner	None	1497264717	0	0	RADCLIFF, MELISSA M NP	11/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2166 SAN ANSELINE AVE	APT 3	LONG BEACH	CA	90815	3144	00	06000	33.79499234	-118.12147	Los Angeles County
293391	Non-Physician Medical Practitioner	None	1114697927	0	0	REXINGER, MATTHEW W PA	2/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWY	STE 150	MISSION VIEJO	CA	92691	8018	00	06000	33.56286021	-117.6673449	Orange County
293399	Non-Physician Medical Practitioner	None	1902261522	0	0	ROBLES, NATALIE M	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19915 GREVILLEA AVE	None	TORRANCE	CA	90503	2123	00	06000	33.851079	-118.3559075	Los Angeles County
293421	Non-Physician Medical Practitioner	None	1477154722	0	0	ROMARATE, MYLEEN D NP	1/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
293447	Non-Physician Medical Practitioner	None	1801937438	0	0	ROBERTS, DORINDA MARY	5/16/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 S FIGUEROA ST	A	LOS ANGELES	CA	90007	3255	00	06000	34.02710249	-118.2766689	Los Angeles County
293486	Non-Physician Medical Practitioner	None	1801883038	0	0	RAPHAEL, CARMEL N PA	5/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11539 HAWTHORNE BLVD	6TH FLOOR	HAWTHORNE	CA	90250	2381	00	06000	33.929352	-118.352747	Los Angeles County
293515	Non-Physician Medical Practitioner	None	1972669513	0	0	RODRIGUEZ, ARTURO	7/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	0000	00	06000	33.97333678	-118.2163277	Los Angeles County
293529	Non-Physician Medical Practitioner	None	1093000937	0	0	RORDEN, EMILY R NP	3/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 W QUINTO ST	None	SANTA BARBARA	CA	93015	4852	00	06000	34.43037685	-119.726571	Santa Barbara County
293618	Non-Physician Medical Practitioner	None	1750912689	0	0	RUIZ, MARTHA E PA	6/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1871 E 4TH ST	None	ONTARIO	CA	91764	2601	00	06000	34.079184	-117.611775	San Bernardino County
293637	Non-Physician Medical Practitioner	None	1205498474	0	0	ROUS, TARA M NP	7/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 OLD DOMINION CT	None	APTOS	CA	95003	3821	00	06000	36.97913818	-121.9099818	Santa Cruz County
293646	Non-Physician Medical Practitioner	None	1699341362	0	0	RICANA, BYRON	8/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5400 SOUTH RAINBOW BLVD.	None	LAS VEGAS	NV	89118	1859	00	06000	36.090072	-115.2405585	Clark County
293647	Non-Physician Medical Practitioner	None	1639347248	0	0	ROBB, KATHY J NP	12/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	00	06000	35.36196445	-119.0749413	Kern County
293657	Non-Physician Medical Practitioner	None	1700555802	0	0	RENTON, RACHAEL M NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 TELEGRAPH AVE	120	BERKELEY	CA	94705	1159	00	06000	37.85808554	-122.2594469	Alameda County
293730	Non-Physician Medical Practitioner	None	1699758003	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	810 E D STREET	None	LEMOORE	CA	93245	9545	00	06000	36.30069303	-119.7694815	Kings County
293737	Non-Physician Medical Practitioner	None	1952338907	0	0	REBER, BRIAN A PA-C	10/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
293738	Non-Physician Medical Practitioner	None	1639448400	0	0	RIDGECREST REGIONAL HOSPITAL	10/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1041 N. CHINA LAKE BLVD.	None	RIDGECREST	CA	93555	3130	00	06000	35.63953945	-117.669891	Kern County
293757	Non-Physician Medical Practitioner	None	1871971580	0	0	RIVERA SAGASTEGUI, MABEL DEL PILAR	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	584 N. SUNRISE AVE	100	ROSEVILLE	CA	95661	2862	00	06000	38.75842021	-121.2528302	Placer County
293764	Non-Physician Medical Practitioner	None	1235372145	0	0	RODGERS, JANE ELLEN	7/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 N MOUNTAIN AVE	SUITE A	UPLAND	CA	91786	8516	00	06000	34.10114204	-117.6702497	San Bernardino County
293794	Non-Physician Medical Practitioner	None	1922885979	0	0	RODRIGUEZ, DAMIANA NP	8/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
293801	Non-Physician Medical Practitioner	None	1346754983	0	0	ROTH, CHRISTINE L	6/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8001 KITTYHAWK AVE	None	LOS ANGELES	CA	90045	3109	00	06000	33.96637237	-118.3832339	Los Angeles County
293805	Non-Physician Medical Practitioner	None	1942073093	0	0	ROGERS, PAIGE A NP	2/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	00	06000	36.98815433	-121.9571695	Santa Cruz County
293813	Non-Physician Medical Practitioner	None	1962435586	0	0	ROCHA, MARTIN	1/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 N HWY 173	None	LAKE ARROWHEAD	CA	92321	0000	00	06000	34.25458933	-117.1731769	San Bernardino County
293828	Non-Physician Medical Practitioner	None	1831794536	0	0	RAI, ANKITA	11/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
293831	Non-Physician Medical Practitioner	None	1730253519	0	0	RODRIGUEZ-CHOI, YUNHE	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
293840	Non-Physician Medical Practitioner	None	1295187987	0	0	RICE, DIANA M NP	7/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	24400 STRINGTOWN ROAD	None	CLARKSBURG	MD	20871	9215	00	06000	39.257793	-77.254785	Montgomery County
293846	Non-Physician Medical Practitioner	None	1790080091	0	0	RANKIN, SARAH L	9/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23336 STONE RIDGE	None	MURRIETA	CA	92562	3310	00	06000	33.57434374	-117.2519069	Riverside County
293909	Non-Physician Medical Practitioner	None	1265837025	0	0	RUSSELL, MARY NP	1/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1955 W CITRACADO PKWY	SUITE 300	ESCONDIDO	CA	92029	4113	00	06000	33.11301099	-117.1202081	San Diego County
293945	Non-Physician Medical Practitioner	None	1346001518	0	0	RANOLA, JOAN K CNP	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	79440 CORPORATE CENTER D	STE 108	LA QUINTA	CA	92253	7243	00	06000	33.70937862	-116.2788139	Riverside County
293955	Non-Physician Medical Practitioner	None	1518392448	0	0	RAMOS, RUBY T	8/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4301 BOULDER PASS DR	None	BAKERSFIELD	CA	93311	2834	00	06000	35.31635086	-119.1194654	Kern County
293982	Non-Physician Medical Practitioner	None	1417053067	0	0	ROSENKRANS, NOELLE PA	11/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
294000	Non-Physician Medical Practitioner	None	1699532838	0	0	RODRIGUEZ, JESUS T PA-C	9/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	575 AUTO CENTER DR	None	WATSONVILLE	CA	95076	3727	00	06000	36.91752728	-121.7672578	Santa Cruz County
294017	Non-Physician Medical Practitioner	None	1629723283	0	0	RODRIGUEZ, KRYSTAL L NP	7/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
294030	Non-Physician Medical Practitioner	None	1255840013	0	0	RIVERA, JESSICA M PA-C	4/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14359 PIONEER BLVD.	SUITE A	NORWALK	CA	90650	4850	00	06000	33.90057	-118.0826075	Los Angeles County
294043	Non-Physician Medical Practitioner	None	1750311007	0	0	R, SCOTT C	5/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 MONTROSE DR	None	SAN LUIS OBISPO	CA	93405	1086	00	06000	35.3062594	-120.6825971	San Luis Obispo County
294156	Non-Physician Medical Practitioner	None	1265774806	0	0	RODRIGUEZ, JESSICA E PA	6/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	00	06000	38.47813376	-122.7279674	Sonoma County
294180	Non-Physician Medical Practitioner	None	1417788217	0	0	ROBINSON, ALIXANDRA NP	10/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1665 S IMPERIAL AVE	SUITE C	EL CENTRO	CA	92243	4247	00	06000	32.77860065	-115.5695241	Imperial County
294191	Non-Physician Medical Practitioner	None	1710683669	0	0	RAFIQ, MAHRUKH PA	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3466 EL CAMINO REAL	None	SANTA CLARA	CA	95051	2809	00	06000	37.35225555	-121.9921875	Santa Clara County
294208	Non-Physician Medical Practitioner	None	1558674796	0	0	REED, MARK NP	12/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	18212 PONDEROSA LN	None	KLAMATH FALLS	OR	97601	9177	00	06000	42.14250976	-121.9615419	Klamath County
294209	Non-Physician Medical Practitioner	None	1487185393	0	0	RIVERLAND, APRIL M PA-C	6/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	06000	43.383456	-124.2330435	Coos County
294223	Non-Physician Medical Practitioner	None	1164096673	0	0	REED, CHRISTOPHER R PA-C	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
294260	Non-Physician Medical Practitioner	None	1497270201	0	0	RHINEHART, DEANA M NP	7/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
294262	Non-Physician Medical Practitioner	None	1437252004	0	0	ROUDA, LINDA	3/1/1992	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3260 KERNER BLVD	None	SAN RAFAEL	CA	94901	4861	00	06000	37.96081282	-122.501833	Marin County
294263	Non-Physician Medical Practitioner	None	1669065223	0	0	RODRIGUEZ, MADELINE R NP	5/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
294279	Non-Physician Medical Practitioner	None	1497006126	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 E WASHINGTON AVE	None	REEDLEY	CA	93654	0000	00	06000	36.59150149	-119.437146	Fresno County
294282	Non-Physician Medical Practitioner	None	1205105806	0	0	RAMIREZ, CAREY NP	10/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
294331	Non-Physician Medical Practitioner	None	1285834242	0	0	REED, LYNDA LEANNE	2/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1532 ELDERTREE DR	None	DIAMOND BAR	CA	91765	3919	00	06000	33.99346751	-117.8336442	Los Angeles County
294336	Non-Physician Medical Practitioner	None	1295974111	0	0	RYAN, MARY J	4/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 MONTEREY AVE	None	CAPITOLA	CA	95010	3613	00	06000	36.97787052	-121.9490749	Santa Cruz County
294366	Non-Physician Medical Practitioner	None	1376277392	0	0	ROACH, WILLIAM R PA-C	9/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
294428	Non-Physician Medical Practitioner	None	1265078778	0	0	RANDHAWA, HARMAN NP	1/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	00	06000	37.5531875	-121.9805141	Alameda County
294467	Non-Physician Medical Practitioner	None	1700485265	0	0	REYES, PHOEBEDEL C NP	4/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
294509	Non-Physician Medical Practitioner	None	1902880032	0	0	RODRIGUEZ, LORI A	8/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4214 SAN GIOVANNI CT	None	LANCASTER	CA	93536	2949	00	06000	34.63891305	-118.2061503	Los Angeles County
294514	Non-Physician Medical Practitioner	None	1164171856	0	0	RODELO, CARINA S PA-C	5/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	00	06000	34.27448266	-119.2572489	Ventura County
294562	Non-Physician Medical Practitioner	None	1598312498	0	0	ROJAS, JONATHAN M NP	11/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
294563	Non-Physician Medical Practitioner	None	1306489570	0	0	RAMOS, ELENA R PA-C	8/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
294580	Non-Physician Medical Practitioner	None	1689003956	0	0	RYAN, ASHLEY N	1/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10230 WATERIDGE CIRCLE	184	SAN DIEGO	CA	92121	5746	00	06000	32.89893258	-117.2046813	San Diego County
294583	Non-Physician Medical Practitioner	None	1255611638	0	0	RAMIREZ, MYRNA S	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 NORTH STATE ST	None	LOS ANGELES	CA	90033	0000	00	06000	34.05855992	-118.209755	Los Angeles County
294589	Non-Physician Medical Practitioner	None	1942200928	0	0	RIDDEL, JAMES PHILIP	2/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
294590	Non-Physician Medical Practitioner	None	1124423082	0	0	RORISON, EVE B NP	6/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21 CLARENCE PLACE	APT 215	SAN FRANCISCO	CA	94107	4917	00	06000	37.77963511	-122.3926224	San Francisco County
294599	Non-Physician Medical Practitioner	None	1437428158	0	0	ROWLEY, DONNA C NP	6/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
294605	Non-Physician Medical Practitioner	None	1275695678	0	0	REILAND, KIMBERLY	2/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1336 NATIVIDAD RD	None	SALINAS	CA	93906	3101	00	06000	36.69908763	-121.6352503	Monterey County
294628	Non-Physician Medical Practitioner	None	1760498869	0	0	RAMSEY, DANA M CNM	8/24/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2905 KRISTIE CT	None	SANTA CRUZ	CA	95065	1816	00	06000	36.98535726	-121.9716496	Santa Cruz County
294675	Non-Physician Medical Practitioner	None	1932560448	0	0	RAFTERY, KATHLEEN PA-C	4/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
294697	Non-Physician Medical Practitioner	None	1639698947	0	0	REYNOLDS, MATTHEW D NP	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SUMMIT ST	2ND FLOOR	OAKLAND	CA	94609	3410	00	06000	37.82018974	-122.2643221	Alameda County
294727	Non-Physician Medical Practitioner	None	1922362284	0	0	REDDY, REENA PA-C	2/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
294731	Non-Physician Medical Practitioner	None	1881908556	0	0	ROSALES, PAULA P	1/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	358 S COCHRAN AVE	STE 203	LOS ANGELES	CA	90036	3349	00	06000	34.06738676	-118.3472156	Los Angeles County
294784	Non-Physician Medical Practitioner	None	1336758705	0	0	RICHARDSON, CAMILLE R PA-C	1/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
294788	Non-Physician Medical Practitioner	None	1013211630	0	0	RANDALL, DANA M PA	11/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	212 ELKS POINT RD	STE 200	ZEPHYR COVE	NV	89448	9800	00	06000	38.98585115	-119.9417018	Douglas County
294815	Non-Physician Medical Practitioner	None	1922149194	0	0	RAULET, NAIS M	1/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	899 VALENCIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94110	1736	00	06000	37.75867161	-122.4212468	San Francisco County
294831	Non-Physician Medical Practitioner	None	1952621930	0	0	RAD, ELIKA J NP	4/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2226 CHERRYSTONE DRIVE	None	SAN JOSE	CA	95128	1218	00	06000	37.33488718	-121.9414438	Santa Clara County
294850	Non-Physician Medical Practitioner	None	1043829229	0	0	RIEL, JESSI PA-C	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	00	06000	36.834984	-119.7641925	Fresno County
294863	Non-Physician Medical Practitioner	None	1598479057	0	0	RUIZ, CHRISTINA M PA-C	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
294891	Non-Physician Medical Practitioner	None	1508057316	0	0	ROBERTS, KAY D PA	8/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	00	06000	34.695693	-118.1480965	Los Angeles County
294896	Non-Physician Medical Practitioner	None	1801199260	0	0	RAMIREZ, VERONICA DIANNA	9/28/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 DWIGHT WAY	ROOM 1363	BERKELEY	CA	94704	2608	00	06000	37.86379498	-122.2689084	Alameda County
294897	Non-Physician Medical Practitioner	None	1144315730	0	0	RETALLICK, ANNE C S NP	9/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	422 S BARNES ST	None	UKIAH	CA	95482	4665	00	06000	39.14532339	-123.2152398	Mendocino County
294907	Non-Physician Medical Practitioner	None	1427360973	0	0	REGALA, FELIX M	1/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3590 CAMINO DEL RIO N	STE 200	SAN DIEGO	CA	92108	1707	00	06000	32.77890046	-117.1170088	San Diego County
294913	Non-Physician Medical Practitioner	None	1467818294	0	0	RAHIMI, SHABNAM NP	4/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
294929	Non-Physician Medical Practitioner	None	1336547256	0	0	RUDGE, CHERRY LOU C NP	11/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1601 AVOCADO AVE	None	NEWPORT BEACH	CA	92660	7798	00	06000	33.61466401	-117.868557	Orange County
294996	Non-Physician Medical Practitioner	None	1811476195	0	0	RICHMOND, KALI PA	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
295004	Non-Physician Medical Practitioner	None	1205020146	0	0	RODGERS, OLGA V	7/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8817 FIADOR COURT	None	ROSEVILLE	CA	95747	8904	00	06000	38.739042	-121.367769	Placer County
295042	Non-Physician Medical Practitioner	None	1386325827	0	0	ROBINSON, DESIREE	1/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
295120	Non-Physician Medical Practitioner	None	1093980823	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1939 ACADEMY AVENUE	None	SANGER	CA	93657	3737	00	06000	36.68936951	-119.5550306	Fresno County
295125	Non-Physician Medical Practitioner	None	1205548245	0	0	RAMONAS, AMALYA NP	2/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
295174	Non-Physician Medical Practitioner	None	1972682482	0	0	ROBINSON, KATHRYN D	5/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2526 OVERHILL LN	None	DAVIS	CA	95616	3051	00	06000	38.55057144	-121.7821151	Yolo County
295176	Non-Physician Medical Practitioner	None	1508991761	0	0	RAI, DEV S PA	6/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 N CLARK ST	STE A	FRESNO	CA	93701	2124	00	06000	36.744102	-119.7860465	Fresno County
295203	Non-Physician Medical Practitioner	None	1982730776	0	0	ROSS, ROBERTA JEAN	1/29/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
295221	Non-Physician Medical Practitioner	None	1952953325	0	0	RAMOS, NATHAN J PA	2/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL RD	LEVEL 2	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
295223	Non-Physician Medical Practitioner	None	1013484807	0	0	REEVS, NANCY	2/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1986 S COAST HIGHWAY	798	LAGUNA BEACH	CA	92651	0000	00	06000	33.52751028	-117.7696451	Orange County
295228	Non-Physician Medical Practitioner	None	1821591652	0	0	RAWLS, TEQUILEA C NP	7/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
295238	Non-Physician Medical Practitioner	None	1467728444	0	0	ROBINSON, KHADIJA S NP	8/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1112 SANTA CLARA	None	ALAMEDA	CA	94501	0000	00	06000	37.77292828	-122.2651886	Alameda County
295252	Non-Physician Medical Practitioner	None	1912949777	0	0	RYMLAND, EMILY NP	11/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	84 GOLDEN HINDE BLVD	None	SAN RAFAEL	CA	94903	3817	00	06000	37.99637994	-122.5453932	Marin County
295255	Non-Physician Medical Practitioner	None	1902520596	0	0	RAMIREZ, SANDIVEL NP	2/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
295268	Non-Physician Medical Practitioner	None	1164582482	0	0	RICHARDSON, SHABNAM BAKSHI	2/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
295293	Non-Physician Medical Practitioner	None	1851347637	0	0	RAMOS, JESUS	1/18/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	00	06000	34.15729818	-118.3277073	Los Angeles County
295300	Non-Physician Medical Practitioner	None	1093244717	0	0	RAMIREZ, SHELCA W NP	8/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38651 PANTHER DRIVE	None	PALMDALE	CA	93551	5050	00	06000	34.58491401	-118.1603058	Los Angeles County
295304	Non-Physician Medical Practitioner	None	1649784414	0	0	RAMIREZ, DESIREE M NP	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
295306	Non-Physician Medical Practitioner	None	1245941806	0	0	RAAB, CALAH R NP	1/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
295307	Non-Physician Medical Practitioner	None	1396923454	0	0	RIOS, VLASCOVIA M V	1/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2313 QUAIL MEADOW DR	None	MODESTO	CA	95355	9248	00	06000	37.67660274	-120.9554212	Stanislaus County
295361	Non-Physician Medical Practitioner	None	1457176554	0	0	RODRIGUES, ROSE MARY NP	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
295421	Non-Physician Medical Practitioner	None	1346778529	0	0	RICHARDS, DANNEAL E NP	6/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7291 W PORTALS AVENUE	None	FRESNO	CA	93723	8146	00	06000	36.81565626	-119.9219551	Fresno County
295431	Non-Physician Medical Practitioner	None	1972751790	0	0	RYCHTERA, TRACY L	9/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	155 SOLANO ST	None	CORNING	CA	96021	3511	00	06000	39.92779745	-122.1687508	Tehama County
295442	Non-Physician Medical Practitioner	None	1083331078	0	0	REPPER, DANIELLE PA	3/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
295445	Non-Physician Medical Practitioner	None	1477279578	0	0	RODRIGUEZ VEGA, FERNANDO NP	5/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 N. VERMONT AVE.	None	LOS ANGELES	CA	90027	6098	00	06000	34.0956033	-118.2916918	Los Angeles County
295482	Non-Physician Medical Practitioner	None	1205822210	0	0	RICE, WILLIAM JR	9/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2403 GRANADA WAY	None	CARLSBAD	CA	92010	2160	00	06000	33.16842137	-117.3182017	San Diego County
295492	Non-Physician Medical Practitioner	None	1861022899	0	0	RODRIGUEZ, JOSHUA A PA	5/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
295502	Non-Physician Medical Practitioner	None	1528504768	0	0	ROTH, SAMANTHA T	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	215 QUEST PARK ST	None	HENDERSON	NV	89074	1498	00	06000	36.04271987	-115.0503596	Clark County
295510	Non-Physician Medical Practitioner	None	1306004304	0	0	RODRIGUEZ, HUGO ALFREDO	3/31/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20440 SHERMAN WAY	None	CANOGA PARK	CA	91306	3110	00	06000	34.20098249	-118.578753	Los Angeles County
295525	Non-Physician Medical Practitioner	None	1255582961	0	0	ROWE, HOLLY A NP	12/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25109 JEFFERSON AVE	SUITE 100	MURRIETA	CA	92562	8116	00	06000	33.55410071	-117.2028115	Riverside County
295563	Non-Physician Medical Practitioner	None	1093162562	0	0	ROJAS, CYNTHIA NP	8/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11458 CORTE SOQUEL	None	JURUPA	CA	91752	5037	00	06000	34.00097519	-117.5356194	Riverside County
295568	Non-Physician Medical Practitioner	None	1043798440	0	0	RAGSDALE, GINA M NP	2/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295609	Non-Physician Medical Practitioner	None	1710441001	0	0	ROJO, MARIA GUADALUPE NP	5/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1511 E. KATELLA AVENUE	None	ORANGE	CA	92867	5025	00	06000	33.80921851	-117.837648	Orange County
295623	Non-Physician Medical Practitioner	None	1598831505	0	0	RODRIGUEZ, JACQUELINE NP	10/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1259 S INDIANA ST	None	LOS ANGELES	CA	90023	3216	00	06000	34.0171089	-118.1922896	Los Angeles County
295645	Non-Physician Medical Practitioner	None	1134523913	0	0	RILEY, ELIZABETH NP	2/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
295668	Non-Physician Medical Practitioner	None	1811360571	0	0	RIVERO, KRISTA CNM	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1665 ESPLANADE	None	CHICO	CA	95926	3312	00	06000	39.74388808	-121.8503372	Butte County
295685	Non-Physician Medical Practitioner	None	1265773907	0	0	ROSAS, CARLOS	5/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3520 HUGHES AVE	APT 202	LOS ANGELES	CA	90034	3970	00	06000	34.02829424	-118.4025898	Los Angeles County
295692	Non-Physician Medical Practitioner	None	1053819961	0	0	ROMIS, GERALDIN S PA-C	3/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
295711	Non-Physician Medical Practitioner	None	1639549447	0	0	RABINOWITZ, EMILY G NP	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1442 TARAVAL ST	# 2	SAN FRANCISCO	CA	94116	2385	00	06000	37.74279454	-122.4818471	San Francisco County
295728	Non-Physician Medical Practitioner	None	1053633206	0	0	REDUBLA, DENNIS M NP	7/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2365 S SABRE DRIVE	None	FRESNO	CA	93727	8842	00	06000	36.71627224	-119.6980596	Fresno County
295738	Non-Physician Medical Practitioner	None	1255391884	0	0	RUTHERFORD, JILLIAN PA	12/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 EL CAMINO REAL	SUITE 200	BURLINGAME	CA	94010	3102	00	06000	37.59600871	-122.384453	San Mateo County
295746	Non-Physician Medical Practitioner	None	1558845891	0	0	ROMERO, ABIGAIL PA	11/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
295789	Non-Physician Medical Practitioner	None	1679237580	0	0	ROMO, JOEL NP	7/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2026 N IMPERIAL AVE	STE C	EL CENTRO	CA	92243	1607	00	06000	32.81256347	-115.5700202	Imperial County
295792	Non-Physician Medical Practitioner	None	1134268998	0	0	RADLER VENTURI, MELODIE V PA	2/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CASA BUENA DR	None	CORTE MADERA	CA	94925	1762	00	06000	37.92483214	-122.51669	Marin County
295811	Non-Physician Medical Practitioner	None	1851057087	0	0	RECHT, SASHA NP	11/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	00	06000	32.74986289	-117.1599343	San Diego County
295818	Non-Physician Medical Practitioner	None	1053533117	0	0	ROBLES, ROMAN	6/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 E MARTIN LUTHER KING	None	STOCKTON	CA	95206	0000	00	06000	37.93871412	-121.2869925	San Joaquin County
295844	Non-Physician Medical Practitioner	None	1487695003	0	0	RUBIN, MARIA C	4/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 9TH STREET	APT 11	SANTA MONICA	CA	90401	1823	00	06000	34.02123107	-118.4915624	Los Angeles County
295852	Non-Physician Medical Practitioner	None	1588878177	0	0	ROSENBLUM, RUTH KOPPEL	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1521 ESTELLE AVE	None	SAN JOSE	CA	95118	1325	00	06000	37.26814072	-121.895703	Santa Clara County
295961	Non-Physician Medical Practitioner	None	1750995478	0	0	ROSARIO, KATHLEEN K NP	12/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
295970	Non-Physician Medical Practitioner	None	1427435395	0	0	RICAFRENTE, NAZARICA N NP	8/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	850 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	6700	00	06000	34.05097684	-118.1379979	Los Angeles County
296021	Non-Physician Medical Practitioner	None	1174046676	0	0	ROMO, DIANA J	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6570 KAISER AVE	None	FONTANA	CA	92336	3260	00	06000	34.13420816	-117.4279904	San Bernardino County
296046	Non-Physician Medical Practitioner	None	1578990461	0	0	ROMANO-HELM, GENEVIEVE NP	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 ADOBE ST	None	CONCORD	CA	94520	2313	00	06000	37.97700068	-122.0381159	Contra Costa County
296054	Non-Physician Medical Practitioner	None	1700220332	0	0	RUSSELL-SHAFFER, RAINA NP	8/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	374 42ND ST	None	OAKLAND	CA	94609	2655	00	06000	37.8311372	-122.2581282	Alameda County
296062	Non-Physician Medical Practitioner	None	1376657544	0	0	ROZENOFF, PATRICIA L NP	7/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 BEATTIE LN	None	SEBASTOPOL	CA	95472	4452	00	06000	38.38736359	-122.8238149	Sonoma County
296064	Non-Physician Medical Practitioner	None	1215500061	0	0	RELOS, ALYSSA C NP	6/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
296069	Non-Physician Medical Practitioner	None	1417108481	0	0	RYDER, CRYSTAL PA	4/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1038 E BROKAW ROAD	SUITE 30	SAN JOSE	CA	95131	2309	00	06000	37.3827822	-121.8982439	Santa Clara County
296073	Non-Physician Medical Practitioner	None	1467882456	0	0	ROLAN, TAMARA M CNM	6/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296106	Non-Physician Medical Practitioner	None	1578907895	0	0	RAMAGE, APRIL R NP	1/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5222 COSUMNES DRIVE	APT 237	STOCKTON	CA	95219	7219	00	06000	38.04873986	-121.3772545	San Joaquin County
296132	Non-Physician Medical Practitioner	None	1013649797	0	0	ROBERTS, JOEL PA-C	11/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
296200	Non-Physician Medical Practitioner	None	1063903201	0	0	ROY, NISHA A NP	4/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
296215	Non-Physician Medical Practitioner	None	1881878247	0	0	ROSSI, MELISSA G	3/2/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	750 WINSCOMBE CT	None	FOLSOM	CA	95630	3600	00	06000	38.665323	-121.1414625	Sacramento County
296229	Non-Physician Medical Practitioner	None	1639413404	0	0	ROBERTS, MARTHA A NP	3/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
296231	Non-Physician Medical Practitioner	None	1689659468	0	0	RADSLIFF NELSON, ELIZABETH C	9/16/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8801 COUNTRY CREEK DR	None	ORANGEVALE	CA	95662	2118	00	06000	38.716893	-121.231026	Sacramento County
296277	Non-Physician Medical Practitioner	None	1932128402	0	0	RAY, CHONA NP	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1043 ELM AVENUE	104	LONG BEACH	CA	90813	3244	00	06000	33.779655	-118.1880065	Los Angeles County
296330	Non-Physician Medical Practitioner	None	1255806535	0	0	RIVERA LANDEROS, WILLIE PA	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
296341	Non-Physician Medical Practitioner	None	1821576026	0	0	ROBINSON, BLAINE E NP	3/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
296364	Non-Physician Medical Practitioner	None	1821733122	0	0	RAYMUNDO, ERIKA C NP	8/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	00	06000	34.13489987	-118.0424069	Los Angeles County
296367	Non-Physician Medical Practitioner	None	1669885539	0	0	RODOLFF, KELLEY L	9/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6911 BROUGHTON COURT	None	ROCKLIN	CA	95677	4526	00	06000	38.77166513	-121.2272346	Placer County
296370	Non-Physician Medical Practitioner	None	1962586479	0	0	RUBIN, SHARLEEN H	10/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	DEPT. OF ORTHOPEDICS	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
296378	Non-Physician Medical Practitioner	None	1316373293	0	0	REYES, JOANNA REINA M NP	6/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1557 E AMAR RD STE F	None	WEST COVINA	CA	91792	1678	00	06000	34.03023504	-117.9121024	Los Angeles County
296405	Non-Physician Medical Practitioner	None	1952611469	0	0	RAWLINSON, KATHERINE A	4/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2828 WEBSTER ST	APT 9	SAN FRANCISCO	CA	94123	4018	00	06000	37.79683794	-122.4336967	San Francisco County
296420	Non-Physician Medical Practitioner	None	1710210232	0	0	RAJA, FURQAN ABBAS	8/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 4TH ST	None	TAFT	CA	93268	2415	00	06000	35.14905085	-119.4534352	Kern County
296443	Non-Physician Medical Practitioner	None	1720618010	0	0	ROBINSON, JONATHAN NP	6/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
296475	Non-Physician Medical Practitioner	None	1831266600	0	0	REYNOLDS, BRADLEY R	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	184 POINSETTIA AVE	None	MONROVIA	CA	91016	2308	00	06000	34.15456627	-117.9954579	Los Angeles County
296479	Non-Physician Medical Practitioner	None	1710382239	0	0	ROBERTS, APHRODITE P NP	4/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
296546	Non-Physician Medical Practitioner	None	1245051085	0	0	RETHMEIER, VIKTORIA	11/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
296582	Non-Physician Medical Practitioner	None	1326063199	0	0	REEDLEY COMMUNITY HOSPITAL	1/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	00	06000	36.60784193	-119.4520057	Fresno County
296606	Non-Physician Medical Practitioner	None	1205253374	0	0	REEDLEY COMMUNITY HOSPITAL	2/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	48677 VICTORIA LN	None	OAKHURST	CA	93644	9216	00	06000	37.32772782	-119.6601883	Madera County
296619	Non-Physician Medical Practitioner	None	1912268145	0	0	ROE, BERNARDITA M NP	6/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4218 STANLEY AVE	None	FREMONT	CA	94538	4159	00	06000	37.52426022	-121.9609261	Alameda County
296670	Non-Physician Medical Practitioner	None	1225364060	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1251 DRAPER STREET	None	KINGSBURG	CA	93631	1934	00	06000	36.51344551	-119.5547644	Fresno County
296707	Non-Physician Medical Practitioner	None	1598307274	0	0	ROMO, ADRIANA PA-C	12/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
296745	Non-Physician Medical Practitioner	None	1154462323	0	0	ROUILLARD, SHARON GERTZ	3/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 NORRIS CANYON RD	STE 140	SAN RAMON	CA	94583	5407	00	06000	37.77772182	-121.9579459	Contra Costa County
296779	Non-Physician Medical Practitioner	None	1235585951	0	0	ROFAEL, MARIO Y PA-C	3/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
296794	Non-Physician Medical Practitioner	None	1912541798	0	0	ROUZYI, IBRAHIM PA	7/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
296812	Non-Physician Medical Practitioner	None	1437695715	0	0	RUMBLE, ERIKA NP	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET	None	CHICO	CA	95926	2241	00	06000	39.75090044	-121.8522609	Butte County
296829	Non-Physician Medical Practitioner	None	1336704402	0	0	RUMMEL, IRENE PA	7/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22419 KENT AVE	None	TORRANCE	CA	90505	2303	00	06000	33.824448	-118.3564765	Los Angeles County
296832	Non-Physician Medical Practitioner	None	1376081976	0	0	ROMACK, RACHEL PA-C	3/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
296846	Non-Physician Medical Practitioner	None	1093748923	0	0	ROSS, MICHAEL A	7/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40 WEGIS AVE	None	BAKERSFIELD	CA	93314	7878	00	06000	35.355123	-119.189823	Kern County
296851	Non-Physician Medical Practitioner	None	1023403896	0	0	RUFFO, LAURA NP	5/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296856	Non-Physician Medical Practitioner	None	1669539805	0	0	RYAN, ELIZABETH MARY	8/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	00	06000	38.2304311	-122.5827918	Sonoma County
296860	Non-Physician Medical Practitioner	None	1447573167	0	0	RANGAN, KASEY E NP	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30264 BARCELONA RD	None	CASTIAC	CA	91384	4796	00	06000	34.46806801	-118.6425411	Los Angeles County
296931	Non-Physician Medical Practitioner	None	1588997860	0	0	RAMIREZ, ERICA	10/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7210 MURRAY DR	None	STOCKTON	CA	95210	3339	00	06000	38.01572012	-121.3009247	San Joaquin County
296936	Non-Physician Medical Practitioner	None	1760565691	0	0	ROW, JAMES ENOCH	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	2SW	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
296960	Non-Physician Medical Practitioner	None	1598027450	0	0	RELLA, KARLAANNE NP	7/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 E CHASE AVE	STE 108	EL CAJON	CA	92020	6305	00	06000	32.78042748	-116.9591715	San Diego County
296969	Non-Physician Medical Practitioner	None	1124050372	0	0	RADOVICH, PATRICIA	1/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	STE.1405	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
296980	Non-Physician Medical Practitioner	None	1164051314	0	0	ROGNESS, ALEC S PA	7/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	00	06000	36.962588	-122.0439201	Santa Cruz County
296995	Non-Physician Medical Practitioner	None	1003332909	0	0	RAFANAN, KENN R NP	12/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3670 DEGNAN BLVD	None	LOS ANGELES	CA	90018	4015	00	06000	34.02110503	-118.329693	Los Angeles County
297003	Non-Physician Medical Practitioner	None	1356312763	0	0	RITTER, BARBARA J NP	11/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 ROCKGREEN PLACE	None	SANTA ROSA	CA	95409	6045	00	06000	38.437704	-122.598459	Sonoma County
297015	Non-Physician Medical Practitioner	None	1801497771	0	0	ROUGHLEY, MATTHEW PA	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
297020	Non-Physician Medical Practitioner	None	1437683174	0	0	RIDDICK, TERA S NP	10/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
297031	Non-Physician Medical Practitioner	None	1609992858	0	0	RAGSAC, ANDREI C	3/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1190 VIA BLAIRO CIR	None	CORONA	CA	92879	8855	00	06000	33.89488476	-117.5486501	Riverside County
297057	Non-Physician Medical Practitioner	None	1154850634	0	0	ROBERTS, JOSEPH E	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1643 BELLA LAGUNA CT	None	ENCINTAS	CA	92024	1292	00	06000	33.08331852	-117.2774936	San Diego County
297060	Non-Physician Medical Practitioner	None	1356400055	0	0	RAMIREZ, ANTONIO	1/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3236 JESSICA STREET	None	NEWBURY PARK	CA	91320	4401	00	06000	34.17767001	-118.9437874	Ventura County
297101	Non-Physician Medical Practitioner	None	1073763835	0	0	RYAN RICIGLIANO, DENISE M NP	2/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 E ROMIE LN	A	SALINAS	CA	93901	4031	00	06000	36.65998191	-121.6461895	Monterey County
297113	Non-Physician Medical Practitioner	None	1205991700	0	0	ROBERTS, DAVID CORBALEY	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
297119	Non-Physician Medical Practitioner	None	1457640765	0	0	RILEY, RACHEL V	4/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10752 OAKWOOD AVENUE	None	HESPERIA	CA	92345	2452	00	06000	34.44596226	-117.3427391	San Bernardino County
297127	Non-Physician Medical Practitioner	None	1083945406	0	0	RIGBY, ALICIA M NP	6/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
297151	Non-Physician Medical Practitioner	None	1346283942	0	0	RIOS, JENNY	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
297192	Non-Physician Medical Practitioner	None	1487340543	0	0	RUSS, KENSLEY B PA-C	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
297235	Non-Physician Medical Practitioner	None	1831641117	0	0	RHODES, CLAIRE E NP	11/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
297259	Non-Physician Medical Practitioner	None	1114357381	0	0	RIVERA, ALEXANDER E PA-C	12/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	00	06000	35.351487	-119.1143025	Kern County
297269	Non-Physician Medical Practitioner	None	1467888719	0	0	ROJAS, HEATHER R	7/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5363 BIRK WAY	None	SACRAMENTO	CA	95835	1544	00	06000	38.672811	-121.5155025	Sacramento County
297276	Non-Physician Medical Practitioner	None	1376972174	0	0	RIPP, CHERYL L NP	4/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1438 REED AVE	None	SAN DIEGO	CA	92109	5351	00	06000	32.79535795	-117.2424851	San Diego County
297281	Non-Physician Medical Practitioner	None	1396170064	0	0	RODRIGUEZ, NATALIE M NP	2/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 N 4TH ST	APT 202	MONTEBELLO	CA	90640	3614	00	06000	34.01636973	-118.1017913	Los Angeles County
297320	Non-Physician Medical Practitioner	None	1831315498	0	0	RATHBURN, CARRIE K	9/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4824 ALFRED AVENUE	None	SAN DIEGO	CA	92120	1023	00	06000	32.79837479	-117.0905424	San Diego County
297366	Non-Physician Medical Practitioner	None	1134509177	0	0	RUIZ, CHRISTINA L NP	8/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	940 NETTLE COURT	None	CORONA	CA	92880	7701	00	06000	33.89647864	-117.5737378	Riverside County
297408	Non-Physician Medical Practitioner	None	1972979201	0	0	RAPOZO, BRITTANY L NP	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2331 SERENA AVENUE	None	CLOVIS	CA	93619	2809	00	06000	36.86591311	-119.6706508	Fresno County
297417	Non-Physician Medical Practitioner	None	1992469159	0	0	RICHMOND, GARY NP	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
297424	Non-Physician Medical Practitioner	None	1093291056	0	0	RHYNER, MICHELLE	11/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 SKYLINE DRIVE	None	MONTEREY	CA	93940	4110	00	06000	36.59323606	-121.9166669	Monterey County
297439	Non-Physician Medical Practitioner	None	1992295000	0	0	REYNOLDS, WADE M NP	12/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	06000	33.38982	-111.8760885	Maricopa County
297480	Non-Physician Medical Practitioner	None	1811939937	0	0	ROBBEN-FOLSOM, DANA PA-C	2/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	440 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3361	00	06000	34.13599629	-117.8714999	Los Angeles County
297486	Non-Physician Medical Practitioner	None	1366899726	0	0	RYAN, TYLER J	9/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	490 HILLCREST DRIVE	None	ENCINITAS	CA	92024	1529	00	06000	33.08107393	-117.3009257	San Diego County
297489	Non-Physician Medical Practitioner	None	1851834279	0	0	RADOVICH, NICOLE M	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3880 MOULTON DRIVE	None	SAN BRUNO	CA	94066	1026	00	06000	37.63304923	-122.469683	San Mateo County
297491	Non-Physician Medical Practitioner	None	1881110567	0	0	ROBLES, LUCILA NP	9/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1535 W MERCED AVE	STE 300	WEST COVINA	CA	91790	3404	00	06000	34.06295577	-117.9482872	Los Angeles County
297506	Non-Physician Medical Practitioner	None	1417624123	0	0	ROBERTS, BELITA S NP	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1777 BELLFLOWER BLVD	STE 101	LONG BEACH	CA	90815	4020	00	06000	33.78791149	-118.1240221	Los Angeles County
297529	Non-Physician Medical Practitioner	None	1700222627	0	0	RIVERA, EVA L NP	2/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2336 SYLVAN AVE	STE A	MODESTO	CA	95355	9211	00	06000	37.68893159	-120.9547915	Stanislaus County
297532	Non-Physician Medical Practitioner	None	1669970778	0	0	ROGERS, JASON A	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8450 E BONITA DR	None	SCOTTSDALE	AZ	85250	7414	00	06000	33.512382	-111.898197	Maricopa County
297550	Non-Physician Medical Practitioner	None	1396117693	0	0	REISDORF, SONIA R NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
297556	Non-Physician Medical Practitioner	None	1477955680	0	0	REESE, SARAH	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	00	06000	36.66192801	-121.6413283	Monterey County
297594	Non-Physician Medical Practitioner	None	1366621336	0	0	RAFLA, SAFWAT B PA-C	7/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1051 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	3354	00	06000	33.14688532	-117.1059138	San Diego County
297598	Non-Physician Medical Practitioner	None	1447066337	0	0	RODRIGUEZ, VANESSA NP	2/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8112 MILLIKEN AVE	SUITE 201	RANCHO CUCAMONGA	CA	91730	7473	00	06000	34.10480366	-117.5570863	San Bernardino County
297606	Non-Physician Medical Practitioner	None	1962849471	0	0	RAJAPAKSE, DEBORAH RAJEENI	9/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4152 ANISE CIR	None	CORONA	CA	92883	0791	00	06000	33.81599286	-117.5448461	Riverside County
297614	Non-Physician Medical Practitioner	None	1730374943	0	0	RYAN, PATRICIA LYNN	11/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	110 BROADWAY	None	BUCKSPORT	ME	04416	0000	00	06000	44.576208	-68.7803625	Hancock County
297645	Non-Physician Medical Practitioner	None	1780310912	0	0	RICHARD, CHRISTINE N	9/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30495 CANWOOD	101	AGOURA HILLS	CA	91301	4331	00	06000	34.14698794	-118.7853623	Los Angeles County
297663	Non-Physician Medical Practitioner	None	1811408511	0	0	RAMIREZ, ALBERTO S PA-C	2/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 E ROMIE LN	None	SALINAS	CA	93901	4029	00	06000	36.65983988	-121.6458041	Monterey County
297665	Non-Physician Medical Practitioner	None	1700435526	0	0	RACE, SHANA E NP	9/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	00	06000	34.02773198	-118.4862675	Los Angeles County
297668	Non-Physician Medical Practitioner	None	1285651745	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2440 W TAHOE	None	CARUTHERS	CA	93609	9476	00	06000	36.54046763	-119.83553	Fresno County
297696	Non-Physician Medical Practitioner	None	1285896043	0	0	RADCHENKO, NADIA	9/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6511 EL CABO COURT	None	CITRUS HEIGHTS	CA	95621	4354	00	06000	38.683656	-121.300479	Sacramento County
297698	Non-Physician Medical Practitioner	None	1619794229	0	0	RESENDIZ, KATELYNN PA-C	10/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	00	06000	34.1315778	-117.3182453	San Bernardino County
297699	Non-Physician Medical Practitioner	None	1548485204	0	0	RUIZ, YOLANDA	8/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	DEPT OF RADIOLOGY	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
297710	Non-Physician Medical Practitioner	None	1326495573	0	0	RO, JAN KIM NP	4/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10707 JASPER AVE	None	REDLANDS	CA	92374	7681	00	06000	34.05941953	-117.136263	San Bernardino County
297711	Non-Physician Medical Practitioner	None	1942745427	0	0	RAZO, KARINA V NP	5/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
297720	Non-Physician Medical Practitioner	None	1588655617	0	0	REILLY, VALERIE J	3/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	838 THEODORA STREET	None	NIPOMO	CA	93444	9335	00	06000	35.02924035	-120.4917309	San Luis Obispo County
297748	Non-Physician Medical Practitioner	None	1770866923	0	0	ROSAASEN, HEATHER PA	7/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1231 VIA FLORENCE	None	REDLANDS	CA	92374	3990	00	06000	34.06861672	-117.1422381	San Bernardino County
297754	Non-Physician Medical Practitioner	None	1588628218	0	0	RUDOLPH, MARY M NP	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1270 HERMOSA WAY	None	MENLO PARK	CA	94025	5507	00	06000	37.44392813	-122.193786	San Mateo County
297757	Non-Physician Medical Practitioner	None	1902912546	0	0	REGISTER, BRADLEY R	1/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10959 YUNIS CT	None	YUCAIPA	CA	92399	9475	00	06000	34.05480433	-117.0305096	San Bernardino County
297831	Non-Physician Medical Practitioner	None	1346555620	0	0	ROSE, JASON PA	7/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
297838	Non-Physician Medical Practitioner	None	1174729040	0	0	RODRIGUEZ, JAVIER	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4316 KENWOOD AVE	None	LOS ANGELES	CA	90037	2323	00	06000	34.00495594	-118.2990874	Los Angeles County
297847	Non-Physician Medical Practitioner	None	1982128591	0	0	ROPER, CORAL N NP	5/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1038 E BROKAW ROAD	SUITE 30	SAN JOSE	CA	95131	2309	00	06000	37.3827822	-121.8982439	Santa Clara County
297851	Non-Physician Medical Practitioner	None	1639393564	0	0	ROBINSON, ROBYN F NP	9/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39 CALLE CABRILLO	None	FOOTHILL RANCH	CA	92610	1747	00	06000	33.69122085	-117.6659162	Orange County
297887	Non-Physician Medical Practitioner	None	1992089478	0	0	ROBERTS, MICHELLE M	10/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16141 BAYBERRY PLACE	None	SHERMAN OAKS	CA	91403	4711	00	06000	34.1351633	-118.4849569	Los Angeles County
297909	Non-Physician Medical Practitioner	None	1346924479	0	0	RAMIREZ-GARCIA, DANIA NP	6/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
297915	Non-Physician Medical Practitioner	None	1053530618	0	0	ROVENSKY, GALINA NP	3/3/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7646 DENSMORE AVE	None	VAN NUYS	CA	91406	2042	00	06000	34.209873	-118.477091	Los Angeles County
297931	Non-Physician Medical Practitioner	None	1013160308	0	0	REITTINGER, STEPHANIE A NP	10/18/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6541 SEAMAN STREET	None	SAN DIEGO	CA	92120	2629	00	06000	32.79176385	-117.0918629	San Diego County
297939	Non-Physician Medical Practitioner	None	1639435613	0	0	RYBKINA, KATERYNA	7/23/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
298015	Non-Physician Medical Practitioner	None	1528757325	0	0	RUTHER, REBEKAH NP	11/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
298059	Non-Physician Medical Practitioner	None	1235726365	0	0	ROMAN, RUTH NP	5/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	402 E HOLT BLVD	None	ONTARIO	CA	91761	1618	00	06000	34.063029	-117.6468075	San Bernardino County
298082	Non-Physician Medical Practitioner	None	1114574159	0	0	RINALDI, JEREMY PA	6/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	00	06000	36.84632065	-119.783885	Fresno County
298099	Non-Physician Medical Practitioner	None	1851658322	0	0	ROSE, JORDAN P NP	4/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1375 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3382	00	06000	38.627145	-122.863779	Sonoma County
298110	Non-Physician Medical Practitioner	None	1144632696	0	0	RYAN, JESSICA L PA-C	3/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	00	06000	34.44257521	-119.7584538	Santa Barbara County
298118	Non-Physician Medical Practitioner	None	1720030323	0	0	RILEY, SAMANTHA S RN CPNP	5/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 TELEGRAPH AVE	2 ND FLOOR	OAKLAND	CA	94609	3210	00	06000	37.82037533	-122.2667839	Alameda County
298177	Non-Physician Medical Practitioner	None	1235388232	0	0	ROBINSON, MARK NP	9/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 RIVER PARK DR	STE 120	SACRAMENTO	CA	95815	4506	00	06000	38.597571	-121.4392905	Sacramento County
298181	Non-Physician Medical Practitioner	None	1356822266	0	0	ROGGE, JARED NP	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	00	06000	38.567007	-121.468068	Sacramento County
298204	Non-Physician Medical Practitioner	None	1336182864	0	0	REYES, JESUS M	2/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10645 BRUNS DRIVE	None	TUSTIN	CA	92782	1415	00	06000	33.76128201	-117.7629849	Orange County
298206	Non-Physician Medical Practitioner	None	1861076267	0	0	ROSE, KELSEA PA	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
298215	Non-Physician Medical Practitioner	None	1023069523	0	0	RICHARDSON, ANDREA L	9/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	75 FRANCIS STREET AMORY	BRIGHAM AND WOMENS HOSPI	BOSTON	MA	02115	0000	00	06000	42.335946	-71.10675	Suffolk County
298242	Non-Physician Medical Practitioner	None	1558779884	0	0	RAHMAN, FARAH S NP	3/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	919 VERMONT ST	None	SAN JOSE	CA	95126	1236	00	06000	37.34454106	-121.9226072	Santa Clara County
298248	Non-Physician Medical Practitioner	None	1477217909	0	0	RIGOR, STEPHANIE A NP	7/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E OCEAN BLVD	110	LONG BEACH	CA	90802	5003	00	06000	33.76653325	-118.185777	Los Angeles County
298252	Non-Physician Medical Practitioner	None	1861957862	0	0	REDDEKOPP, JARAD A NP	4/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	00	06000	38.599614	-121.438728	Sacramento County
298260	Non-Physician Medical Practitioner	None	1710344759	0	0	RUIZ, LINDA B NP	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	968 FAIRWAY HILL ST	None	HENDERSON	NV	89002	9735	00	06000	35.99858634	-114.9737429	Clark County
298273	Non-Physician Medical Practitioner	None	1902324478	0	0	REDMAN, BLYTHE J	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2370 ORANGE AVE	APT 2	COSTA MESA	CA	92627	6574	00	06000	33.65426786	-117.8998795	Orange County
298335	Non-Physician Medical Practitioner	None	1336554351	0	0	RAMIREZ, MANUEL O	11/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	538 W 7TH ST	None	HOLTVILLE	CA	92250	1042	00	06000	32.81463691	-115.3863938	Imperial County
298345	Non-Physician Medical Practitioner	None	1821456716	0	0	RAMOS, ROMULUS A NP	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29012 GARNET CYN DRIVE	None	SANTA CLARITA	CA	91390	5265	00	06000	34.4730631	-118.5225491	Los Angeles County
298351	Non-Physician Medical Practitioner	None	1407336241	0	0	ROMANTIC, CORINNA L NP	10/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	217 ADA AVE	APT 40	MOUNTAIN VIEW	CA	94043	4961	00	06000	37.39484557	-122.065076	Santa Clara County
298372	Non-Physician Medical Practitioner	None	1528041779	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16916 5TH STREET	None	HURON	CA	93234	0250	00	06000	36.2004513	-120.101827	Fresno County
298376	Non-Physician Medical Practitioner	None	1780283168	0	0	RHIMA, BRENDA R NP	11/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
298388	Non-Physician Medical Practitioner	None	1235963208	0	0	RAMIREZ, GWENDOLYN E PA-C	11/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
298398	Non-Physician Medical Practitioner	None	1730540030	0	0	ROBINSON, LUKE D	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1238 E MAIN STREET	None	VENTURA	CA	93001	3104	00	06000	34.28081868	-119.2818199	Ventura County
298458	Non-Physician Medical Practitioner	None	1851320675	0	0	RAJ, RASHPAL S	4/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2939 MUTTONBIRD WAY	None	SACRAMENTO	CA	95834	2623	00	06000	38.629602	-121.526379	Sacramento County
298461	Non-Physician Medical Practitioner	None	1932532058	0	0	RAJAPAKSE, RUWAN I NP	7/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	66 W RINCON AVE	UNIT E	CAMPBELL	CA	95008	2834	00	06000	37.28488247	-121.951161	Santa Clara County
298477	Non-Physician Medical Practitioner	None	1518079482	0	0	RECH, PEGGY LYNN	4/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
298515	Non-Physician Medical Practitioner	None	1225132764	0	0	RODRIGUEZ, PETER CRUZ	5/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
298531	Non-Physician Medical Practitioner	None	1598407652	0	0	RELUCIO, RUTH ALMA VANESSA NP	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	06000	36.143271	-115.1254975	Clark County
298551	Non-Physician Medical Practitioner	None	1528556743	0	0	RAMIREZ, EUGENIA NP	3/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	00	06000	33.84718298	-117.933758	Orange County
298559	Non-Physician Medical Practitioner	None	1689757627	0	0	REMBUSKOS, TERRI M PA	9/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	00	06000	34.13101049	-118.151532	Los Angeles County
298561	Non-Physician Medical Practitioner	None	1285288183	0	0	REITNOUER, KEELEY B PA	11/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
298616	Non-Physician Medical Practitioner	None	1760686133	0	0	RIVERA, CARMEN L NP	4/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	618 CASA VERDE ST	None	BAKERSFIELD	CA	93306	7903	00	06000	35.36056202	-118.9004196	Kern County
298624	Non-Physician Medical Practitioner	None	1295160182	0	0	RAMOS, KIMBERLY L NP	4/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14681 DONCASTER RD	None	IRVINE	CA	92604	2431	00	06000	33.69411028	-117.7773341	Orange County
298630	Non-Physician Medical Practitioner	None	1174564058	0	0	RAFIZADEH, ARDAVAN	6/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 SAN JOSE ST	STE 301	SALINAS	CA	93901	3928	00	06000	36.65853377	-121.6476066	Monterey County
298676	Non-Physician Medical Practitioner	None	1518254937	0	0	REED, JULIE W PA	3/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
298723	Non-Physician Medical Practitioner	None	1669650180	0	0	RAJARATNAM, DANIEL	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6354 HERMOSA CT	None	PALMDALE	CA	93551	1636	00	06000	34.6387925	-118.2440977	Los Angeles County
298727	Non-Physician Medical Practitioner	None	1891190724	0	0	ROMANO, ASHLEY S	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1703 PACIFIC AVE	None	ALAMEDA	CA	94501	1214	00	06000	37.77355079	-122.2545406	Alameda County
298740	Non-Physician Medical Practitioner	None	1891460531	0	0	RAJA, ARCHITHA PA	3/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1114 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63901905	-121.0057149	Stanislaus County
298764	Non-Physician Medical Practitioner	None	1013099753	0	0	REDDICK, JAIDESH K PA-C	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
298768	Non-Physician Medical Practitioner	None	1902826910	0	0	ROJAS, ADRIAN	12/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29734 CREEKBED RD	None	CASTAIC	CA	91384	3582	00	06000	34.45591889	-118.6206878	Los Angeles County
298802	Non-Physician Medical Practitioner	None	1407528771	0	0	REIVITIS, ALEXANDRA N PA-C	6/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
298806	Non-Physician Medical Practitioner	None	1801069984	0	0	RAMOS, RODERICK P	2/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28628 FRIARSTONE COURT	None	RANCHO PALOS VERD	CA	90275	1812	00	06000	33.759126	-118.3110225	Los Angeles County
298843	Non-Physician Medical Practitioner	None	1649756974	0	0	ROSENSTEIN, IRVING PA	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
298847	Non-Physician Medical Practitioner	None	1689251266	0	0	RODRIGUEZ, MERCEDES A PA	3/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
298853	Non-Physician Medical Practitioner	None	1649017773	0	0	RODRIGUEZ, MARIA	11/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25485 MEDICAL CENTER DR	SUITE 204	MURRIETA	CA	92562	5978	00	06000	33.55785761	-117.1842222	Riverside County
298857	Non-Physician Medical Practitioner	None	1790191385	0	0	ROLDAN, MILTON A	9/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 S MAIN ST	PH 123	LOS ANGELES	CA	90014	2043	00	06000	34.04496317	-118.2501915	Los Angeles County
298893	Non-Physician Medical Practitioner	None	1972015055	0	0	RHEE, RUTH H NP	12/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 DEL MEDIO AVE	SUITE 323	MOUNTAIN VIEW	CA	94040	0041	00	06000	37.40908261	-122.1113478	Santa Clara County
298923	Non-Physician Medical Practitioner	None	1023487006	0	0	RIVES, ANDREW V PA-C	9/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8805 HAVEN AVE	SUITE 100	RANCHO CUCAMONGA	CA	91730	5149	00	06000	34.09424614	-117.5756838	San Bernardino County
298943	Non-Physician Medical Practitioner	None	1093732554	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	119 S 6TH STREET	None	FOWLER	CA	93625	2439	00	06000	36.62995919	-119.678276	Fresno County
298954	Non-Physician Medical Practitioner	None	1861013708	0	0	RIEFF, LEAH CNM	2/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
298989	Non-Physician Medical Practitioner	None	1558400135	0	0	RODGERS, MEGAN LEIGH	3/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	00	06000	34.03122319	-118.4797185	Los Angeles County
299007	Non-Physician Medical Practitioner	None	1215080718	0	0	ROSE, MURIEL L PA-C	10/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	815 BAY AVE	None	CAPITOLA	CA	95010	2186	00	06000	36.98097987	-121.9554791	Santa Cruz County
299046	Non-Physician Medical Practitioner	None	1295421196	0	0	RYAN, RACHEL S PA-C	7/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
299074	Non-Physician Medical Practitioner	None	1417447756	0	0	ROJAS, CINTHIA V NP	1/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
299075	Non-Physician Medical Practitioner	None	1245342377	0	0	REED, DORIAN J	12/28/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1670 KETTNER BLVD	#121	SAN DIEGO	CA	92101	2556	00	06000	32.722497	-117.169217	San Diego County
299079	Non-Physician Medical Practitioner	None	1730492935	0	0	RHOADS, EMILY A	10/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
299097	Non-Physician Medical Practitioner	None	1043566169	0	0	RICH, HEATHER L PA-C	8/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299102	Non-Physician Medical Practitioner	None	1255873238	0	0	RAMIREZ, GLADYS B NP	5/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2444 LEEBE AVE	None	POMONA	CA	91768	2740	00	06000	34.05830262	-117.7952385	Los Angeles County
299132	Non-Physician Medical Practitioner	None	1407189145	0	0	ROBERTSON, CHRISTOPHER M	10/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34487 MARR DRIVE	None	BEAUMONT	CA	92223	7453	00	06000	33.96143592	-117.0641248	Riverside County
299144	Non-Physician Medical Practitioner	None	1194449439	0	0	RODRIGUEZ, ERICA NP	8/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1196 N PARK AVE	None	POMONA	CA	91768	3027	00	06000	34.06976919	-117.7549069	Los Angeles County
299149	Non-Physician Medical Practitioner	None	1639117989	0	0	REGAN, KATHLEEN C	2/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 S ELISEO DR	SUITE 3	GREENBRAE	CA	94904	2017	00	06000	37.94358265	-122.5345035	Marin County
299156	Non-Physician Medical Practitioner	None	1447809876	0	0	RYAN, CORY PA	7/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 E 7TH ST	SUITE D	UPLAND	CA	91786	6701	00	06000	34.08880374	-117.6465151	San Bernardino County
299161	Non-Physician Medical Practitioner	None	1124723390	0	0	RIVERA, MALLORY R	6/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
299168	Non-Physician Medical Practitioner	None	1659326858	0	0	ROMERO, MARIA L	9/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2957 W BUENA VISTA AVE	None	VISALIA	CA	93291	8548	00	06000	36.345348	-119.324412	Tulare County
299199	Non-Physician Medical Practitioner	None	1104251909	0	0	ROWLAND, TODD C NP	7/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	516 S SORRELL	None	RIDGECREST	CA	93555	5313	00	06000	35.61431254	-117.6647704	Kern County
299211	Non-Physician Medical Practitioner	None	1427305622	0	0	REED, MORGAN MEREA	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
299213	Non-Physician Medical Practitioner	None	1265726574	0	0	RUNNELS, HILLARY DUNCAN	8/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	00	06000	34.28924598	-118.7439214	Ventura County
299215	Non-Physician Medical Practitioner	None	1396343224	0	0	REYES, ALEXANDRA	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
299235	Non-Physician Medical Practitioner	None	1548406515	0	0	ROBERTSON, CHRISTA A NP	6/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	00	06000	38.44950583	-122.7351601	Sonoma County
299261	Non-Physician Medical Practitioner	None	1205859782	0	0	ROD, LINDA KRISTEN	3/8/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
299328	Non-Physician Medical Practitioner	None	1932285327	0	0	ROMERO, ROSALVA NP	5/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	451 W GONZALES RD	STE 230	OXNARD	CA	93036	0719	00	06000	34.21921445	-119.1816945	Ventura County
299339	Non-Physician Medical Practitioner	None	1962111203	0	0	ROETHLER, MARIAN NP	2/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
299358	Non-Physician Medical Practitioner	None	1750663126	0	0	RIDING, BRIAN R	3/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	403 N KENWOOD	UNIT C	ORANGE	CA	92869	7576	00	06000	33.79338099	-117.8194812	Orange County
299369	Non-Physician Medical Practitioner	None	1215719349	0	0	REYNA, YESSENIA	11/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 HOSPITAL DR	STE 200	VALLEJO	CA	94589	2580	00	06000	38.13100118	-122.2403008	Solano County
299382	Non-Physician Medical Practitioner	None	1477288298	0	0	ROMAN, ERIC A PA	7/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
299400	Non-Physician Medical Practitioner	None	1730359696	0	0	ROBERTS-MITCHELL, DIANA LYNN	1/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 EL CAMINO REAL	KAISER HOSPITAL SSF	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
299406	Non-Physician Medical Practitioner	None	1205174257	0	0	ROXBOROUGH, DIANNE J	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 S GRAND AVE	APT 302	LOS ANGELES	CA	90012	3045	00	06000	34.05338656	-118.2510765	Los Angeles County
299539	Non-Physician Medical Practitioner	None	1821397381	0	0	RAGO-ROSE, DAWN M NP	10/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
299554	Non-Physician Medical Practitioner	None	1003195827	0	0	RASMUSSEN, STEPHANIE J	9/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
299580	Non-Physician Medical Practitioner	None	1225485790	0	0	RAUDYS, KAROLIS	12/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	165 N CAMBRIDGE AVE	None	CLAREMONT	CA	91711	4525	00	06000	34.09525729	-117.7276417	Los Angeles County
299583	Non-Physician Medical Practitioner	None	1609237908	0	0	ROHANI, NATASHA	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3963 LENAMARIE CT	None	LAS VEGAS	NV	89103	0114	00	06000	36.11706462	-115.2217362	Clark County
299597	Non-Physician Medical Practitioner	None	1285629428	0	0	RICKELMAN, KRISTIN D	5/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1015 KENT DRIVE	None	DAVIS	CA	95695	0932	00	06000	38.55932609	-121.7620401	Yolo County
299598	Non-Physician Medical Practitioner	None	1972994267	0	0	RAFIQUE, ZAHRA	6/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2610 E NEES AVE	APT 257	FRESNO	CA	93720	6022	00	06000	36.85217642	-119.7373427	Fresno County
299603	Non-Physician Medical Practitioner	None	1992885800	0	0	RAMSEY, PAULA	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 E HACIENDA AVE	INTERNAL MEDICINE	CAMPBELL	CA	95008	6617	00	06000	37.26914953	-121.9566285	Santa Clara County
299637	Non-Physician Medical Practitioner	None	1376845206	0	0	RATTS, MANICHANH J	10/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2601 W LINCOLN AVE	None	YAKIMA	WA	98902	2341	00	06000	46.60352716	-120.5437752	Yakima County
299666	Non-Physician Medical Practitioner	None	1316286776	0	0	RASCO, STEPHEN W NP	10/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5915 PLUMMER SLADE CT	None	TAMPA	FL	33625	4137	00	06000	28.06711546	-82.5478335	Hillsborough County
299681	Non-Physician Medical Practitioner	None	1417930892	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1025 N DOUTY ST	None	HANFORD	CA	93230	5906	00	06000	36.33611794	-119.6460191	Kings County
299735	Non-Physician Medical Practitioner	None	1548683378	0	0	ROSS, CRYSTAL H NP	7/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
299738	Non-Physician Medical Practitioner	None	1689006876	0	0	RALEIGH, DEBORAH J NP	1/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15555 HUNTINGTON VILLAGE	APT 162	HUNTINGTON BEACH	CA	92647	3060	00	06000	33.73662965	-117.9974438	Orange County
299740	Non-Physician Medical Practitioner	None	1124158712	0	0	REILLY, SHAWNNA T	3/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18015 REAMER ROAD	None	CASTRO VALLEY	CA	94546	1231	00	06000	37.71681793	-122.0855157	Alameda County
299743	Non-Physician Medical Practitioner	None	1114396710	0	0	RODRIGUEZ, CRISTINA	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3058 EMERALD BAY PLACE	None	TULARE	CA	93274	7541	00	06000	36.20579279	-119.3020598	Tulare County
299766	Non-Physician Medical Practitioner	None	1821327149	0	0	REDMON, ANDREA D NP	2/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
299802	Non-Physician Medical Practitioner	None	1265683080	0	0	RYERSON, JENNIFER VICTORIA	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	00	06000	37.36893518	-122.0779448	Santa Clara County
299818	Non-Physician Medical Practitioner	None	1235122961	0	0	RUIZ, JOSE L PA-C	3/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DRIVE	SUITE 501	LA MESA	CA	91942	3017	00	06000	32.78189749	-117.0075062	San Diego County
299841	Non-Physician Medical Practitioner	None	1649685280	0	0	RICCI, JOSEPH B	10/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	784 BRIGHTON AVE	None	GROVER BEACH	CA	93433	1608	00	06000	35.12390576	-120.6215482	San Luis Obispo County
299877	Non-Physician Medical Practitioner	None	1538569751	0	0	RATCLIFF, RUBY LHEE A NP	2/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7229 E REDLANDS AVE	None	FRESNO	CA	93737	9242	00	06000	36.78312776	-119.6604209	Fresno County
299894	Non-Physician Medical Practitioner	None	1427448281	0	0	REYES, NINA P NP	7/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 SUNCREEK	None	IRVINE	CA	92604	4620	00	06000	33.67998518	-117.7920444	Orange County
299904	Non-Physician Medical Practitioner	None	1831383850	0	0	RIVERA, CARMEN MARIA	10/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	#208	OAKLAND	CA	94609	3424	00	06000	37.81892183	-122.2640154	Alameda County
299963	Non-Physician Medical Practitioner	None	1073915229	0	0	ROSARIO, CLARISSA NP	1/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 CATHERINE LANE	STE F	GRASS VALLEY	CA	95945	5719	00	06000	39.22894557	-121.0489578	Nevada County
299994	Non-Physician Medical Practitioner	None	1114934411	0	0	ROSS, DUSTIN A	4/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1022 KENTWORTH ST	None	ALLEN	TX	75013	5828	00	06000	33.13658273	-96.68140015	Collin County
300009	Non-Physician Medical Practitioner	None	1891852216	0	0	ROMO, JORGE RAMON	5/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	00	06000	32.77989265	-115.5697382	Imperial County
300012	Non-Physician Medical Practitioner	None	1508587676	0	0	RUNGSISULLATANONT, RITT PA-C	2/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 WARNER	SUITE 140	FOUNTAIN VALLEY	CA	92708	3207	00	06000	33.71568247	-117.977193	Orange County
300022	Non-Physician Medical Practitioner	None	1427549146	0	0	REAL, COURTNEY R NP	7/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3219 W 187TH ST	None	TORRANCE	CA	90504	5911	00	06000	33.86129051	-118.3288005	Los Angeles County
300036	Non-Physician Medical Practitioner	None	1093476111	0	0	ROSSELLI, JORDANNA D PA-C	8/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
300057	Non-Physician Medical Practitioner	None	1881796969	0	0	ROE, MARIAN DOWNEY	1/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	00	06000	38.76553806	-121.2497067	Placer County
300059	Non-Physician Medical Practitioner	None	1093264400	0	0	RAVAL, CHANDNI V PA-C	1/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
300092	Non-Physician Medical Practitioner	None	1184270381	0	0	RODELLO, JESSICA N NP	9/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	00	06000	33.96266399	-117.3956871	Riverside County
300103	Non-Physician Medical Practitioner	None	1790341618	0	0	REVENKO, CASEY S PA-C	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	100	OAKLAND	CA	94609	3422	00	06000	37.81892183	-122.2640154	Alameda County
300108	Non-Physician Medical Practitioner	None	1093926982	0	0	ROBINSON, BRENDA R	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	339 PIPPIN DR	None	FALLBROOK	CA	92028	3484	00	06000	33.37240949	-117.2462501	San Diego County
300120	Non-Physician Medical Practitioner	None	1649655259	0	0	RICHLAND, SEAN T PA-C	12/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	00	06000	33.714	-117.9333585	Orange County
300186	Non-Physician Medical Practitioner	None	1619457991	0	0	ROBINSON, NICOLE L NP	7/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	00	06000	34.05159882	-118.4385447	Los Angeles County
300194	Non-Physician Medical Practitioner	None	1841770609	0	0	RALPH, KELLIE C PA-C	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
300255	Non-Physician Medical Practitioner	None	1366025850	0	0	REID, MELINDA D NP	12/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	00	06000	37.77580025	-121.9664884	Contra Costa County
300267	Non-Physician Medical Practitioner	None	1184887408	0	0	RIDGWAY, CATHERINE A PA	2/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
300274	Non-Physician Medical Practitioner	None	1780087288	0	0	RUGGIERO, NATALIE L	10/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
300284	Non-Physician Medical Practitioner	None	1669066262	0	0	ROBINSON, SAMANTHA L PA	6/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	00	06000	40.57278686	-122.3958519	Shasta County
300285	Non-Physician Medical Practitioner	None	1689140139	0	0	RUIZ, SHANN MIKA B NP	5/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300343	Non-Physician Medical Practitioner	None	1205945953	0	0	REA, LEE K NP	5/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	00	06000	38.7257686	-120.7910663	El Dorado County
300384	Non-Physician Medical Practitioner	None	1417461294	0	0	RUBI, ESMERALDA C NP	11/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	00	06000	34.093089	-117.3703775	San Bernardino County
300450	Non-Physician Medical Practitioner	None	1114041621	0	0	ROSENBLATT, SHERILYN S	3/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6846 CASSELBERRY WAY	None	SAN DIEGO	CA	92119	2219	00	06000	32.79931513	-117.0481022	San Diego County
300472	Non-Physician Medical Practitioner	None	1942202387	0	0	ROBLES, GUADALUPE	9/29/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 AUBURN ST UNIT A	None	BAKERSFIELD	CA	93306	2977	00	06000	35.39788552	-118.9317825	Kern County
300475	Non-Physician Medical Practitioner	None	1164509899	0	0	RODDICK, JASON L	12/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 DEL NORTE AVE	None	YUBA CITY	CA	95991	4123	00	06000	39.14502655	-121.615685	Sutter County
300505	Non-Physician Medical Practitioner	None	1770934424	0	0	REIDINGER, MICHAEL J	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 ORANGE AVENUE	UNIT 201	REDLANDS	CA	92373	1492	00	06000	34.05201151	-117.207558	San Bernardino County
300527	Non-Physician Medical Practitioner	None	1346507555	0	0	REDMOND, VICTORIA T	7/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	524 EAST 21ST STREET	APT 3	OAKLAND	CA	94606	5409	00	06000	37.80002369	-122.2469488	Alameda County
300536	Non-Physician Medical Practitioner	None	1265861397	0	0	REGIDOR, RONNELL S NP	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1308 BLUE HILL RD	None	LOS ANGELES	CA	90041	1509	00	06000	34.14563973	-118.193171	Los Angeles County
300538	Non-Physician Medical Practitioner	None	1417697483	0	0	RIOS, JOSEPH A PA-C	9/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
300563	Non-Physician Medical Practitioner	None	1164997086	0	0	REYES, IVONNE E NP	6/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	00	06000	34.27448266	-119.2572489	Ventura County
300595	Non-Physician Medical Practitioner	None	1356494850	0	0	RUBY, RACHEL H NP	1/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
300604	Non-Physician Medical Practitioner	None	1932699667	0	0	ROMERO, CESAR O	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3340 E 2ND ST	APT 8	LONG BEACH	CA	90803	6505	00	06000	33.76353262	-118.1528208	Los Angeles County
300608	Non-Physician Medical Practitioner	None	1376188805	0	0	ROCHFORD, SARAH NP	7/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	00	06000	38.4962723	-122.752117	Sonoma County
300611	Non-Physician Medical Practitioner	None	1114022233	0	0	REEDY, MARIE J	5/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5909 FIRE STICK COURT	None	CITRUS HEIGHTS	CA	95621	4728	00	06000	38.686554	-121.326102	Sacramento County
300632	Non-Physician Medical Practitioner	None	1447542303	0	0	ROYE-MADISON, MARCIA P NP	1/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2864 HYANNIS WAY	None	SACRAMENTO	CA	95827	1315	00	06000	38.576601	-121.3365555	Sacramento County
300643	Non-Physician Medical Practitioner	None	1053614115	0	0	REMTULLA, SHAMIM M	6/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10883 ROSE AVE	STE 201	LOS ANGELES	CA	90034	5383	00	06000	34.02431701	-118.4181311	Los Angeles County
300659	Non-Physician Medical Practitioner	None	1710676085	0	0	RATHOD, JISHITA J NP	11/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
300662	Non-Physician Medical Practitioner	None	1235696964	0	0	ROY, LUKE C NP	9/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8860 CENTER DRIVE	SUITE 320	LA MESA	CA	91942	7001	00	06000	32.78189749	-117.0075062	San Diego County
300694	Non-Physician Medical Practitioner	None	1184409963	0	0	RIDDLE, LAUREN PA	4/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
300698	Non-Physician Medical Practitioner	None	1457498453	0	0	ROEN, DOUGLAS LEE	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
300739	Non-Physician Medical Practitioner	None	1447918628	0	0	RAMIREZ, EMILY L NP	9/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	00	06000	32.80027449	-117.153846	San Diego County
300760	Non-Physician Medical Practitioner	None	1326583998	0	0	RAY, PEGGY W NP	1/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31091 KAHWEA ROAD	None	TEMECULA	CA	92591	1790	00	06000	33.53013855	-117.117139	Riverside County
300766	Non-Physician Medical Practitioner	None	1952510943	0	0	RHINER, MICHELLE I NP	7/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5455 EVENING CANYON WAY	None	RANCH CUCAMONGA	CA	91737	1784	00	06000	34.15484986	-117.5876941	San Bernardino County
300804	Non-Physician Medical Practitioner	None	1851051577	0	0	ROESSLER, KEVIN M PA-C	5/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
300820	Non-Physician Medical Practitioner	None	1831369222	0	0	RADER, COLLIN M PA-C	9/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
300859	Non-Physician Medical Practitioner	None	1447687041	0	0	RUIZ, RAY M	2/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15734 SWIFT PL	None	MOORPARK	CA	93021	3232	00	06000	34.30446294	-118.8345322	Ventura County
300908	Non-Physician Medical Practitioner	None	1720744162	0	0	RUIZ, MONA L NP	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
300909	Non-Physician Medical Practitioner	None	1255925202	0	0	RIDLING, ALEXANDRIA PA-C	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2290 SACRAMENTO ST	None	VALLEJO	CA	94590	2929	00	06000	38.12370851	-122.2637378	Solano County
300923	Non-Physician Medical Practitioner	None	1225285133	0	0	RUSLAN, KHABATYUK	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3427 ROBIN LN	SUITE 100	CAMERON PARK	CA	95682	7254	00	06000	38.65580389	-120.9675841	El Dorado County
300930	Non-Physician Medical Practitioner	None	1962485839	0	0	REGUERA, TIFFANY L NP	1/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9014 BURTON LN	None	REDDING	CA	96002	9576	00	06000	40.5499433	-122.2800961	Shasta County
300931	Non-Physician Medical Practitioner	None	1174823454	0	0	ROSTAI, AKLIL M	12/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4232 FITZWILLIAM ST	None	DUBLIN	CA	94568	4572	00	06000	37.70668149	-121.8629278	Alameda County
300952	Non-Physician Medical Practitioner	None	1952560641	0	0	RODRIGUEZ-WARGO, TERESA CHRISTINE	1/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5271 F ST BLDG C	None	SACRAMENTO	CA	95819	3225	00	06000	38.570598	-121.437828	Sacramento County
300954	Non-Physician Medical Practitioner	None	1457623969	0	0	REICHERT, CHRISTINA M NP	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3717 ROXBURY ST	None	SAN PEDRO	CA	90731	6442	00	06000	33.71111079	-118.2984015	Los Angeles County
300990	Non-Physician Medical Practitioner	None	1386046662	0	0	ROWLEY, EVAN PA-C	9/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8590 RIO SAN DIEGO DR	SUITE 111	SAN DIEGO	CA	92108	5507	00	06000	32.77472926	-117.1448295	San Diego County
301031	Non-Physician Medical Practitioner	None	1528324167	0	0	REEDLEY COMMUNITY HOSPITAL	9/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 6TH ST	None	TAFT	CA	93268	2704	00	06000	35.14427303	-119.4591272	Kern County
301032	Non-Physician Medical Practitioner	None	1417624693	0	0	RAMIREZ, LUZ NP	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	00	06000	34.09054375	-118.392295	Los Angeles County
301033	Non-Physician Medical Practitioner	None	1144733866	0	0	ROY, CARLY PA	10/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
301055	Non-Physician Medical Practitioner	None	1487834644	0	0	ROWAN, RYAN D PA-C	4/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44054 MARGARITA RD STE 1	None	TEMECULA	CA	92592	2737	00	06000	33.48386484	-117.102706	Riverside County
301070	Non-Physician Medical Practitioner	None	1083985832	0	0	ROGERS, LISA M NP	8/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3666 BARHAM BLVD	APT N111	LOS ANGELES	CA	90068	1291	00	06000	34.1398171	-118.339319	Los Angeles County
301078	Non-Physician Medical Practitioner	None	1457530768	0	0	ROSETE, NATHANIEL	9/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9717 SIERRA AVE	None	FONTANA	CA	92335	6716	00	06000	34.07725718	-117.4356118	San Bernardino County
301120	Non-Physician Medical Practitioner	None	1700190055	0	0	RECHTZIGEL, DEANNA L NP	12/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9879 CATHEDRAL PINES AVE	None	LAS VEGAS	NV	89149	1957	00	06000	36.29708487	-115.3120056	Clark County
301126	Non-Physician Medical Practitioner	None	1174871933	0	0	RYAN, MARILYSE A	6/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 EUREKA RD	STE 506	ROSEVILLE	CA	95661	7705	00	06000	38.7396613	-121.2421966	Placer County
301134	Non-Physician Medical Practitioner	None	1679737381	0	0	REYNOSO, ROBERTO	6/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1630 E HERNDON AVE	None	FRESNO	CA	93720	3305	00	06000	36.83756049	-119.7583515	Fresno County
301147	Non-Physician Medical Practitioner	None	1982790085	0	0	REIDER-DEMER, MELISSA M NP	1/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3201 EARLMAR DRIVE	None	LOS ANGELES	CA	90064	4712	00	06000	34.03451322	-118.4056266	Los Angeles County
301173	Non-Physician Medical Practitioner	None	1205011996	0	0	RICHINA, CAROL ANN	4/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7033 N FRESNO ST STE 301	7033 N. FRESNO SUITE301	FRESNO	CA	93720	2979	00	06000	36.838044	-119.7813175	Fresno County
301195	Non-Physician Medical Practitioner	None	1578292843	0	0	REED, DIONNE D CNP	9/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2271 E PALMDALE BLVD	SUITE E	PALMDALE	CA	93550	1340	00	06000	34.58021047	-118.087218	Los Angeles County
301286	Non-Physician Medical Practitioner	None	1104836931	0	0	REYES, ROBIN ELIZABETH	10/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2633 16TH ST	None	BAKERSFIELD	CA	93301	3348	00	06000	35.37232854	-119.0327985	Kern County
301289	Non-Physician Medical Practitioner	None	1255000576	0	0	REYES-GARCIA, BREANNA R PA-C	12/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3332	00	06000	33.85291987	-117.5664344	Riverside County
301304	Non-Physician Medical Practitioner	None	1023388519	0	0	RANCOURT, LORA M	7/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 UNION ST	APT C	SAN FRANCISCO	CA	94133	2747	00	06000	37.80012747	-122.41185	San Francisco County
301338	Non-Physician Medical Practitioner	None	1649287426	0	0	ROBSON, JANET C NP	7/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8755 EAST GARDEN VIEW DR	None	ANAHEIM	CA	92808	1669	00	06000	33.86066751	-117.7232045	Orange County
301353	Non-Physician Medical Practitioner	None	1518718410	0	0	ROBINSON, ANDREA	10/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301398	Non-Physician Medical Practitioner	None	1982251260	0	0	ROBERTS, SARAH E NP	1/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
301399	Non-Physician Medical Practitioner	None	1386123255	0	0	RAMSEY, ALICIA PA	9/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
301439	Non-Physician Medical Practitioner	None	1194962266	0	0	ROSS-MCCORMICK, CAROL	1/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	568 E HERNDON AVE	SUITE 201	FRESNO	CA	93720	2989	00	06000	36.83752653	-119.7776433	Fresno County
301441	Non-Physician Medical Practitioner	None	1093304388	0	0	REZEKALLA, KYRLLOS A PA-C	4/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
301459	Non-Physician Medical Practitioner	None	1245307008	0	0	RAPONI, NYLA J	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10872 2ND ST	None	VICTORVILLE	CA	92392	0815	00	06000	34.4576865	-117.426622	San Bernardino County
301533	Non-Physician Medical Practitioner	None	1225462401	0	0	REYES-DAVID, FEMINA G NP	10/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8337 HANDEL DRIVE	None	BUENA PARK	CA	90621	3116	00	06000	33.86864464	-117.9873566	Orange County
301538	Non-Physician Medical Practitioner	None	1598394371	0	0	RUBIO, HALEY M PA-C	10/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	00	06000	33.66214655	-117.6532809	Orange County
301562	Non-Physician Medical Practitioner	None	1215943758	0	0	REITH, JAMES L	2/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1829 GLENBROOK AVE	None	CAMARILLO	CA	93010	1919	00	06000	34.23603192	-119.0523595	Ventura County
301570	Non-Physician Medical Practitioner	None	1194759464	0	0	RACINE, JUDY K	1/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	SUITE 102B	LOMA LINDA	CA	92354	3128	00	06000	34.04805253	-117.249534	San Bernardino County
301592	Non-Physician Medical Practitioner	None	1366969867	0	0	RYAN, RACHEL M NP	10/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5253 EL CERRITO DR	APT 109	RIVERSIDE	CA	92507	6276	00	06000	33.95583551	-117.3330666	Riverside County
301601	Non-Physician Medical Practitioner	None	1285323295	0	0	REID, COLTON R NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 JEFFERSON AVE	STE M	REDWOOD CITY	CA	94063	1804	00	06000	37.48599384	-122.2282125	San Mateo County
301605	Non-Physician Medical Practitioner	None	1356042576	0	0	RUVALCABA, CAZANDRA NP	4/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
301612	Non-Physician Medical Practitioner	None	1508963299	0	0	RUSKIN, JACQUELIN RANDY	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	270 INTERNATIONAL CIR	2 NORTH	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
301630	Non-Physician Medical Practitioner	None	1780958330	0	0	RABARA, ROSELOU D	12/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
301673	Non-Physician Medical Practitioner	None	1154459287	0	0	REYNOLDS, SUSAN J NP	9/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20652 FARNSWORTH LANE	None	HUNTINGTON BEACH	CA	92646	5522	00	06000	33.66257115	-117.9841405	Orange County
301693	Non-Physician Medical Practitioner	None	1003989872	0	0	ROSEN, JANE PA-C	1/8/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
301745	Non-Physician Medical Practitioner	None	1639899867	0	0	RICHARDS, DAVID T PA-C	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
301750	Non-Physician Medical Practitioner	None	1083867683	0	0	ROBLES-BONHAM, SANDRA	8/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9015 HOPE LN	None	STOCKTON	CA	95212	1512	00	06000	38.0335526	-121.2474796	San Joaquin County
301769	Non-Physician Medical Practitioner	None	1629541354	0	0	RIDA, ANDREA PA	8/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
301781	Non-Physician Medical Practitioner	None	1811107840	0	0	RODRIGUEZ, IRMA I NP	5/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29381 VALERIO CT	None	LAGUNA NIGUEL	CA	92677	1850	00	06000	33.53622959	-117.6907664	Orange County
301798	Non-Physician Medical Practitioner	None	1457607558	0	0	REID, JOHN ANDREW	9/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1617 E 1ST ST	None	SANTA ANA	CA	92701	6385	00	06000	33.74616534	-117.8462414	Orange County
301819	Non-Physician Medical Practitioner	None	1194419002	0	0	ROSS, CELESTE PA-C	8/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	168 N BRENT ST	STE 503	VENTURA	CA	93003	2892	00	06000	34.27448266	-119.2572489	Ventura County
301888	Non-Physician Medical Practitioner	None	1457007247	0	0	RIVERA CHAVEZ, BIBIANA D PA-C	5/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
301917	Non-Physician Medical Practitioner	None	1457379117	0	0	RANZENBACH, EDWARD A	9/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1531 ESPLANADE	None	CHICO	CA	95926	3310	00	06000	39.74248474	-121.8493369	Butte County
301948	Non-Physician Medical Practitioner	None	1447865860	0	0	RIVERO, ELYSSA B NP	4/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
301977	Non-Physician Medical Practitioner	None	1083078901	0	0	ROBLES, MARIA CELIS D NP	10/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10823 MOLETTE STREET	None	NORWALK	CA	90650	5438	00	06000	33.89190744	-118.103038	Los Angeles County
301987	Non-Physician Medical Practitioner	None	1326675414	0	0	REAL HERNANDEZ, MELISSA PA-C	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 S FAIR OAKS AVE	405	PASADENA	CA	91105	2562	00	06000	34.140348	-118.1504565	Los Angeles County
302012	Non-Physician Medical Practitioner	None	1861936742	0	0	ROMNEY, TESSA PA-C	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
302018	Non-Physician Medical Practitioner	None	1700161031	0	0	RAETHER, COLLEEN	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
302019	Non-Physician Medical Practitioner	None	1154778561	0	0	RABB, NATALIE NP	10/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1513 GRAND AVE	STE. 360	LOS ANGELES	CA	90015	3075	00	06000	34.03596303	-118.266212	Los Angeles County
302032	Non-Physician Medical Practitioner	None	1740639319	0	0	RAIKE, SARAH PA	5/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
302061	Non-Physician Medical Practitioner	None	1679955942	0	0	ROMO, LOURDES NP	3/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302068	Non-Physician Medical Practitioner	None	1710065933	0	0	RADYS CHILDRENS HOSPITAL SAN	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11752 EL CAMINO REAL	SUITE 100	SAN DIEGO	CA	92130	2050	00	06000	32.93046973	-117.2372372	San Diego County
302075	Non-Physician Medical Practitioner	None	1477543759	0	0	RAVESSOUD, SUSANN	10/1/1998	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4351 E LOHMAN AVE	SUITE 301	LAS CRUCES	NM	88011	8259	00	06000	32.32353423	-106.726982	Doña Ana County
302078	Non-Physician Medical Practitioner	None	1225133341	0	0	ROHOVIT, STACIE ONSTAD	9/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	MC5553, NEONATOLOGY	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
302112	Non-Physician Medical Practitioner	None	1881293876	0	0	RADA, DENISE Q NP	12/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
302127	Non-Physician Medical Practitioner	None	1205169570	0	0	RO, JAMIE	9/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	908 SAKURA DRIVE	None	SAN JOSE	CA	95112	3131	00	06000	37.3564719	-121.8947044	Santa Clara County
302168	Non-Physician Medical Practitioner	None	1497013965	0	0	RAMSDEN, CHRISTINA F	11/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	715 DE LUZ ROAD	None	FALLBROOK	CA	92028	1507	00	06000	33.38769588	-117.2523502	San Diego County
302196	Non-Physician Medical Practitioner	None	1497309876	0	0	RORISON, FLAVIA NP	8/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	00	06000	37.662489	-120.957588	Stanislaus County
302197	Non-Physician Medical Practitioner	None	1336164102	0	0	REID, CRAIG N	9/1/1996	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
302204	Non-Physician Medical Practitioner	None	1154724987	0	0	RULL, TEEJAY C	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2016 COURAGE ST	None	VISTA	CA	92081	7023	00	06000	33.15966622	-117.250141	San Diego County
302243	Non-Physician Medical Practitioner	None	1801967153	0	0	ROMERO, ANNA	12/5/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3760 BOLSA CT	None	SACRAMENTO	CA	95864	2934	00	06000	38.591865	-121.3763805	Sacramento County
302273	Non-Physician Medical Practitioner	None	1891833786	0	0	RONQUILLO, EDUARDO D PA-C	9/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W LUGONIA AVE	SUITE 230	REDLANDS	CA	92374	9703	00	06000	34.07027851	-117.218421	San Bernardino County
302280	Non-Physician Medical Practitioner	None	1154865913	0	0	REARDON, TAYLOR V PA-C	3/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
302304	Non-Physician Medical Practitioner	None	1760438733	0	0	REGULES, HEATHER NICOLE	11/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12980 FREDERICK ST STE D	None	MORENO VALLEY	CA	92553	5263	00	06000	33.931872	-117.2613835	Riverside County
302326	Non-Physician Medical Practitioner	None	1023591054	0	0	ROSENKRANZ, EKCHHANAK L PA	10/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	E318	PALM SPRINGS	CA	92262	4809	00	06000	33.839505	-116.5455735	Riverside County
302337	Non-Physician Medical Practitioner	None	1326353251	0	0	RUE, NATALIE NP	7/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4857	00	06000	33.839505	-116.5455735	Riverside County
302420	Non-Physician Medical Practitioner	None	1295423127	0	0	RENTERIA, SOPHIA M NP	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
302424	Non-Physician Medical Practitioner	None	1477137800	0	0	REEDY, STEVEN J NP	5/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
302456	Non-Physician Medical Practitioner	None	1528261864	0	0	RHODE, NADA N NP	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
302484	Non-Physician Medical Practitioner	None	1508240862	0	0	ROBLES, MAYRA C NP	4/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	686 BAHIA ST	None	IMPERIAL	CA	92251	8002	00	06000	32.83898648	-115.59357	Imperial County
302485	Non-Physician Medical Practitioner	None	1619391182	0	0	ROGERS, LISA PA-C	1/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
302489	Non-Physician Medical Practitioner	None	1124666938	0	0	REINHARDT, ERIN M PA	7/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302503	Non-Physician Medical Practitioner	None	1134689102	0	0	REYES, PIA ADELLE NP	5/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9043 WOODMAN AVE	STE C	ARLETA	CA	91331	6493	00	06000	34.23411011	-118.4395658	Los Angeles County
302539	Non-Physician Medical Practitioner	None	1114493053	0	0	RODRIGUEZ, ALEXANDRA M PA-C	1/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	00	06000	37.90582392	-122.0613697	Contra Costa County
302540	Non-Physician Medical Practitioner	None	1629404082	0	0	REYES, MARIA D C NP	9/27/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1633 AMBERWOOD DRIVE	APT 20	SOUTH PASADENA	CA	91030	5101	00	06000	34.12268652	-118.148877	Los Angeles County
302638	Non-Physician Medical Practitioner	None	1982081899	0	0	RATTANAPICHETKUL, JANET NP	2/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
302664	Non-Physician Medical Practitioner	None	1295750065	0	0	RHEE, JOAN J	3/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	00	06000	34.2738618	-118.4678337	Los Angeles County
302699	Non-Physician Medical Practitioner	None	1508172172	0	0	RAMAGE, AMBER L NP	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	00	06000	38.421306	-121.408173	Sacramento County
302723	Non-Physician Medical Practitioner	None	1346891827	0	0	ROZENBERG, REBECCA L NP	1/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
302730	Non-Physician Medical Practitioner	None	1003295205	0	0	ROOS, LAUREN G NP	8/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 FALLEN LEAF DR	None	HILLSBOROUGH	CA	94010	6919	00	06000	37.55974032	-122.3354405	San Mateo County
302747	Non-Physician Medical Practitioner	None	1487226452	0	0	RAPHAEL, EVA	3/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	127 HOSPITAL DR	204	VALLEJO	CA	94589	2562	00	06000	38.13103371	-122.2387342	Solano County
302772	Non-Physician Medical Practitioner	None	1053470799	0	0	RODRIGUEZ, CRESPIN	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25961 SANDALIA DR	None	VALENCIA	CA	91355	3309	00	06000	34.4111163	-118.5439376	Los Angeles County
302794	Non-Physician Medical Practitioner	None	1376066225	0	0	ROMERO, DANIELLE M	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4752 MATTERHORN WAY	None	ANTIOCH	CA	94531	7406	00	06000	37.97249452	-121.8039681	Contra Costa County
302805	Non-Physician Medical Practitioner	None	1679238711	0	0	RAAFAT, SEBASTIAN J PA	2/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
302830	Non-Physician Medical Practitioner	None	1467404947	0	0	RUIZ, PAULA	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27053 ESWARD DR	None	CALABASAS	CA	91301	2322	00	06000	34.14661632	-118.7150522	Los Angeles County
302833	Non-Physician Medical Practitioner	None	1659748242	0	0	ROMERO, AMANDA M NP	7/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
302844	Non-Physician Medical Practitioner	None	1427659754	0	0	REYES, JUSTIN NP	9/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
302847	Non-Physician Medical Practitioner	None	1598760092	0	0	RICHARDS, KURT MASON	7/5/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DR	SUITE 200	WEST HILLS	CA	91307	1925	00	06000	34.20369349	-118.629837	Los Angeles County
302848	Non-Physician Medical Practitioner	None	1780456400	0	0	RAMIREZ, ADRIANA	12/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302858	Non-Physician Medical Practitioner	None	1174936454	0	0	ROYSTER, JAMES A NP	7/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
302874	Non-Physician Medical Practitioner	None	1669702205	0	0	RANKIN, MARY K	8/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	71 WATER STREET	None	SAN FRANCISCO	CA	94133	1813	00	06000	37.80424671	-122.4144518	San Francisco County
302877	Non-Physician Medical Practitioner	None	1275778847	0	0	REDWOOD COAST MEDICAL SERVICES, INC.	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30 MILL STREET	None	POINT ARENA	CA	95468	9902	00	06000	38.90849634	-123.6916637	Mendocino County
302879	Non-Physician Medical Practitioner	None	1215130562	0	0	ROULEAU, KEITH D	1/17/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3451 EDGEWATER PLACE	None	VALLEJO	CA	94591	8398	00	06000	38.128658	-122.2074974	Solano County
302891	Non-Physician Medical Practitioner	None	1851865158	0	0	ROQUE, CHRISTINE M NP	5/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1552 COFFEE ROAD	SUITE 200	MODESTO	CA	95355	3122	00	06000	37.666872	-120.975684	Stanislaus County
302946	Non-Physician Medical Practitioner	None	1215912019	0	0	ROHDE-MOE, GUNNAR E	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1321 PRINCETON AVE	None	MODESTO	CA	95350	5724	00	06000	37.6565435	-121.0133385	Stanislaus County
302953	Non-Physician Medical Practitioner	None	1245561125	0	0	RAYMOND, CHRISTINE E NP	12/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2945 RODEO LANE	None	LIVERMORE	CA	94550	6813	00	06000	37.67287596	-121.757777	Alameda County
302985	Non-Physician Medical Practitioner	None	1902470537	0	0	RICE, ELIZABETH M NP	8/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
303054	Non-Physician Medical Practitioner	None	1194984252	0	0	RODRIGUEZ, ARTEMIO PA	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 N PALM CANYON	SUITE 206	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
303056	Non-Physician Medical Practitioner	None	1578058327	0	0	RAJIC, JOVANKA NP	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	00	06000	38.65716	-121.1738175	Sacramento County
303082	Non-Physician Medical Practitioner	None	1710490149	0	0	RICCI, JASON J	4/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3900 BUSINESS CENTR DR	APT 7305	FAIRFIELD	CA	94534	4236	00	06000	38.23118925	-122.1182555	Solano County
303103	Non-Physician Medical Practitioner	None	1558557348	0	0	RANDLE, CARRIE A NP	2/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
303122	Non-Physician Medical Practitioner	None	1598881740	0	0	ROY, MICHAEL E	3/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3009 SHADID DRIVE	None	COLTON	CA	92324	9759	00	06000	34.02764047	-117.2781765	San Bernardino County
303123	Non-Physician Medical Practitioner	None	1174971840	0	0	RIZWAN, MUDDASSIR NP	9/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
303125	Non-Physician Medical Practitioner	None	1487900106	0	0	RASMUSSEN, CARA M CNM	1/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	580 BALSAN AVE	None	SUNNYVALE	CA	94085	3769	00	06000	37.38759521	-122.0164403	Santa Clara County
303136	Non-Physician Medical Practitioner	None	1871351791	0	0	REID, CAROLYN PA-C	12/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	00	06000	40.57267376	-122.3643496	Shasta County
303142	Non-Physician Medical Practitioner	None	1356744221	0	0	REED, SAMEELAH M	11/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3250 E YOUNTVILLE DR	UNIT 9	ONTARIO	CA	91761	3805	00	06000	33.999327	-117.580851	San Bernardino County
303175	Non-Physician Medical Practitioner	None	1215119821	0	0	ROSALES, CRISTINA MARIE	4/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5823 YORK BLVD STE 3	None	LOS ANGELES	CA	90042	2634	00	06000	34.11850913	-118.1915335	Los Angeles County
303179	Non-Physician Medical Practitioner	None	1750604997	0	0	ROSENTHAL, YAEL L NP	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5523 VOLETTA PLACE	None	VALLEY VLG	CA	91607	1919	00	06000	34.171038	-118.411138	Los Angeles County
303205	Non-Physician Medical Practitioner	None	1578046173	0	0	REINHOLT, ELIZABETH A	12/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2612 FREMONT AVE	None	CLOVIS	CA	93611	6822	00	06000	36.8356968	-119.6630697	Fresno County
303210	Non-Physician Medical Practitioner	None	1740763374	0	0	ROHRKEMPER, KRISTINA H PA-C	4/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
303215	Non-Physician Medical Practitioner	None	1376753574	0	0	ROBINSON, ADELA E NP	10/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7926 JORDAN AVE	None	CANOGA PARK	CA	91304	4863	00	06000	34.21452228	-118.602626	Los Angeles County
303219	Non-Physician Medical Practitioner	None	1679116701	0	0	RAMIREZ, GIMA A NP	2/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
303259	Non-Physician Medical Practitioner	None	1750871760	0	0	RICHARDSON, AMANDA M PA	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
303273	Non-Physician Medical Practitioner	None	1427368711	0	0	RUEDA, EVA NANETTE	5/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1314 S CALIFORNIA AVE	None	WEST COVINA	CA	91790	4041	00	06000	34.05615259	-117.9431512	Los Angeles County
303278	Non-Physician Medical Practitioner	None	1801356043	0	0	RUSSICK, SEAN	7/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
303281	Non-Physician Medical Practitioner	None	1043456973	0	0	RIVAS-TEJADA, DANIEL	1/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6758 PASSONS BLVD	None	PICO RIVERA	CA	90660	3666	00	06000	33.97999121	-118.0894442	Los Angeles County
303284	Non-Physician Medical Practitioner	None	1326256447	0	0	ROACH, MICHAEL S PA	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
303288	Non-Physician Medical Practitioner	None	1104915727	0	0	RUHE, SHARLYN PA-C	12/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
303356	Non-Physician Medical Practitioner	None	1790761112	0	0	ROSELLI, LAURIE E	1/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	DAVIS 5 INTENSIVE CARE N	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
303358	Non-Physician Medical Practitioner	None	1437754652	0	0	RIGHTLER, KAREN NP	7/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	00	06000	33.994269	-117.3485375	Riverside County
303369	Non-Physician Medical Practitioner	None	1285679779	0	0	ROYSTON, LEON DENSON	9/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2012 FRANKLIN ST	None	CHICO	CA	95928	6727	00	06000	39.72386626	-121.8175571	Butte County
303371	Non-Physician Medical Practitioner	None	1902066301	0	0	RAMOS, MARIE C NP	5/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 3606	None	BAKERSFIELD	CA	93385	3606	00	06000	0	0	None
303417	Non-Physician Medical Practitioner	None	1265841407	0	0	RAYOME, RYAN PA-C	8/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
303450	Non-Physician Medical Practitioner	None	1134748080	0	0	RASMUSSEN, SHANNON	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	00	06000	33.61321911	-117.8722084	Orange County
303452	Non-Physician Medical Practitioner	None	1235464033	0	0	RAINUSSO, KARA M NP	9/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	648 CARIBBEAN WAY	None	SAN MATEO	CA	94402	3419	00	06000	37.54718478	-122.3260737	San Mateo County
303466	Non-Physician Medical Practitioner	None	1104231489	0	0	REYES, KELBY T	9/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6757 BROOK FALLS CIR	None	STOCKTON	CA	95219	2443	00	06000	37.99252974	-121.3536287	San Joaquin County
303476	Non-Physician Medical Practitioner	None	1003992900	0	0	ROSBRUGH, MELISSA	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	00	06000	34.131303	-117.3225325	San Bernardino County
303478	Non-Physician Medical Practitioner	None	1518032762	0	0	RONQUILLO, MARIA D	7/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 S ALVARADO ST	SUITE 707	LOS ANGELES	CA	90057	2320	00	06000	34.06417777	-118.2719543	Los Angeles County
303492	Non-Physician Medical Practitioner	None	1942996152	0	0	RAMIREZ, CHITO I NP	1/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
303501	Non-Physician Medical Practitioner	None	1427182864	0	0	RAPHAEL, DAN	11/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 S MAIN ST	None	ORANGE	CA	92868	3852	00	06000	33.784695	-117.867327	Orange County
303531	Non-Physician Medical Practitioner	None	1750942561	0	0	ROTHSTEIN, DANIEL PA-C	1/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	STE 251	SAN BERNARDINO	CA	92404	3800	00	06000	34.1358627	-117.2757778	San Bernardino County
303541	Non-Physician Medical Practitioner	None	1558059451	0	0	RAY, AMANDA N NP	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4770 HERNDON	105	FRESNO	CA	93722	8401	00	06000	36.83717984	-119.8778388	Fresno County
303546	Non-Physician Medical Practitioner	None	1730547886	0	0	RI, KO NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 DEL MEDIO AVE	UNIT 226	MOUNTAIN VIEW	CA	94040	1055	00	06000	37.40908261	-122.1113478	Santa Clara County
303634	Non-Physician Medical Practitioner	None	1790940104	0	0	REDDICK, HARDEEP S	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5220 AREZZO DR	None	SAN JOSE	CA	95138	2203	00	06000	37.27680436	-121.7781077	Santa Clara County
303654	Non-Physician Medical Practitioner	None	1932276789	0	0	ROBINSON, ZENIA L	2/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9925 TUNNEY AVENUE	None	NORTHRIDGE	CA	91324	1040	00	06000	34.25091828	-118.5579844	Los Angeles County
303657	Non-Physician Medical Practitioner	None	1518992312	0	0	ROSE, BARBARA J	4/22/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 CLEMENT ST	None	SAN FRANCISCO	CA	94121	1545	00	06000	37.78109398	-122.5051321	San Francisco County
303676	Non-Physician Medical Practitioner	None	1851875215	0	0	READING, JENNA M PA-C	3/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	00	06000	36.834984	-119.7641925	Fresno County
303688	Non-Physician Medical Practitioner	None	1285870139	0	0	RODRIGUEZ, SYLVIA O	10/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2810 S BRISTOL ST	None	SANTA ANA	CA	92704	6204	00	06000	33.709428	-117.8854685	Orange County
303722	Non-Physician Medical Practitioner	None	1972145084	0	0	RODRIGUEZ, ELVIRA NP	6/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
303743	Non-Physician Medical Practitioner	None	1902361785	0	0	RUIZ, JORDANNE NP	4/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
303780	Non-Physician Medical Practitioner	None	1427087261	0	0	ROYSTON, DWIGHT	10/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	975 KIRMAN AVE	AMBULATORY CARE SERVICE	RENO	NV	89502	0993	00	06000	39.51596363	-119.7984968	Washoe County
303782	Non-Physician Medical Practitioner	None	1427768217	0	0	RAMIREZ CISNEROS, MONICA D PA	7/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
303798	Non-Physician Medical Practitioner	None	1396470175	0	0	RAZAL, NEIL RYAN NP	11/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	00	06000	34.27684353	-118.4684024	Los Angeles County
303874	Non-Physician Medical Practitioner	None	1740408939	0	0	RAMOS, LEYDA	4/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2550 W MAIN ST	301	ALHAMBRA	CA	91801	1694	00	06000	34.09508966	-118.1517558	Los Angeles County
303877	Non-Physician Medical Practitioner	None	1780159228	0	0	ROBERTSON, ALLISON PA-C	2/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
303883	Non-Physician Medical Practitioner	None	1043206675	0	0	RAI, CLAIRE R	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19994 GRAYSTONE LN	None	SAN JOSE	CA	95120	1033	00	06000	37.221237	-121.8223035	Santa Clara County
303901	Non-Physician Medical Practitioner	None	1972888279	0	0	RAMOS, LUPE M NP	10/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 W 21ST STREET	None	SANTA ANA	CA	92706	3547	00	06000	33.76359551	-117.881856	Orange County
303906	Non-Physician Medical Practitioner	None	1134895907	0	0	RUBEN, HANNAH I NP	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
303961	Non-Physician Medical Practitioner	None	1396999116	0	0	RYAVEC, LISA G PA-C	4/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	00	06000	34.65803329	-120.4576446	Santa Barbara County
303967	Non-Physician Medical Practitioner	None	1649842634	0	0	RIZZUTO, ANTHONY J PA	4/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
303992	Non-Physician Medical Practitioner	None	1417306242	0	0	RAMA, JISSILLE	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25430 PRADO DE AMOR	None	CALABASAS	CA	91302	3659	00	06000	34.13998093	-118.6818079	Los Angeles County
304009	Non-Physician Medical Practitioner	None	1649357054	0	0	REYNAGA-RANKIN, ANTONIA MODESTA	4/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
304039	Non-Physician Medical Practitioner	None	1821632753	0	0	RAI, MADHUMEETA CNP	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2271 E PALMDALE BLVD	SUITE E	PALMDALE	CA	93550	1340	00	06000	34.58021047	-118.087218	Los Angeles County
304040	Non-Physician Medical Practitioner	None	1962288233	0	0	RAM, JANNEL PA-C	1/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81800 DR. CARREON BLVD	SUITE A	INDIO	CA	92201	5595	00	06000	33.70743053	-116.2372995	Riverside County
304046	Non-Physician Medical Practitioner	None	1891154548	0	0	RUSSELL, ALEXANDRA L	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5468 MAISEL WAY	None	SAN DIEGO	CA	92115	2245	00	06000	32.76684447	-117.0782435	San Diego County
304049	Non-Physician Medical Practitioner	None	1811024342	0	0	RANGEL, JUSTINE NP	1/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
304057	Non-Physician Medical Practitioner	None	1457368227	0	0	ROBLES, VICTOR H	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2639 LAS MERCEDES LANE	None	CORONA	CA	92879	7798	00	06000	33.90037117	-117.5173442	Riverside County
304074	Non-Physician Medical Practitioner	None	1588391775	0	0	RODRIGUEZ, MELINDA	8/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
304082	Non-Physician Medical Practitioner	None	1104333574	0	0	ROBERSON, GERALYN A NP	1/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
304097	Non-Physician Medical Practitioner	None	1659811859	0	0	ROBERTSON, ABBY E NP	9/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304114	Non-Physician Medical Practitioner	None	1871789982	0	0	ROBERTS, RANAE M	1/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1335 N DUTTON AVE	None	SANTA ROSA	CA	95401	4609	00	06000	38.449431	-122.734035	Sonoma County
304136	Non-Physician Medical Practitioner	None	1316344674	0	0	ROBINSON, JESSICA PA-C	8/31/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 3RD ST	STE 817	SAN FRANCISCO	CA	94107	1207	00	06000	37.78356835	-122.3987357	San Francisco County
304198	Non-Physician Medical Practitioner	None	1003445016	0	0	REESINK, MARIA K PA-C	5/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 CREEKSIDE DRIVE	None	FOLSOM	CA	95630	3400	00	06000	38.67021	-121.145382	Sacramento County
304220	Non-Physician Medical Practitioner	None	1366153645	0	0	RICH, MATTHEW PA	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	00	06000	38.421135	-122.752008	Sonoma County
304223	Non-Physician Medical Practitioner	None	1730701863	0	0	ROLAND, KAREN NP	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
304233	Non-Physician Medical Practitioner	None	1700506987	0	0	RODRIGUEZ, RICO PA-C	5/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	00	06000	35.356392	-119.092153	Kern County
304262	Non-Physician Medical Practitioner	None	1164889184	0	0	ROEWER, HANNA CHARIZ NP	9/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
304285	Non-Physician Medical Practitioner	None	1629677232	0	0	RAJ, RADHIKA Y PA	9/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304319	Non-Physician Medical Practitioner	None	1205828076	0	0	RODRIGUEZ, SANDRA F CNM	3/13/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1858 VERONICA LANE	None	SANTA MARIA	CA	93454	5514	00	06000	34.97443615	-120.4194176	Santa Barbara County
304333	Non-Physician Medical Practitioner	None	1841520939	0	0	REEVES, KEMI IYABO	5/9/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4911 VAN NUYS BLVD	SUITE 100	SHERMAN OAKS	CA	91403	1716	00	06000	34.1596563	-118.4487403	Los Angeles County
304371	Non-Physician Medical Practitioner	None	1043802044	0	0	RIEDER, HALEY N PA-C	12/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	00	06000	37.9141514	-122.0422089	Contra Costa County
304372	Non-Physician Medical Practitioner	None	1063869733	0	0	RIVAS, EVA P	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9419 PIONEER BLVD	None	SANTA FE SPRINGS	CA	90670	1006	00	06000	33.95540048	-118.0861432	Los Angeles County
304385	Non-Physician Medical Practitioner	None	1669893376	0	0	REYES, ALVIN E NP	3/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
304400	Non-Physician Medical Practitioner	None	1164729125	0	0	RAYMOND, ALAIN L	12/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4111 MASSACHUSETTS AVE	UNIT 18	LA MESA	CA	91941	7570	00	06000	32.751792	-117.0427335	San Diego County
304428	Non-Physician Medical Practitioner	None	1861474033	0	0	RIVERA, EDWIN	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14759 DASH WY	None	POWAY	CA	92064	2913	00	06000	32.97950242	-117.0443657	San Diego County
304450	Non-Physician Medical Practitioner	None	1629179502	0	0	RHODES, KRISTIN C NP	10/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	00	06000	33.74821163	-117.8097851	Orange County
304456	Non-Physician Medical Practitioner	None	1235475484	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 HANNA AVE	SUITE 1 & 3	CORCORAN	CA	93212	2314	00	06000	36.09975818	-119.5641426	Kings County
304479	Non-Physician Medical Practitioner	None	1760151013	0	0	RUIZ, DESIREE	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
304500	Non-Physician Medical Practitioner	None	1265833545	0	0	ROGERS, JESSICA L	11/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4580 HARMONY LANE	None	SANTA MARIA	CA	93455	4090	00	06000	34.87418632	-120.4072267	Santa Barbara County
304502	Non-Physician Medical Practitioner	None	1114393022	0	0	RONQUILLO, JURY O NP	4/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8225 LONG BEACH BLVD	STE C	SOUTH GATE	CA	90280	2010	00	06000	33.96371607	-118.2251842	Los Angeles County
304526	Non-Physician Medical Practitioner	None	1780008839	0	0	RIVERSIDE CITY COLLEGE	6/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4800 MAGNOLIA AVE	None	RIVERSIDE	CA	92506	1299	00	06000	33.970626	-117.3826755	Riverside County
304555	Non-Physician Medical Practitioner	None	1164036547	0	0	ROCCO, STEFANI NP	12/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8170 LAGUNA BLVD	STE 101	ELK GROVE	CA	95758	7902	00	06000	38.421054	-121.405365	Sacramento County
304618	Non-Physician Medical Practitioner	None	1558854000	0	0	RESTELLI, LYNDSEY RN CPNP	4/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8881 FLETCHER PKWY	STE 200	LA MESA	CA	91942	3135	00	06000	32.78442148	-117.0073814	San Diego County
304626	Non-Physician Medical Practitioner	None	1114535937	0	0	ROSSO, ASHLEY E NP	3/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	00	06000	38.443806	-122.701374	Sonoma County
304641	Non-Physician Medical Practitioner	None	1942861182	0	0	RAMIREZ, JUSTIN J PA-C	12/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
304664	Non-Physician Medical Practitioner	None	1891234340	0	0	RAZACK, OMAR C PA-C	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
304683	Non-Physician Medical Practitioner	None	1700829371	0	0	RAMOS, MARK S D	10/2/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20536 PESARO WAY	None	PORTER RANCH	CA	91326	4148	00	06000	34.27529082	-118.5803207	Los Angeles County
304694	Non-Physician Medical Practitioner	None	1295988699	0	0	RAY, TOMMY L PA	1/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
304708	Non-Physician Medical Practitioner	None	1386402071	0	0	RADOI, NAOMI E PA-C	3/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6926 BROCKTON AVE	SUITE 6	RIVERSIDE	CA	92506	3804	00	06000	33.947919	-117.3967225	Riverside County
304730	Non-Physician Medical Practitioner	None	1073948709	0	0	REYES, BECK L NP	1/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
304774	Non-Physician Medical Practitioner	None	1194975003	0	0	RHOADES, CLAUDETTE	3/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	14550 S STAGECOACH ROAD	None	TUCSON	AZ	85736	1431	00	06000	31.986756	-111.300219	Pima County
304799	Non-Physician Medical Practitioner	None	1982742185	0	0	ROSS, PEGGY	2/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2940 WHIPPLE AVE	SUITE B	REDWOOD CITY	CA	94062	2857	00	06000	37.47840623	-122.2549871	San Mateo County
304825	Non-Physician Medical Practitioner	None	1649814187	0	0	REA, SARAH NP	4/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16100 SAND CANYON AVE	STE 240	IRVINE	CA	92618	3724	00	06000	33.6632187	-117.7721984	Orange County
304826	Non-Physician Medical Practitioner	None	1871326264	0	0	RICH, NOEL	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304832	Non-Physician Medical Practitioner	None	1730801804	0	0	ROSALES, STEVEN A	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304847	Non-Physician Medical Practitioner	None	1801234281	0	0	RUMLEY, ANGELICA I PA-C	4/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
304898	Non-Physician Medical Practitioner	None	1720147077	0	0	RUIZ, ROBERT W	5/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1415 ROSS AVENUE	None	EL CENTRO	CA	99243	4306	00	06000	32.78144947	-115.568541	Imperial County
304918	Non-Physician Medical Practitioner	None	1205907409	0	0	RUBIO, ANTONIO B	4/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3060 SIERRA VIEW CIRCLE	None	LINCOLN	CA	95648	8016	00	06000	38.87543897	-121.3059128	Placer County
304935	Non-Physician Medical Practitioner	None	1023180007	0	0	RENSCHLER, NICHOLE M	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	287 MARINER CT	None	LODI	CA	95240	8875	00	06000	38.10248368	-121.2670849	San Joaquin County
304966	Non-Physician Medical Practitioner	None	1689242208	0	0	RIZO, CLAUDIA T NP	12/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
304968	Non-Physician Medical Practitioner	None	1013592658	0	0	REYES, MEGAN E PA-C	9/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	969 S. SANTA FE AVE	A	VISTA	CA	92083	6910	00	06000	33.1927833	-117.2316819	San Diego County
304974	Non-Physician Medical Practitioner	None	1215669650	0	0	ROBERTS, MICHAEL NP	1/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	00	06000	37.67984327	-122.4730264	San Mateo County
305032	Non-Physician Medical Practitioner	None	1629439567	0	0	RODRIGUEZ, MELISSA E NP	3/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3410 E LAMBETH CT	UNIT C	ORANGE	CA	92869	7550	00	06000	33.79908125	-117.8171048	Orange County
305045	Non-Physician Medical Practitioner	None	1821360702	0	0	RUBALCABA, ANA D	8/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16281 SAN BERNARDINO AVE	None	FONTANA	CA	92335	5508	00	06000	34.0775055	-117.449415	San Bernardino County
305057	Non-Physician Medical Practitioner	None	1285397992	0	0	REMER, LAUREN C PA	5/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305088	Non-Physician Medical Practitioner	None	1285950147	0	0	RONDOU, CECELIA A CNM	2/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1590 CUNNINGHAM WAY	None	SANTA ROSA	CA	95403	2342	00	06000	38.456199	-122.759091	Sonoma County
305096	Non-Physician Medical Practitioner	None	1841647724	0	0	ROMERO, GENELE GRACE NOVILLA NP	1/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
305100	Non-Physician Medical Practitioner	None	1316074529	0	0	RICHARDS, LINDA SUE	4/26/1996	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	00	06000	34.18546095	-118.4487065	Los Angeles County
305101	Non-Physician Medical Practitioner	None	1790720381	0	0	ROLDAN, GUSTAVO M	1/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3221 LIBERTY BLVD	None	SOUTH GATE	CA	90280	5742	00	06000	33.96078579	-118.2116546	Los Angeles County
305111	Non-Physician Medical Practitioner	None	1942573134	0	0	RUBY, JASON PA-C	7/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
305139	Non-Physician Medical Practitioner	None	1104990274	0	0	ROGGENBUCK, VALERIE PA	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1679 E MONTE VISTA AVE	STE. 140	VACAVILLE	CA	95688	3122	00	06000	38.36981273	-121.9599958	Solano County
305153	Non-Physician Medical Practitioner	None	1386382224	0	0	ROCHE, CHLOE NP	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
305190	Non-Physician Medical Practitioner	None	1245631365	0	0	REGALADO, GERARDO A NP	2/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1822 DAVID COURT	None	WEST COVINA	CA	91790	1126	00	06000	34.08762319	-117.9428449	Los Angeles County
305193	Non-Physician Medical Practitioner	None	1669957593	0	0	ROSS, ERIN CNP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305201	Non-Physician Medical Practitioner	None	1659791986	0	0	RUSSELL, JENNIFER E NP	3/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
305206	Non-Physician Medical Practitioner	None	1992185847	0	0	RAMIREZ, NANCY A NP	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10174 MASON AVE	None	CHATSWORTH	CA	91311	3301	00	06000	34.255611	-118.5798115	Los Angeles County
305241	Non-Physician Medical Practitioner	None	1043972870	0	0	RUIZ, TIFFANIE C NP	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	00	06000	34.0662144	-117.9274205	Los Angeles County
305242	Non-Physician Medical Practitioner	None	1780109355	0	0	RIOT, KELLY M	8/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3523 COUNTRY CLUB PL	None	DANVILLE	CA	94506	5879	00	06000	37.80990128	-121.8903564	Contra Costa County
305244	Non-Physician Medical Practitioner	None	1245048206	0	0	ROY, CHRISTIAN G PA-C	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
305258	Non-Physician Medical Practitioner	None	1083843940	0	0	ROMERO, LORRAINE M NP	7/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
305259	Non-Physician Medical Practitioner	None	1356994776	0	0	ROOT, NOLAN M PA	3/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
305264	Non-Physician Medical Practitioner	None	1578503140	0	0	RODRIGUEZ, MARIA LOURDES MARTIREZ	10/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	SPECTRUM HEALTHCARE RESO	6760 CORPORATE DRIVE SUI	COLORADO SPRINGS	CO	80919	0000	00	06000	0	0	None
305314	Non-Physician Medical Practitioner	None	1780256545	0	0	RAYA, DANIEL PA-C	10/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
305319	Non-Physician Medical Practitioner	None	1023337219	0	0	RODRIGUEZ, WILLOW ANNE	9/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 CLIPPER ST APT 1	None	SAN FRANCISCO	CA	94114	3634	00	06000	37.74875337	-122.4370012	San Francisco County
305320	Non-Physician Medical Practitioner	None	1861989790	0	0	RADI, MICHAEL S NP	3/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
305333	Non-Physician Medical Practitioner	None	1841530185	0	0	RONALDO, DELA V	7/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
305346	Non-Physician Medical Practitioner	None	1255667887	0	0	ROMERO, SANDRO PA	10/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
305372	Non-Physician Medical Practitioner	None	1588664791	0	0	ROSSI, MICHAEL J PA-C	7/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
305422	Non-Physician Medical Practitioner	None	1770171944	0	0	ROGACION LABAO, CAMILLE E NP	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305436	Non-Physician Medical Practitioner	None	1740234269	0	0	RODGERS, PATRICIA C	4/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
305493	Non-Physician Medical Practitioner	None	1578639324	0	0	RAYFORD, PAMELA S CNM	1/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7740 BALBOA AVE	None	VAN NUYS	CA	91406	2227	00	06000	34.211313	-118.501123	Los Angeles County
305533	Non-Physician Medical Practitioner	None	1932576584	0	0	RUSKELL, LAUREN M NP	4/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6112 E ILLINOIS AVE	None	FRESNO	CA	93727	6803	00	06000	36.74591625	-119.6800446	Fresno County
305538	Non-Physician Medical Practitioner	None	1689986168	0	0	ROBINSON, JENELLE N PA	9/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
305552	Non-Physician Medical Practitioner	None	1205466141	0	0	REYES, MARGARET E PA	4/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
305562	Non-Physician Medical Practitioner	None	1245834589	0	0	RAMSEY, JESSIE C PA-C	8/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
305564	Non-Physician Medical Practitioner	None	1821102393	0	0	RYAN, MARCIE L	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6907 CORTE BARCELONA	None	PLEASANTON	CA	94566	8602	00	06000	37.66910071	-121.9079056	Alameda County
305569	Non-Physician Medical Practitioner	None	1396070959	0	0	RAJANI, ASGHAR ALI	10/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19059 BEAR VALLEY ROAD	None	APPLE VALLEY	CA	92308	0000	00	06000	34.47094795	-117.2477532	San Bernardino County
305581	Non-Physician Medical Practitioner	None	1891342838	0	0	ROSS, LORI R PA	12/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
305599	Non-Physician Medical Practitioner	None	1518054840	0	0	RAMOS, AILEEN ODI	8/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
305653	Non-Physician Medical Practitioner	None	1275158321	0	0	RANDHAWA, HARMANJIT PA-C	5/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
305663	Non-Physician Medical Practitioner	None	1902823461	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S MADERA AVE	None	KERMAN	CA	93630	1750	00	06000	36.73489098	-120.0600426	Fresno County
305670	Non-Physician Medical Practitioner	None	1811109986	0	0	RUDOLPH, ANDREA C NP	2/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1270 E MAIN ST	None	VENTURA	CA	93001	2543	00	06000	34.28073199	-119.2813247	Ventura County
305684	Non-Physician Medical Practitioner	None	1275595563	0	0	ROBERTSON, ARLEADA F	7/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 FIRST ST	None	PASO ROBLES	CA	93446	3742	00	06000	35.61526854	-120.6924512	San Luis Obispo County
305713	Non-Physician Medical Practitioner	None	1780982819	0	0	RENE DE COTRET, CRYSTAL LISA	8/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1019 S CENTRAL AVE	None	GLENDALE	CA	91204	2210	00	06000	34.13405999	-118.2578839	Los Angeles County
305729	Non-Physician Medical Practitioner	None	1700320025	0	0	RANGOOLA, ANMOL PA-C	12/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	591 N 13TH AVE	SUITE 5	UPLAND	CA	91786	4968	00	06000	34.10081218	-117.6336095	San Bernardino County
305752	Non-Physician Medical Practitioner	None	1881930964	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2357 W TAHOE	None	CARUTHERS	CA	93609	0000	00	06000	36.54170344	-119.8338188	Fresno County
305763	Non-Physician Medical Practitioner	None	1558710038	0	0	ROGERS, TANYA L NP	12/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 L ST	APT 435	SACRAMENTO	CA	95811	4168	00	06000	38.575431	-121.4827245	Sacramento County
305773	Non-Physician Medical Practitioner	None	1760531602	0	0	REDDY, MAHIMA PA	8/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
305777	Non-Physician Medical Practitioner	None	1558890848	0	0	ROTH, BOBBI LEE NP	2/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	236 W 6TH ST	STE 401	RENO	NV	89503	4553	00	06000	39.53151304	-119.8186228	Washoe County
305781	Non-Physician Medical Practitioner	None	1174940753	0	0	ROBERTS, KATHRYN CNM	1/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	00	06000	38.56554	-121.4664615	Sacramento County
305785	Non-Physician Medical Practitioner	None	1679777239	0	0	REGENHARDT, SUSAN G	6/12/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	314 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4305	00	06000	34.43103031	-119.7236859	Santa Barbara County
305787	Non-Physician Medical Practitioner	None	1417172495	0	0	RINGER, JILL R	4/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 FOOTHILL BLVD	None	CALISTOGA	CA	94515	9666	00	06000	38.573199	-122.5681875	Napa County
305795	Non-Physician Medical Practitioner	None	1326109125	0	0	REILLY, DAVID TRAVIS	3/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 N. HOWARD	None	FRESNO	CA	93701	2214	00	06000	36.745623	-119.7826685	Fresno County
305802	Non-Physician Medical Practitioner	None	1629796263	0	0	ROUTZEN, KAITLYN S CNM	10/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	00	06000	37.91229899	-122.0423696	Contra Costa County
305812	Non-Physician Medical Practitioner	None	1528171287	0	0	RUCKELSHAUS, JENNIFER L	8/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MISSION BOULEVARD	None	JACKSON	CA	95642	2564	00	06000	38.35007723	-120.7659932	Amador County
305817	Non-Physician Medical Practitioner	None	1487604948	0	0	ROSEBERRY, TY M	7/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8722 BANDICOOT TRAIL	None	OAK HILLS	CA	92344	4101	00	06000	34.40906701	-117.3597198	San Bernardino County
305881	Non-Physician Medical Practitioner	None	1811379472	0	0	RESENDIZ, EBER E	11/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7511 RAINFORD STREET	None	LAS VEGAS	NV	89148	1834	00	06000	36.05164205	-115.2967769	Clark County
305912	Non-Physician Medical Practitioner	None	1932617156	0	0	ROBLEDO, CONNIE A CNP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305928	Non-Physician Medical Practitioner	None	1588946941	0	0	REDIN, JESSICA	11/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305993	Non-Physician Medical Practitioner	None	1336389402	0	0	ROGERS, PAUL H	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	754 W WESTWARD AVE	None	BANNING	CA	92220	4974	00	06000	33.9180087	-116.8849665	Riverside County
306038	Non-Physician Medical Practitioner	None	1114149150	0	0	RODRIGUEZ, SYLVIA	9/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4146 E OLYMPIC BLVD	SUITE B	LOS ANGELES	CA	90023	3347	00	06000	34.01887148	-118.184463	Los Angeles County
306059	Non-Physician Medical Practitioner	None	1700368552	0	0	RAGHOW, JILLIAN G	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	168 MONTECITO AVE	APT E	OAKLAND	CA	94610	4537	00	06000	37.81201078	-122.2590338	Alameda County
306075	Non-Physician Medical Practitioner	None	1992360036	0	0	ROMAN, ANGELA MAE NP	12/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	625 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2613	00	06000	34.134894	-118.1504155	Los Angeles County
306076	Non-Physician Medical Practitioner	None	1811942071	0	0	RAMIREZ, ANDREW N.	1/10/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10101 RIDGEGATE PARKWAY	None	LONE TREE	CO	80124	9810	00	06000	39.529305	-104.870799	Douglas County
306084	Non-Physician Medical Practitioner	None	1003357344	0	0	RUTLEDGE, HAYLEY PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
306151	Non-Physician Medical Practitioner	None	1467588087	0	0	ROUCHE, LYNDE A	11/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 HALE DR	None	CONCORD	CA	94518	1516	00	06000	37.96635291	-122.0157356	Contra Costa County
306176	Non-Physician Medical Practitioner	None	1386917573	0	0	RANGUELOV, ASEN S	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11818 RIVERSIDE DR	APT 221	VALLEY VILLAGE	CA	91607	4077	00	06000	34.15759955	-118.3907385	Los Angeles County
306177	Non-Physician Medical Practitioner	None	1932653383	0	0	RIVERA, JESSE R NP	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
306178	Non-Physician Medical Practitioner	None	1649252842	0	0	ROMERO, MARIA ELENA	12/29/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
306198	Non-Physician Medical Practitioner	None	1922278696	0	0	RULIFFSON, KATHRYN R PA	4/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
306264	Non-Physician Medical Practitioner	None	1962083766	0	0	ROLDAN, KATERINA PA	8/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
306281	Non-Physician Medical Practitioner	None	1396451027	0	0	RIPS, MATTHEW E PA-C	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
306283	Non-Physician Medical Practitioner	None	1285967034	0	0	RAWSON, JENNIFER MICHELLE	12/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6664 E KEYNOTE ST	None	LONG BEACH	CA	90808	2948	00	06000	33.82294954	-118.103076	Los Angeles County
306307	Non-Physician Medical Practitioner	None	1093293623	0	0	RENDON, ALEJANDRO PA	2/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
306325	Non-Physician Medical Practitioner	None	1548665706	0	0	RUBIO, JEFFREY W PA-C	11/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
306371	Non-Physician Medical Practitioner	None	1831109651	0	0	RAMIRA, MARIA L NP	6/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	739 EAST PENNSYLVANIA AV	STE C	ESCONDIDO	CA	92025	3004	00	06000	33.12712182	-117.0727888	San Diego County
306402	Non-Physician Medical Practitioner	None	1134100563	0	0	ROSS, DAVID G	7/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13939 E 14TH ST	SUITE 150	SAN LEANDRO	CA	94578	2601	00	06000	37.71377536	-122.1407447	Alameda County
306414	Non-Physician Medical Practitioner	None	1114333614	0	0	ROBIN-MCCONNELL, ROBYNN L	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	709 E ALDER ST	None	BREA	CA	92821	4488	00	06000	33.9073943	-117.8982763	Orange County
306423	Non-Physician Medical Practitioner	None	1912156043	0	0	RICHARDS, JENNIFER J	5/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 SAGE	None	LAKE FOREST	CA	92630	8370	00	06000	33.66927	-117.681436	Orange County
306428	Non-Physician Medical Practitioner	None	1790861672	0	0	ROSARIO, ROSINA K	9/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4311 NORWALK DR	201	SAN JOSE	CA	95129	1781	00	06000	37.31848152	-121.9793805	Santa Clara County
306504	Non-Physician Medical Practitioner	None	1467186999	0	0	RODRIGUEZ, BRENDA	10/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
306516	Non-Physician Medical Practitioner	None	1063811404	0	0	ROBINSON, JULIA D	2/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12752 MONTFORD STREET	None	PACOIMA	CA	91331	1116	00	06000	34.28273524	-118.4108085	Los Angeles County
306518	Non-Physician Medical Practitioner	None	1255535282	0	0	REYES-MONTOYA, LOLITA B PA	10/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
306522	Non-Physician Medical Practitioner	None	1639485758	0	0	ROSALES, LOUIS ALEXANDER	3/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5385 FRNAKLIN BLVD	STE K	SACRAMENTO	CA	95824	0000	00	06000	38.526282	-121.471398	Sacramento County
306527	Non-Physician Medical Practitioner	None	1962525360	0	0	ROBINSON, BAYCELISA M	12/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6703 CITRINE COURT	None	MIRA LOMA	CA	91752	4444	00	06000	33.96649592	-117.5413767	Riverside County
306540	Non-Physician Medical Practitioner	None	1881317600	0	0	RADLER, DIANA NP	11/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
306547	Non-Physician Medical Practitioner	None	1265801971	0	0	RODRIGUEZ, MICHAEL	4/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3058 EMERALD BAY PLACE	None	TULARE	CA	93274	7541	00	06000	36.20579279	-119.3020598	Tulare County
306583	Non-Physician Medical Practitioner	None	1679287957	0	0	ROMAN HERNANDEZ, MAYRA NP	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 N EUCLID AVE	STE B	UPLAND	CA	91786	8322	00	06000	34.097508	-117.6509735	San Bernardino County
306585	Non-Physician Medical Practitioner	None	1174773808	0	0	ROSS, STACY N	2/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 HERNDON	210 AND 230	FRESNO	CA	93720	3303	00	06000	36.83756048	-119.7609525	Fresno County
306589	Non-Physician Medical Practitioner	None	1588729941	0	0	RUSSO, PETER J	4/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6164 E MORADA LANE	None	STOCKTON	CA	95212	9430	00	06000	38.03726781	-121.2401986	San Joaquin County
306616	Non-Physician Medical Practitioner	None	1235298951	0	0	RODRIGUEZ, RAUL JR	1/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1976 SOUTH LA CIENEGA	23	LOS ANGELES	CA	90034	1627	00	06000	34.04059768	-118.3768966	Los Angeles County
306659	Non-Physician Medical Practitioner	None	1811914377	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 HIGH STREET	None	SELMA	CA	93662	3065	00	06000	36.57049208	-119.6139528	Fresno County
306706	Non-Physician Medical Practitioner	None	1497806921	0	0	RUMMEL, LAURA A PA-C	7/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
306731	Non-Physician Medical Practitioner	None	1013136332	0	0	RAIDER, ANDREA M	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4272 LAKESHORE AVE	None	OAKLAND	CA	94610	1136	00	06000	37.81508415	-122.2323437	Alameda County
306776	Non-Physician Medical Practitioner	None	1427614619	0	0	ROY, BINDHU NP	7/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	00	06000	38.599614	-121.438728	Sacramento County
306784	Non-Physician Medical Practitioner	None	1134992753	0	0	RUIZ, SUSAN NP	5/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
306793	Non-Physician Medical Practitioner	None	1689013161	0	0	RESENDIZ, EBER E	11/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7511 RAINFORD STREET	None	LAS VEGAS	NV	89148	1834	00	06000	36.05164205	-115.2967769	Clark County
306846	Non-Physician Medical Practitioner	None	1548833411	0	0	RAMOS, RIGOBERTO PA	2/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
306849	Non-Physician Medical Practitioner	None	1407228208	0	0	RISENHOOVER, DALE T	8/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1024 PARK BLVD	None	WEST SACRAMENTO	CA	95691	3741	00	06000	38.57442057	-121.5272449	Yolo County
306850	Non-Physician Medical Practitioner	None	1578949004	0	0	REZNIK, YANA	3/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44 FOREST VIEW DRIVE	None	SAN FRANCISCO	CA	94132	1443	00	06000	37.73341954	-122.4836766	San Francisco County
306920	Non-Physician Medical Practitioner	None	1043411374	0	0	RYALL, KRISTINE M NP	11/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9936 MANZANITA DR	None	ALTA LOMA	CA	91737	2916	00	06000	34.14701259	-117.5879922	San Bernardino County
306970	Non-Physician Medical Practitioner	None	1831815653	0	0	RURY, MORGAN S PA-C	5/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11939 RANCHO BERNARDO RD	STE 115	SAN DIEGO	CA	92128	2073	00	06000	33.02279756	-117.0732316	San Diego County
306980	Non-Physician Medical Practitioner	None	1134747595	0	0	ROSE, DAWN E NP	7/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
306985	Non-Physician Medical Practitioner	None	1205432150	0	0	RIGGS, ROBYN C PA	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 W 6TH ST	250	ONTARIO	CA	91762	1108	00	06000	34.084404	-117.6717015	San Bernardino County
307031	Non-Physician Medical Practitioner	None	1063629111	0	0	REYNOLDS, JODI	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
307046	Non-Physician Medical Practitioner	None	1497200869	0	0	RODRIGUEZ, YURI A NP	10/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1370 N WALNUT ST	None	LA HABRA HEIGHTS	CA	90631	8312	00	06000	33.94931877	-117.9491579	Los Angeles County
307066	Non-Physician Medical Practitioner	None	1275239758	0	0	RAMIREZ, EVELYN NP	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1620 S GRAND AVE	None	GLENDORA	CA	91740	5433	00	06000	34.10974369	-117.872489	Los Angeles County
307103	Non-Physician Medical Practitioner	None	1669676300	0	0	RAMOS, GUSTAVO	10/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
307196	Non-Physician Medical Practitioner	None	1548878747	0	0	REYNADO-SABADO, ZACHARY C NP	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
307226	Non-Physician Medical Practitioner	None	1366154882	0	0	RAJ, ANISHA NP	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
307240	Non-Physician Medical Practitioner	None	1073537213	0	0	ROSSI, JANET A	4/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6625 MOKELUMNE AVE	None	OAKLAND	CA	94605	2212	00	06000	37.77565392	-122.1722266	Alameda County
307273	Non-Physician Medical Practitioner	None	1639253420	0	0	RAZON, MATTHEW A PA-C	7/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	00	06000	37.89525674	-122.5158838	Marin County
307343	Non-Physician Medical Practitioner	None	1912122276	0	0	RUDDER, WINSTON E	10/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	75270 COTTONWOOD LANE	None	29 PALMS	CA	92277	3692	00	06000	34.13062835	-116.0195813	San Bernardino County
307345	Non-Physician Medical Practitioner	None	1801322466	0	0	RIVERS, ROBERT J PA-C	12/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
307383	Non-Physician Medical Practitioner	None	1063843928	0	0	REYNA, SOMCHIT S NP	9/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 N LAKE RD	None	MERCED	CA	95340	9118	00	06000	37.34559062	-120.4326688	Merced County
307411	Non-Physician Medical Practitioner	None	1629130398	0	0	RUGGLES, DEBORAH HELEN	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	KPMG DEPARTMENT OF PEDIA	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
307423	Non-Physician Medical Practitioner	None	1346791761	0	0	REMIGIO, ANA T NP	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	264 N HIGHLAND SPRINGS A	STE 5A	BANNING	CA	92220	3083	00	06000	33.93063	-116.946864	Riverside County
307453	Non-Physician Medical Practitioner	None	1740397413	0	0	REYES, ERICSON P NP	10/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	00	06000	33.86018093	-118.1537163	Los Angeles County
307476	Non-Physician Medical Practitioner	None	1043612013	0	0	RAMIREZ, AVELINA T NP	3/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	213 ACAPULCO DRIVE	None	IMPERIAL	CA	92251	9660	00	06000	32.82682492	-115.5542657	Imperial County
307501	Non-Physician Medical Practitioner	None	1487611364	0	0	ROBBINS, DALE A	2/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9106 CARNEGIE HALL LN	None	BAKERSFIELD	CA	93311	9552	00	06000	35.29823049	-119.1037905	Kern County
307549	Non-Physician Medical Practitioner	None	1881339729	0	0	REVIL, MARIA ISABEL A	8/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1680 EAST 120TH ST	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
307588	Non-Physician Medical Practitioner	None	1073888202	0	0	RODRIGUEZ, SORAIDA M NP	3/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1238 BROOKVIEW AVE	None	WESTLAKE VILLAGE	CA	91361	1628	00	06000	34.14946631	-118.8476309	Ventura County
307617	Non-Physician Medical Practitioner	None	1073918413	0	0	ROBERTSON, JARED M	12/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	262 OSBORNE CT	None	RIVERSIDE	CA	92507	1519	00	06000	34.01479942	-117.3172292	Riverside County
307704	Non-Physician Medical Practitioner	None	1578654232	0	0	RUNDLE, SUSAN MARY	10/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
307708	Non-Physician Medical Practitioner	None	1861692378	0	0	RIPPERTON, GEMMA CELESTE	5/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
307727	Non-Physician Medical Practitioner	None	1598430555	0	0	RODRIGUEZ, YESENIA NP	2/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 S OAK AVE	None	OAKDALE	CA	95361	3519	00	06000	37.75764557	-120.8600743	Stanislaus County
307748	Non-Physician Medical Practitioner	None	1508993635	0	0	ROBLES, JOSE M	7/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	547 N LOS ROBLES	None	PASADENA	CA	91101	1001	00	06000	34.15533535	-118.1415454	Los Angeles County
307759	Non-Physician Medical Practitioner	None	1063609170	0	0	RAFES, STEFANIE	4/3/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	00	06000	33.12542915	-117.0764725	San Diego County
307776	Non-Physician Medical Practitioner	None	1811294283	0	0	ROBLEZ, MARICEL C	9/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1860 PENNSYLVANIA AVE	SUITE 230	FAIRFIELD	CA	94533	3590	00	06000	38.261952	-122.0498745	Solano County
307796	Non-Physician Medical Practitioner	None	1508590324	0	0	RESURRECCION, LIGAYA NP	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	00	06000	33.994269	-117.3485375	Riverside County
307817	Non-Physician Medical Practitioner	None	1164785093	0	0	ROBBINS, DAVID V II	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3904 HIDDEN VALLEY ROAD	None	BUTTE VALLEY	CA	95965	9148	00	06000	39.66886082	-121.6257233	Butte County
307824	Non-Physician Medical Practitioner	None	1811314867	0	0	RUSCH, KRISTINA J	8/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2119 CORONET BLVD	None	BELMONT	CA	94002	1663	00	06000	37.51974819	-122.2983591	San Mateo County
307829	Non-Physician Medical Practitioner	None	1205240660	0	0	ROJAS, DAVID Z	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3429 SUMMER DR	None	MODESTO	CA	95355	7329	00	06000	37.68758846	-120.9256673	Stanislaus County
307840	Non-Physician Medical Practitioner	None	1851980585	0	0	RUBINSTEIN, KYLE N PA	3/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	00	06000	33.82476552	-117.994914	Orange County
307865	Non-Physician Medical Practitioner	None	1205381845	0	0	RODRIGUES, ANNETTE A PA	8/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
307886	Non-Physician Medical Practitioner	None	1831231034	0	0	RICAFORT, DOLLY	12/19/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 3RD AVE	None	CHULA VISTA	CA	91910	5616	00	06000	32.63367609	-117.0769202	San Diego County
307902	Non-Physician Medical Practitioner	None	1376312033	0	0	RAGHUBANSH, AAKASH PA	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
307909	Non-Physician Medical Practitioner	None	1497512800	0	0	RUBALCAVA, DIANA PA-C	5/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
307964	Non-Physician Medical Practitioner	None	1730170176	0	0	RIEL, DAVID W	7/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 OLD RIVER RD	SUITE 150	BAKERSFIELD	CA	93311	9503	00	06000	35.352648	-119.1122505	Kern County
307968	Non-Physician Medical Practitioner	None	1336505247	0	0	RITTERMAN, IRENE M M NP	3/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1927 BRIDGEPOINTE PKWY	231	FOSTER CITY	CA	94404	5005	00	06000	37.56331576	-122.2842637	San Mateo County
307984	Non-Physician Medical Practitioner	None	1548381361	0	0	RAWSON, KIMBER L NP	9/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2225 CANYON DRIVE	None	COLTON	CA	92324	9787	00	06000	34.02980922	-117.283149	San Bernardino County
307985	Non-Physician Medical Practitioner	None	1356670665	0	0	RODRIGUEZ, LAURA MABEL	6/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3175 SAINT ROSE PKWY	SUITE 320	HENDERSON	NV	89052	3506	00	06000	35.99940075	-115.12488	Clark County
308037	Non-Physician Medical Practitioner	None	1417966870	0	0	RAMOS-SCOTT, CHEREAMIE C NP	2/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4725 FIRST STREET	SUITE 100	PLEASANTON	CA	94566	7366	00	06000	37.65692944	-121.8767827	Alameda County
308039	Non-Physician Medical Practitioner	None	1871598896	0	0	ROSS, ELIZABETH A NP	5/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	00	06000	38.02139448	-121.347738	San Joaquin County
308064	Non-Physician Medical Practitioner	None	1376110809	0	0	RODRIGUEZ, BRIAN M PA-C	11/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
308068	Non-Physician Medical Practitioner	None	1164725677	0	0	REGETS, KEITH V	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1252 1/2 N GARDER STREET	None	LOS ANGELES	CA	90046	5616	00	06000	34.0939537	-118.3528124	Los Angeles County
308087	Non-Physician Medical Practitioner	None	1952620833	0	0	REEVES, INGUNA NP	10/31/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8598 WOODPECKER AVE	None	FOUNTAIN VALLEY	CA	92708	6239	00	06000	33.688071	-117.9784495	Orange County
308089	Non-Physician Medical Practitioner	None	1164794228	0	0	RODRIGUEZ, EVANGELINE G	8/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9642 VIA RIMINI	None	BURBANK	CA	91504	1401	00	06000	34.21051371	-118.3406635	Los Angeles County
308140	Non-Physician Medical Practitioner	None	1184018012	0	0	REED, LATESHA T NP	5/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	00	06000	33.02310224	-117.2826142	San Diego County
308160	Non-Physician Medical Practitioner	None	1922463835	0	0	RODRIGUEZ, THAO T NP	5/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
308166	Non-Physician Medical Practitioner	None	1558839837	0	0	RODRIGUEZ, NATALY E NP	9/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
308192	Non-Physician Medical Practitioner	None	1992486153	0	0	ROBINSON, GIANA M NP	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
308206	Non-Physician Medical Practitioner	None	1427704345	0	0	RAGONESE, STERLIE CLAIRE A NP	7/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
308243	Non-Physician Medical Practitioner	None	1649633199	0	0	RYE, MEGAN NP	7/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
308276	Non-Physician Medical Practitioner	None	1871791806	0	0	RONNEBERG, MARCY ROACH	12/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	00	06000	38.576079	-121.2938325	Sacramento County
308279	Non-Physician Medical Practitioner	None	1184633976	0	0	RAFAH, HAZRAT G	6/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	388 GLENBRIAR CIRCLE	None	TRACY	CA	95377	7053	00	06000	37.70550553	-121.4249301	San Joaquin County
308375	Non-Physician Medical Practitioner	None	1124454426	0	0	RAGEN, ERICA M	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1165 WELLESLEY AVE	302	LOS ANGELES	CA	90049	5884	00	06000	34.04356587	-118.4700481	Los Angeles County
308404	Non-Physician Medical Practitioner	None	1144747403	0	0	ROBISON, KIAH	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2290 TOSCANA PLACE	None	AUBURN	CA	95603	7738	00	06000	38.856835	-121.0953955	Placer County
308443	Non-Physician Medical Practitioner	None	1942806237	0	0	ROMERO, CHRISTIAN O NP	2/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 E COLE BLVD	None	CALEXICO	CA	92231	3211	00	06000	32.69391949	-115.495038	Imperial County
308478	Non-Physician Medical Practitioner	None	1457182362	0	0	ROSAS-GARCIA, JESSICA NP	3/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
308507	Non-Physician Medical Practitioner	None	1093181406	0	0	ROSELEE, CAREY	11/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
308541	Non-Physician Medical Practitioner	None	1487136446	0	0	RAGHAVAN, MAYURA PA	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
308542	Non-Physician Medical Practitioner	None	1457095259	0	0	REYES RENDON, PAOLO C PA	11/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
308559	Non-Physician Medical Practitioner	None	1346491222	0	0	ROSQUIST, JAMIE L	1/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1611 SILVER LAKE BLVD	None	LOS ANGELES	CA	90026	1310	00	06000	34.0883346	-118.269215	Los Angeles County
308563	Non-Physician Medical Practitioner	None	1891074423	0	0	RAHEEN, NEDA	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3236 MALCOLM ISLAND ST	None	WEST SACRAMENTO	CA	95691	5945	00	06000	38.53876592	-121.5811445	Yolo County
308582	Non-Physician Medical Practitioner	None	1083081467	0	0	REID, EMILY NP	4/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	00	06000	33.02257788	-117.0856332	San Diego County
308611	Non-Physician Medical Practitioner	None	1548374028	0	0	RAY, CANDACE M.	10/31/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 MEDICAL CENTER DR	SUITE 3	ROHNERT PARK	CA	94928	2924	00	06000	38.34758366	-122.6816633	Sonoma County
308638	Non-Physician Medical Practitioner	None	1871122168	0	0	ROCHMAN, ALEXANDRA E PA	5/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308717	Non-Physician Medical Practitioner	None	1891369526	0	0	RUAN, VIVIAN C CNP	6/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4100 E COMMERCE WAY	BLDG J STE 100	SACRAMENTO	CA	95834	9679	00	06000	38.644866	-121.519188	Sacramento County
308733	Non-Physician Medical Practitioner	None	1104221258	0	0	RIVANI, NILOO	6/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10820 HOLMAN AVE	APT 302	LOS ANGELES	CA	90024	5782	00	06000	34.0534527	-118.4382214	Los Angeles County
308754	Non-Physician Medical Practitioner	None	1295416733	0	0	RAMIREZ, JESSICA	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308760	Non-Physician Medical Practitioner	None	1881458727	0	0	RAMIREZ, LUZMARIE B NP	12/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
308765	Non-Physician Medical Practitioner	None	1275992190	0	0	REYES, KARL LEXTER	4/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308799	Non-Physician Medical Practitioner	None	1992864623	0	0	RILEY, MICHELE D	6/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23746 LIVEWOOD LANE	None	HARBOR CITY	CA	90710	1215	00	06000	33.80944385	-118.2956567	Los Angeles County
308864	Non-Physician Medical Practitioner	None	1306941158	0	0	ROBERTSON, CAROLYN	11/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11601 WILSHIRE BLVD	5TH FLOOR	LOS ANGELES	CA	90025	0509	00	06000	34.05052592	-118.4595943	Los Angeles County
308895	Non-Physician Medical Practitioner	None	1578231320	0	0	RINCON, JOSEPH PA-C	9/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
308935	Non-Physician Medical Practitioner	None	1891447595	0	0	RANKIN, RACHEL NP	7/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
308950	Non-Physician Medical Practitioner	None	1750189106	0	0	RASMUSSEN, BARBARA NP	3/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
308955	Non-Physician Medical Practitioner	None	1457869018	0	0	RANGE, ADAM W	8/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4608 JULESBURG DR	None	LAS VEGAS	NV	89139	5797	00	06000	36.04670065	-115.2038769	Clark County
308968	Non-Physician Medical Practitioner	None	1134345226	0	0	ROMINE, KATHLEEN K	10/20/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8210 FROST STREET	SUITE 500	SAN DIEGO	CA	92123	0000	00	06000	32.80024139	-117.1531966	San Diego County
309037	Non-Physician Medical Practitioner	None	1275644635	0	0	ROBIE, PAUL JOSEPH	6/22/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	0000	00	06000	39.506454	-121.5412785	Butte County
309044	Non-Physician Medical Practitioner	None	1982943684	0	0	REYES, MICHELLE	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13830 BROOKHURST ST	None	GARDEN GROVE	CA	92843	3121	00	06000	33.761034	-117.954832	Orange County
309045	Non-Physician Medical Practitioner	None	1104930536	0	0	REITZ, BRIAN L	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1267 LASTERBROOK ST	None	PLACENTIA	CA	92870	3905	00	06000	33.88514443	-117.8398025	Orange County
309051	Non-Physician Medical Practitioner	None	1275100638	0	0	RONAGHY, ARMIN PA	5/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
309101	Non-Physician Medical Practitioner	None	1306388905	0	0	RUFO, ROSAVIDA NP	12/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
309104	Non-Physician Medical Practitioner	None	1538495312	0	0	RICHARDSON, BEVERLY KAY	9/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 WARREN ST	None	REDWOOD CITY	CA	94063	1578	00	06000	37.48729928	-122.2318924	San Mateo County
309121	Non-Physician Medical Practitioner	None	1891231700	0	0	REYES, JAY A M NP	8/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24221 HOLLYOAK	APT E	ALISO VIEJO	CA	92656	6956	00	06000	33.57609267	-117.7085296	Orange County
309130	Non-Physician Medical Practitioner	None	1144778200	0	0	RAMIREZ, VERONICA NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
309134	Non-Physician Medical Practitioner	None	1922689330	0	0	REICH, KIM C NP	1/29/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6430 SOUTH ST	None	LAKEWOOD	CA	90713	1713	00	06000	33.85826253	-118.107441	Los Angeles County
309190	Non-Physician Medical Practitioner	None	1124411616	0	0	RODRIGUEZ, GREGORIO E NP	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1507 MONTE DIABLO AVE	None	SAN MATEO	CA	94401	1351	00	06000	37.57805477	-122.3174392	San Mateo County
309200	Non-Physician Medical Practitioner	None	1962108332	0	0	RUIZ, KYLE C NP	12/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
309228	Non-Physician Medical Practitioner	None	1790478154	0	0	REIDY, LINDA M NP	2/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	00	06000	34.42739162	-119.7253175	Santa Barbara County
309257	Non-Physician Medical Practitioner	None	1396348975	0	0	ROBINSON, KRYSTLE CNP	3/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27522 ANTONIO PKWY	P3	LADERA RANCH	CA	92694	2166	00	06000	33.56343335	-117.6292292	Orange County
309290	Non-Physician Medical Practitioner	None	1083858823	0	0	ROOTS COMMUNITY HEALTH CENTER	2/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9925 INTERNATIONAL BLVD	#5	OAKLAND	CA	94603	2558	00	06000	37.74332565	-122.1698542	Alameda County
309310	Non-Physician Medical Practitioner	None	1518413087	0	0	RODGERS-BLANKENSHIP, MAUNALO	10/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27391 SHIMMER CT	None	MORENO VALLEY	CA	92555	4732	00	06000	33.90490373	-117.1844374	Riverside County
309312	Non-Physician Medical Practitioner	None	1558562447	0	0	RAGSDALE, STANLEY D	10/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	998 ASHFORD CIRCLE	None	CORONA	CA	92881	7436	00	06000	33.85192992	-117.5472361	Riverside County
309316	Non-Physician Medical Practitioner	None	1205307519	0	0	ROBINSON, ANNA M NP	2/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
309317	Non-Physician Medical Practitioner	None	1336651223	0	0	ROCHA, RENEE NP	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
309347	Non-Physician Medical Practitioner	None	1942510698	0	0	REEVES, LAURIE ANNE	5/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6367 ALVARDO CT.	SUITE #200	SAN DIEGO	CA	92120	0000	00	06000	32.77665968	-117.0614306	San Diego County
309357	Non-Physician Medical Practitioner	None	1205977246	0	0	REYES, JOY	5/28/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17620 BELLFLOWER BLVD ST	None	BELLFLOWER	CA	90706	8001	00	06000	33.872373	-118.1251005	Los Angeles County
309362	Non-Physician Medical Practitioner	None	1437515566	0	0	RAMOS, JOANNA LEE	12/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1775 W LINCOLN AVE	None	ANAHEIM	CA	92801	6715	00	06000	33.83260148	-117.945333	Orange County
309365	Non-Physician Medical Practitioner	None	1366953903	0	0	ROY, ARPHY PA-C	3/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
309375	Non-Physician Medical Practitioner	None	1528288719	0	0	RUFF, AZUCENA	10/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 LOCKHEED WAY	BLDG 601 / MEDICAL / ROO	PALMDALE	CA	93599	0199	00	06000	34.614864	-118.112994	Los Angeles County
309401	Non-Physician Medical Practitioner	None	1093832578	0	0	REYNO, ALFRED T JR	8/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	336 S MADRONA AVENUE	None	BREA	CA	92821	5339	00	06000	33.91606841	-117.903199	Orange County
309419	Non-Physician Medical Practitioner	None	1891139788	0	0	RIEMER, KENT DONALD	9/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 POWELL ST STE 920	None	EMERYVILLE	CA	94608	1844	00	06000	37.83953006	-122.2990736	Alameda County
309423	Non-Physician Medical Practitioner	None	1679121768	0	0	RODRIGUEZ-ADEDOJA, SYLVIA L NP	10/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2600 L ST	None	SACRAMENTO	CA	95816	5612	00	06000	38.571921	-121.472541	Sacramento County
309454	Non-Physician Medical Practitioner	None	1386013274	0	0	REHDER, MEGAN H NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
309472	Non-Physician Medical Practitioner	None	1730698846	0	0	RAPOZO, OLIVIA NP	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2887 HONEYSUCKLE WAY	None	SACRAMENTO	CA	95826	3139	00	06000	38.555172	-121.378743	Sacramento County
309495	Non-Physician Medical Practitioner	None	1649285529	0	0	RHODES, JANIE	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	00	06000	37.60574038	-122.0836254	Alameda County
309570	Non-Physician Medical Practitioner	None	1326750480	0	0	RAMEY, JORDYN L NP	2/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3975 JACKSON STREET	SUITE 110	RIVERSIDE	CA	92503	3946	00	06000	33.92729721	-117.4413503	Riverside County
309573	Non-Physician Medical Practitioner	None	1639494024	0	0	RHOADS, SUSAN M	1/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	660 MADISON ST	APT A	MONTEREY	CA	93940	2675	00	06000	36.59796897	-121.9006489	Monterey County
309578	Non-Physician Medical Practitioner	None	1821370602	0	0	ROTZ, COURTNEY A NP	5/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
309579	Non-Physician Medical Practitioner	None	1255023966	0	0	RODERICK, RYLAND PA	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
309619	Non-Physician Medical Practitioner	None	1770532871	0	0	ROSSINI, MARI K	8/26/1994	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
309622	Non-Physician Medical Practitioner	None	1386968816	0	0	REY, LUELLEN NP	4/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14747 MCCORMICK ST	None	SHERMAN OAKS	CA	91411	2002	00	06000	34.16579239	-118.4547451	Los Angeles County
309638	Non-Physician Medical Practitioner	None	1831674191	0	0	RIGBY, LAURA L NP	10/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3660 PARK SIERRA DR	208	RIVERSIDE	CA	92501	1768	00	06000	33.90330693	-117.4707039	Riverside County
309647	Non-Physician Medical Practitioner	None	1851932099	0	0	RUIZ, BACILIO PA-C	4/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
309662	Non-Physician Medical Practitioner	None	1730867243	0	0	RAMANI, DIVYA PA-C	12/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
309697	Non-Physician Medical Practitioner	None	1467515809	0	0	ROMERO, ROMULO M PA	1/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1181 VIA MATEO	None	SAN JOSE	CA	95120	2811	00	06000	37.2231178	-121.8712349	Santa Clara County
309701	Non-Physician Medical Practitioner	None	1356862163	0	0	RUIZ, NATASHA M NP	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
309714	Non-Physician Medical Practitioner	None	1952705113	0	0	RINALDI, MARIE E NP	1/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1513 ESCONDIDO WAY	None	BELMONT	CA	94002	3634	00	06000	37.51381991	-122.2837872	San Mateo County
309720	Non-Physician Medical Practitioner	None	1033256557	0	0	RESNEY-DEEMS, DAWN H	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
309757	Non-Physician Medical Practitioner	None	1356430599	0	0	RODGERS, DAVID CLARENCE	1/11/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
309762	Non-Physician Medical Practitioner	None	1053831354	0	0	RAMOS, SILVIA G NP	8/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
309769	Non-Physician Medical Practitioner	None	1649722950	0	0	RODRIGUEZ, MICAELA I NP	12/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	00	06000	37.67984327	-122.4730264	San Mateo County
309774	Non-Physician Medical Practitioner	None	1952388662	0	0	RITCHEY, ROBERT PHILLIP	4/14/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 SUTTER ST	None	YUBA CITY	CA	95991	3459	00	06000	39.14436772	-121.6133922	Sutter County
309789	Non-Physician Medical Practitioner	None	1316036528	0	0	RIVERS, JANIS	8/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
309796	Non-Physician Medical Practitioner	None	1699916817	0	0	RYDER, LISA D	5/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 5TH AVE	UNIT B	HALF MOON BAY	CA	94019	5126	00	06000	37.49633356	-122.4562081	San Mateo County
309800	Non-Physician Medical Practitioner	None	1821298308	0	0	RAY, ROSHNI DINESH	11/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 N PLACENTIA AVE	None	PLACENTIA	CA	92870	2332	00	06000	33.89044889	-117.8741363	Orange County
309818	Non-Physician Medical Practitioner	None	1871948398	0	0	RIGBY, ALISON J NP	8/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	945 ROCKDALE DR	None	SAN FRANCISCO	CA	94127	9412	00	06000	37.74073318	-122.4549316	San Francisco County
309819	Non-Physician Medical Practitioner	None	1073127841	0	0	RICHARDSON, JANICE NP	6/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	00	06000	34.51312455	-117.325854	San Bernardino County
309827	Non-Physician Medical Practitioner	None	1619042447	0	0	RAY, JOHN J	12/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5655 AURA AVE	None	TARZANA	CA	91356	1198	00	06000	34.17423476	-118.5542409	Los Angeles County
309835	Non-Physician Medical Practitioner	None	1730799214	0	0	ROGERS, CHRISTOPHER	5/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
309906	Non-Physician Medical Practitioner	None	1679819742	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3567 MT. WHITNEY AVENUE	None	RIVERDALE	CA	93656	0000	00	06000	36.43078218	-119.8620732	Fresno County
309921	Non-Physician Medical Practitioner	None	1811088909	0	0	RAMATOWSKI, LINDA C	8/29/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2800 L ST	#500	SACRAMENTO	CA	95816	5616	00	06000	38.571237	-121.469958	Sacramento County
309925	Non-Physician Medical Practitioner	None	1124058144	0	0	ROETTGEN, GAIL V NP	9/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 BOLINAS RD	None	FAIRFAX	CA	94930	2019	00	06000	37.9805992	-122.5939192	Marin County
309967	Non-Physician Medical Practitioner	None	1225227028	0	0	ROBBINS, ROBIN K NP	7/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12843 MUSTANG ST	None	CORONA	CA	92880	8949	00	06000	33.9665825	-117.5637046	Riverside County
309979	Non-Physician Medical Practitioner	None	1326068214	0	0	REYES, FLORITA	6/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1439 SPRING VALLEY DRIVE	None	ROSEVILLE	CA	95661	7338	00	06000	38.72708089	-121.2422273	Placer County
309982	Non-Physician Medical Practitioner	None	1730806068	0	0	RALPH, MAXWELL PA	5/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
310000	Non-Physician Medical Practitioner	None	1427633940	0	0	REED, BRYAN D PA	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2071 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
310009	Non-Physician Medical Practitioner	None	1720422934	0	0	RICHMOND, SSHANNON K NP	7/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1517 LA PALOMA DR	None	KNOXVILLE	TN	37923	1421	00	06000	35.94879409	-84.09214489	Knox County
310012	Non-Physician Medical Practitioner	None	1588091300	0	0	RYAN, MAUREEN ANN NP	12/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	690 LONG BRIDGE ST	UNIT 128	SAN FRANCISCO	CA	94158	2395	00	06000	37.77261309	-122.3925455	San Francisco County
310026	Non-Physician Medical Practitioner	None	1801887195	0	0	REED, DENAE KATINA	4/17/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
310092	Non-Physician Medical Practitioner	None	1457017618	0	0	ROYER, TIMOTHY NP	12/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	00	06000	34.13101049	-118.151532	Los Angeles County
310117	Non-Physician Medical Practitioner	None	1184249146	0	0	RAGLAND, TAKARA PA	10/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	00	06000	38.22519621	-122.1327459	Solano County
310137	Non-Physician Medical Practitioner	None	1619222742	0	0	ROLDAN, KARINA	1/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5810 JAMESON CT STE 1	None	CARMICHAEL	CA	95608	0881	00	06000	38.650878	-121.329036	Sacramento County
310149	Non-Physician Medical Practitioner	None	1750621728	0	0	RIBA, ALIZA	6/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 PARK NEWPORT	APT 303	NEWPORT BEACH	CA	92660	6004	00	06000	33.62670001	-117.8812454	Orange County
310157	Non-Physician Medical Practitioner	None	1376257899	0	0	RAHIM, ARIANNA S PA	1/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
310166	Non-Physician Medical Practitioner	None	1790063543	0	0	RUIZ, ERIKA	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5701 ELINORA LN	None	CYPRESS	CA	90630	4529	00	06000	33.81107346	-118.033164	Orange County
310172	Non-Physician Medical Practitioner	None	1972051019	0	0	RYAN, LISA PA	7/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
310178	Non-Physician Medical Practitioner	None	1326384579	0	0	REEDLEY COMMUNITY HOSPITAL	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	337 E KINGS ST	None	AVENAL	CA	93204	1630	00	06000	36.00253508	-120.1335979	Kings County
310189	Non-Physician Medical Practitioner	None	1245302579	0	0	RUELAS RUBIO, ROCIO NP	3/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	51544 CESAR CHAVEZ ST	1D	COACHELLA	CA	92236	1504	00	06000	33.674436	-116.181531	Riverside County
310212	Non-Physician Medical Practitioner	None	1427411677	0	0	ROSE, SALLY A NP	10/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
310236	Non-Physician Medical Practitioner	None	1881631786	0	0	RENTERIA, SUSAN KAY	8/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10885 TELEGRAPH RD	None	VENTURA	CA	93004	1272	00	06000	34.29407641	-119.1629642	Ventura County
310240	Non-Physician Medical Practitioner	None	1629104476	0	0	RUBEN, ELIZABETH ANN	5/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 SACRAMENTO ST	SUITE 216	SAN FRANCISCO	CA	94118	1625	00	06000	37.78707021	-122.4555217	San Francisco County
310241	Non-Physician Medical Practitioner	None	1932498516	0	0	ROBINSON, MARY L NP	4/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5331 WISHFIELD CIRCLE	None	HUNTINGTON BEACH	CA	92649	6015	00	06000	33.71742547	-118.0357258	Orange County
310262	Non-Physician Medical Practitioner	None	1457660359	0	0	RAMIREZ, RUDY M PA-C	7/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 W COLLEGE ST	None	COVINA	CA	91723	1902	00	06000	34.08746822	-117.8933488	Los Angeles County
310268	Non-Physician Medical Practitioner	None	1043760069	0	0	ROH, DONGYON NP	10/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4343 CORTE AL FRESCO	None	SAN DIEGO	CA	92130	2161	00	06000	32.94989078	-117.2230224	San Diego County
310288	Non-Physician Medical Practitioner	None	1679168181	0	0	ROBINSON, BROOKE A PA	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
310362	Non-Physician Medical Practitioner	None	1831181932	0	0	ROMONA, DOLAN	10/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4909 CENTENNIAL PLAZA WA	None	BAKERSFIELD	CA	93312	2011	00	06000	35.40410521	-119.0932287	Kern County
310441	Non-Physician Medical Practitioner	None	1588347488	0	0	RODAS, YENIFER NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
310454	Non-Physician Medical Practitioner	None	1932570801	0	0	ROUSE, BRIAN J PA-C	10/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2780 EUREKA WAY	None	REDDING	CA	96001	0223	00	06000	40.58585835	-122.4124086	Shasta County
310456	Non-Physician Medical Practitioner	None	1205370160	0	0	RODRIGUEZ, SERGIO E	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 5943	None	SALINAS	CA	93915	5943	00	06000	0	0	None
310498	Non-Physician Medical Practitioner	None	1508025628	0	0	RICO ERB, CHRISTINE JOY	10/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DR	G213	STANFORD	CA	94305	5847	00	06000	37.43562782	-122.1766097	Santa Clara County
310510	Non-Physician Medical Practitioner	None	1770629784	0	0	REPPE, CHARLES R	5/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	904 RUTH AVENUE	None	BELMONT	CA	94002	2036	00	06000	37.52768523	-122.2892968	San Mateo County
310513	Non-Physician Medical Practitioner	None	1972691384	0	0	ROBINSON, MANDA PA-C	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4305 SANTA FE AVE	None	LOS ANGELES	CA	90058	1714	00	06000	34.004754	-118.2302665	Los Angeles County
310564	Non-Physician Medical Practitioner	None	1427621820	0	0	ROTHHAMMER-RUIZ, ANA M NP	5/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
310565	Non-Physician Medical Practitioner	None	1619083896	0	0	RIGBY, DAVID MATTHEW	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
310571	Non-Physician Medical Practitioner	None	1982482444	0	0	RODARTE, GUADALUPE NP	10/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	425 E FOOTHILL BLVD	None	RIALTO	CA	92376	5153	00	06000	34.10673051	-117.363051	San Bernardino County
310583	Non-Physician Medical Practitioner	None	1821310103	0	0	REEDYFARR, SOMJAI R	3/29/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16678 E EDNA PLACE	None	COVINA	CA	91722	3016	00	06000	34.09250948	-117.919926	Los Angeles County
310586	Non-Physician Medical Practitioner	None	1770898710	0	0	RUELAS, ADRIAN PA	12/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	00	06000	34.08060971	-117.9958001	Los Angeles County
310608	Non-Physician Medical Practitioner	None	1225412869	0	0	RAGG, DEVAN PA	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	00	06000	38.74234873	-121.2521259	Placer County
310618	Non-Physician Medical Practitioner	None	1629673157	0	0	ROSARIO, DONNA M NP	5/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	00	06000	36.328536	-119.293569	Tulare County
310633	Non-Physician Medical Practitioner	None	1134198286	0	0	RAYMOND, MARY C NP	4/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16455 MAIN ST	STE 1	HESPERIA	CA	92345	3500	00	06000	34.42186386	-117.3038021	San Bernardino County
310654	Non-Physician Medical Practitioner	None	1518589027	0	0	REES, ELIANA PA-C	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
310681	Non-Physician Medical Practitioner	None	1275962383	0	0	ROMO, JORGE I	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3567 SUNFLOWER COURT	None	EL CENTRO	CA	92243	8425	00	06000	32.761872	-115.545722	Imperial County
310687	Non-Physician Medical Practitioner	None	1962449249	0	0	ROZELLE, MARY CHIEN	12/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 HEDGE RD	None	MENLO PARK	CA	94025	1714	00	06000	37.47606671	-122.1739674	San Mateo County
310690	Non-Physician Medical Practitioner	None	1053043034	0	0	RAMANAN, SHARMETHA NP	3/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1530 E CHEVY CHASE DR	STE 202	GLENDALE	CA	91206	4139	00	06000	34.150689	-118.2303855	Los Angeles County
310714	Non-Physician Medical Practitioner	None	1518322866	0	0	RYBERG, KAYCE H NP	3/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3640 CRESTLINE WAY	None	SOQUEL	CA	95073	2716	00	06000	36.99418774	-121.9475536	Santa Cruz County
310733	Non-Physician Medical Practitioner	None	1790941128	0	0	RODRIGUEZ, STEPHANY	4/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	5TH FLOOR, HEMATOLOGY	SAN FRANCISCO	CA	94143	0000	00	06000	37.76344756	-122.4581992	San Francisco County
310754	Non-Physician Medical Practitioner	None	1467678342	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11899 SHAW PLACE	None	HANFORD	CA	93230	6644	00	06000	36.30003132	-119.6312291	Kings County
310774	Non-Physician Medical Practitioner	None	1164705356	0	0	RIDDER, CYNDI N NP	6/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
310783	Non-Physician Medical Practitioner	None	1508820648	0	0	ROSS, MICHAEL M	5/4/1994	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 W ROWLAND ST	None	COVINA	CA	91723	2943	00	06000	34.078949	-117.8963031	Los Angeles County
310819	Non-Physician Medical Practitioner	None	1437581774	0	0	RIVAS, RICARDO	12/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23504 CANTERBURY WAY	None	MURRIETA	CA	92562	5065	00	06000	33.57179348	-117.2490547	Riverside County
310831	Non-Physician Medical Practitioner	None	1386966216	0	0	RINDAHL, KATHLEEN S NP	8/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2303 W LOMA LINDA AVE	None	FRESNO	CA	93711	0417	00	06000	36.84614914	-119.8331974	Fresno County
310859	Non-Physician Medical Practitioner	None	1316344302	0	0	ROUTSON, STEPHANIE M NP	5/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	395 E EVELYN AVE	APT 136	SUNNYVALE	CA	94086	3201	00	06000	37.37662148	-122.0266496	Santa Clara County
310877	Non-Physician Medical Practitioner	None	1669936860	0	0	RATIANI, LAUREN M NP	4/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	00	06000	38.442618	-122.6984265	Sonoma County
310909	Non-Physician Medical Practitioner	None	1518334465	0	0	RYAZANTSEVA, MARIYA I NP	2/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
310920	Non-Physician Medical Practitioner	None	1790238046	0	0	RUBALCAVA, LETICIA PA	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
310952	Non-Physician Medical Practitioner	None	1316508328	0	0	RADA, MELANIE NP	7/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
310968	Non-Physician Medical Practitioner	None	1922304922	0	0	RECINOS, CHRISTINA MAUREEN	8/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	00	06000	34.06593048	-118.2708351	Los Angeles County
310994	Non-Physician Medical Practitioner	None	1801840392	0	0	RYNDIN, NATALIA	4/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRAND AVE	EMERGENCY DEPARTMENT	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
311009	Non-Physician Medical Practitioner	None	1982874152	0	0	REUTER, JEMMY GISSELLA	5/14/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	720 N TUSTIN AVE	SUITE 100	SANTA ANA	CA	92705	3606	00	06000	33.75168221	-117.8342151	Orange County
311022	Non-Physician Medical Practitioner	None	1467461913	0	0	RAMOS, RICHARD D	2/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26627 MILLHOUSE DR	None	SANTA CLARA	CA	91350	5733	00	06000	34.42348924	-118.5285832	Los Angeles County
311023	Non-Physician Medical Practitioner	None	1215262118	0	0	RANADE, ALISON L	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4041 DAGGETT DR	None	GRANITE BAY	CA	95746	6473	00	06000	38.71951108	-121.2218464	Placer County
311066	Non-Physician Medical Practitioner	None	1235166810	0	0	ROBLES-GRAY, YASMIN C NP	7/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12186 HESPERIA RD	None	VICTORVILLE	CA	92395	5822	00	06000	34.47264211	-117.291816	San Bernardino County
311067	Non-Physician Medical Practitioner	None	1750943668	0	0	RINARD, BENJAMIN A PA-C	11/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
311116	Non-Physician Medical Practitioner	None	1831686104	0	0	RODRIGUEZ, LISA L PA-C	8/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
311124	Non-Physician Medical Practitioner	None	1790318525	0	0	ROY, CASSANDRA A NP	11/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
311143	Non-Physician Medical Practitioner	None	1023224755	0	0	RODRIGUEZ, MARIA G NP	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6570 LEWIS AVE	None	LONG BEACH	CA	90805	2452	00	06000	33.87399949	-118.1801538	Los Angeles County
311183	Non-Physician Medical Practitioner	None	1861048845	0	0	RICHARDS, TAYLEN G PA-C	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S. RAYMOND AVE	None	PASADENA	CA	91105	3229	00	06000	34.13185488	-118.1487468	Los Angeles County
311185	Non-Physician Medical Practitioner	None	1346306123	0	0	RADOFF, SUSAN	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 HARBOR DR	UNIT 3B	OCEANSIDE	CA	92054	1062	00	06000	33.20705347	-117.3898818	San Diego County
311202	Non-Physician Medical Practitioner	None	1215191689	0	0	RODNICK, AMY ZABINSKI	8/19/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
311206	Non-Physician Medical Practitioner	None	1134969702	0	0	RYBAK, IRYNA PA-C	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 STONE BLVD	STE 190	WEST SACRAMENTO	CA	95691	4055	00	06000	38.56318049	-121.5379228	Yolo County
311217	Non-Physician Medical Practitioner	None	1356018550	0	0	REYNOSO, MELISSA A NP	5/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1921 18TH ST	None	BAKERSFIELD	CA	93301	4205	00	06000	35.37525954	-119.024586	Kern County
311266	Non-Physician Medical Practitioner	None	1134112295	0	0	REGENTS OF THE UNIV OF CA	8/25/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
311305	Non-Physician Medical Practitioner	None	1245635218	0	0	REFORMINA, RYAN P NP	5/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2919 E CHEVY CHASE DRIVE	None	GLENDALE	CA	91206	1903	00	06000	34.16713033	-118.206053	Los Angeles County
311314	Non-Physician Medical Practitioner	None	1518645043	0	0	RODARTE, ERIK NP	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	00	06000	34.13396893	-118.1528162	Los Angeles County
311317	Non-Physician Medical Practitioner	None	1467799148	0	0	RYAN, SHAVAWN K	7/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 VILLA ST	APT 212	MOUNTAIN VIEW	CA	94041	1171	00	06000	37.39734275	-122.0878172	Santa Clara County
311338	Non-Physician Medical Practitioner	None	1619315595	0	0	ROJAS, ANDRES	6/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2096 SALERNO AVE	None	MENTONE	CA	92359	1328	00	06000	34.07547955	-117.1220756	San Bernardino County
311406	Non-Physician Medical Practitioner	None	1518714344	0	0	RAMAGE, KIMBERLY A NP	7/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E HARDY ST	IRA KAUFMAN PAVILION	INGLEWOOD	CA	90301	4106	00	06000	33.94909549	-118.3481595	Los Angeles County
311416	Non-Physician Medical Practitioner	None	1831634575	0	0	RODRIGUEZ, ANGELIKA A NP	2/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10982 ROEBLING AVE	APT 501	LOS ANGELES	CA	90024	2790	00	06000	34.06483729	-118.4495996	Los Angeles County
311422	Non-Physician Medical Practitioner	None	1649826678	0	0	REIMER, ERRIN B NP	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
311494	Non-Physician Medical Practitioner	None	1912520297	0	0	ROLLINS, SHAFON PA-C	1/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13939 14TH	STE 200	SAN LEANDRO	CA	94578	2601	00	06000	37.71377536	-122.1407447	Alameda County
311512	Non-Physician Medical Practitioner	None	1992235766	0	0	RASMUSSEN, KAYLA L NP	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1580 VALENCIA ST	STE 802	SAN FRANCISCO	CA	94110	4415	00	06000	37.74746923	-122.4202583	San Francisco County
311517	Non-Physician Medical Practitioner	None	1205995743	0	0	RITSEMA, ALMA C NP	10/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7 ELENA RD	None	WATSONVILLE	CA	95076	1612	00	06000	36.93842411	-121.856248	Santa Cruz County
311566	Non-Physician Medical Practitioner	None	1205828704	0	0	RISEMAN, REBECCA J NP	12/29/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3716 BALFOUR AVENUE	None	OAKLAND	CA	94610	1705	00	06000	37.81295473	-122.2391589	Alameda County
311598	Non-Physician Medical Practitioner	None	1174929194	0	0	RODRIGUEZ, CARLOS PA-C	5/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8590 RIO SAN DIEGO DR	SUITE 111	SAN DIEGO	CA	92108	5507	00	06000	32.77472926	-117.1448295	San Diego County
311649	Non-Physician Medical Practitioner	None	1225174170	0	0	REED, JULIE G	10/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	00	06000	37.43304542	-122.1759654	Santa Clara County
311661	Non-Physician Medical Practitioner	None	1477820470	0	0	ROBES, KATHERINE KAY	3/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 E. WHITTIER BLVD	None	WHITTIER	CA	90603	0000	00	06000	33.94435533	-117.9931159	Los Angeles County
311670	Non-Physician Medical Practitioner	None	1194562181	0	0	RAMIREZ, PATTY A NP	10/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	00	06000	38.570652	-121.4535465	Sacramento County
311684	Non-Physician Medical Practitioner	None	1245636182	0	0	REGNERY, SAMANTHA M	7/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3420 S CENTINELA AVE	APT 2	LOS ANGELES	CA	90066	1844	00	06000	34.01206361	-118.4399127	Los Angeles County
311696	Non-Physician Medical Practitioner	None	1568815595	0	0	RODOLFA, EUGENE Q	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7314 W ROBINWOOD LANE	None	FRESNO	CA	93723	8145	00	06000	36.8164762	-119.9224952	Fresno County
311697	Non-Physician Medical Practitioner	None	1760170419	0	0	REEVES, WILLIAM J PA	9/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311710	Non-Physician Medical Practitioner	None	1518360437	0	0	REYES, HONEYLEEN NP	4/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	412 W CARROLL AVE	SUITE 108	GLENDORA	CA	91741	4707	00	06000	34.13415622	-117.8702547	Los Angeles County
311717	Non-Physician Medical Practitioner	None	1568226223	0	0	RICK, CARLY M NP	4/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
311719	Non-Physician Medical Practitioner	None	1326636549	0	0	REYES, MONIQUE PA-C	5/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
311731	Non-Physician Medical Practitioner	None	1356755003	0	0	RABOLD, STEFANIE E NP	6/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3211 SAN TOMAS DR	None	OCEANSIDE	CA	92056	3251	00	06000	33.19816449	-117.3124381	San Diego County
311742	Non-Physician Medical Practitioner	None	1043762958	0	0	RICE, ALLISON G PA-C	8/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
311752	Non-Physician Medical Practitioner	None	1205480449	0	0	RAMIREZ, SAMANTHA NP	2/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
311765	Non-Physician Medical Practitioner	None	1033219662	0	0	ROBERTS, CRAIG A	12/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1759 FULTON	#140	FRESNO	CA	93721	1651	00	06000	36.74133692	-119.798338	Fresno County
311816	Non-Physician Medical Practitioner	None	1659634590	0	0	RUVALCABA, ERNESTO PA	5/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	00	06000	34.03833368	-118.3726622	Los Angeles County
311846	Non-Physician Medical Practitioner	None	1972939007	0	0	ROJAS, LORRAINE PA-C	1/23/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23451 MADISON ST	340	TORRANCE	CA	90505	4737	00	06000	33.81197627	-118.3478154	Los Angeles County
311852	Non-Physician Medical Practitioner	None	1710386057	0	0	ROOIJAKKERS, JOHANNA	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E CARRILLO ST	None	SANTA BARBARA	CA	93101	1460	00	06000	34.42588572	-119.6972176	Santa Barbara County
311886	Non-Physician Medical Practitioner	None	1134276041	0	0	RICK, LAURENCE M	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2348 LIVE OAK MEADOWS RD	None	MALIBU	CA	90265	3009	00	06000	34.06573758	-118.6418856	Los Angeles County
311890	Non-Physician Medical Practitioner	None	1487164539	0	0	ROSENDAHL, MARGARET M NP	8/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2122 CLINTON AVE	APT 1	ALAMEDA	CA	94501	4986	00	06000	37.76248522	-122.2519343	Alameda County
311913	Non-Physician Medical Practitioner	None	1154524429	0	0	ROKES, RAAFAT S	10/25/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
311934	Non-Physician Medical Practitioner	None	1619931128	0	0	RUELAS, RAUL	4/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11475 CENTRAL AVE	APT 3	CHINO HILLS	CA	91710	6432	00	06000	34.044912	-117.689452	San Bernardino County
311943	Non-Physician Medical Practitioner	None	1992906697	0	0	RICHARD, CURTIS L JR	7/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4134 PACIFIC COAST HWY	UNIT 138	TORRANCE	CA	90505	8713	00	06000	33.80691478	-118.3561672	Los Angeles County
311952	Non-Physician Medical Practitioner	None	1629493150	0	0	REYNOLDS, MEGAN A CNP	9/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12677 HESPERIA RD	STE 160	VICTORVILLE	CA	92395	7735	00	06000	34.48148078	-117.2906175	San Bernardino County
311982	Non-Physician Medical Practitioner	None	1346422821	0	0	RIVAS, LANCE D	12/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3238 30TH STREET	None	SAN DIEGO	CA	92104	4508	00	06000	32.738931	-117.1293455	San Diego County
311989	Non-Physician Medical Practitioner	None	1720217433	0	0	RHODE, JULIANNA D W	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26221 BEACHCOMBER LN	None	SAN JUAN CAPISTRA	CA	92675	1243	00	06000	33.53014497	-117.6720178	Orange County
311999	Non-Physician Medical Practitioner	None	1639863798	0	0	RATAJCZAK, CELESTE NP	7/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	00	06000	33.75116909	-116.9601666	Riverside County
312017	Non-Physician Medical Practitioner	None	1487902565	0	0	ROBERS, JOSHUA M NP	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7733 HAMPTON AVE	STE 2	LOS ANGELES	CA	90033	5313	00	06000	34.09352735	-118.3578468	Los Angeles County
312085	Non-Physician Medical Practitioner	None	1265530018	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1041 ROSE AVE	None	SELMA	CA	93662	3240	00	06000	36.56879252	-119.596257	Fresno County
312096	Non-Physician Medical Practitioner	None	1568092260	0	0	RAMOS, STACIE ANN K NP	9/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 E SOUTH ST	STE 304	LONG BEACH	CA	90805	4549	00	06000	33.86018093	-118.1537163	Los Angeles County
312171	Non-Physician Medical Practitioner	None	1619576410	0	0	REEVES, OLIVIA B NP	4/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
312196	Non-Physician Medical Practitioner	None	1891738324	0	0	REYES, EDGAR	2/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10316 CORS AVE	None	DOWNEY	CA	90241	2919	00	06000	33.94148307	-118.1099668	Los Angeles County
312210	Non-Physician Medical Practitioner	None	1215361589	0	0	RICHARDSON, KATHRYN MARIE	10/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
312233	Non-Physician Medical Practitioner	None	1548843311	0	0	RUIZ, JAIMIE L NP	10/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
312248	Non-Physician Medical Practitioner	None	1114255056	0	0	REYES, MARIBEL ESPERANZA	9/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2240 GLADSTONE DR	SUITE #4	PITTSBURG	CA	94565	5126	00	06000	38.00627609	-121.8667626	Contra Costa County
312252	Non-Physician Medical Practitioner	None	1134519408	0	0	REHM, KAYLA E PA-C	2/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2021 VAN KARAJAN DR	None	RANCHO PALOS VERD	CA	90275	1607	00	06000	33.75888052	-118.3160484	Los Angeles County
312258	Non-Physician Medical Practitioner	None	1568835833	0	0	RIORDAN, BRIGID M NP	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
312260	Non-Physician Medical Practitioner	None	1164888780	0	0	RICE, THADDEUS S NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10280 KURT ST	None	SYLMAR	CA	91342	6932	00	06000	34.27703884	-118.3535815	Los Angeles County
312262	Non-Physician Medical Practitioner	None	1972984896	0	0	REYNOLDS, LINDSEY P	1/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
312280	Non-Physician Medical Practitioner	None	1538837521	0	0	RUANO, CHASE PA	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
312306	Non-Physician Medical Practitioner	None	1861435323	0	0	ROMEO, NICOLE WILLIAMS	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
312311	Non-Physician Medical Practitioner	None	1619616687	0	0	REESE, BRANDON A NP	3/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
312336	Non-Physician Medical Practitioner	None	1194376129	0	0	RODRIGUEZ-FEO, CASSIE M PA-C	10/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	909 S FAIR OAKS AVE	None	PASADENA	CA	91105	2625	00	06000	34.13056002	-118.1503751	Los Angeles County
312347	Non-Physician Medical Practitioner	None	1194193748	0	0	RANDHAWA, HARJEET K NP	10/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1739 COLORADO AVE	None	TURLOCK	CA	95382	2714	00	06000	37.508976	-120.835306	Stanislaus County
312348	Non-Physician Medical Practitioner	None	1871698241	0	0	ROSS, CAROLEE A	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	690 GUZZI LN	STE. C	SONORA	CA	95370	5289	00	06000	37.97649546	-120.3719077	Tuolumne County
312367	Non-Physician Medical Practitioner	None	1477291169	0	0	ROSEFF, MAIYA PA-C	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 S BROOKHURST ST	SUITE # 101	ANAHEIM	CA	92804	3510	00	06000	33.823647	-117.9589675	Orange County
312389	Non-Physician Medical Practitioner	None	1760975825	0	0	RANABHAT, AMBIKA NP	10/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
312400	Non-Physician Medical Practitioner	None	1215110879	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	216 E FRESNO ST	None	AVENAL	CA	93204	1525	00	06000	36.00349612	-120.1355935	Kings County
312418	Non-Physician Medical Practitioner	None	1104946250	0	0	ROBERTS, MELISSA B	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1432 TICONDEROGA DR	None	FRESNO	CA	93720	1336	00	06000	36.87856648	-119.7575235	Fresno County
312459	Non-Physician Medical Practitioner	None	1093831257	0	0	ROCKSTAD, RICHARD T	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11315 WYBOURN	None	RIVERSIDE	CA	92503	5165	00	06000	33.89626406	-117.4760909	Riverside County
312483	Non-Physician Medical Practitioner	None	1871517532	0	0	ROMITO, JANICE M	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1301 CONCORD TERRACE	ATTN.: MEDICAL STAFF CRE	FORT LAUDERDALE	FL	33323	2843	00	06000	26.13430094	-80.34196843	Broward County
312485	Non-Physician Medical Practitioner	None	1710917018	0	0	ROLL, GUNNAR	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	75 NIELSON STREET	None	WATSONVILLE	CA	95076	0000	00	06000	36.9282117	-121.7937089	Santa Cruz County
312520	Non-Physician Medical Practitioner	None	1033624036	0	0	RUSTIA, CORNELIO E	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1324 WILLOWSTONE CT	None	SAN JACINTO	CA	92582	4247	00	06000	33.77646527	-116.9860047	Riverside County
312554	Non-Physician Medical Practitioner	None	1194299404	0	0	ROSETE, LEIKAMARRIE NP	3/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23861 MCBEAN PKWY	STE A-1	VALENCIA	CA	91355	2003	00	06000	34.39567343	-118.5542698	Los Angeles County
312577	Non-Physician Medical Practitioner	None	1588793483	0	0	RIEDEMAN, NANETTE L	12/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	60 EAST 21ST STREET	None	MERCED	CA	95340	3918	00	06000	37.3022576	-120.4724698	Merced County
312581	Non-Physician Medical Practitioner	None	1104221548	0	0	ROSCHE, NINA E NP	12/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2049 HAYES ST	APT 2	SAN FRANCISCO	CA	94117	1127	00	06000	37.77339113	-122.4501934	San Francisco County
312597	Non-Physician Medical Practitioner	None	1629260971	0	0	ROZOVA, ALLA P	2/22/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
312598	Non-Physician Medical Practitioner	None	1497282016	0	0	RHODES, BREZYA	10/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
312603	Non-Physician Medical Practitioner	None	1689780629	0	0	ROBERTS, LAURIE L CNM	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15758 RAWHIDE LANE	None	RIVERSIDE	CA	92504	9520	00	06000	33.85441148	-117.3833775	Riverside County
312604	Non-Physician Medical Practitioner	None	1154547040	0	0	RAY, JANICE M NP	1/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7102 FIREBAUGH STREET	None	BAKERSFIELD	CA	93313	4944	00	06000	35.29745989	-119.0819106	Kern County
312623	Non-Physician Medical Practitioner	None	1871864751	0	0	ROSENBERG, CORINNE N PA	10/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312632	Non-Physician Medical Practitioner	None	1477133668	0	0	RAMOS, FATIMA B NP	2/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2040 PACIFIC COAST HWY	SUITE S	LOMITA	CA	90717	2660	00	06000	33.78948351	-118.316493	Los Angeles County
312633	Non-Physician Medical Practitioner	None	1083082234	0	0	RUGGE, ASHLEY M	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 S SYCAMORE AVE	None	RIALTO	CA	92376	6579	00	06000	34.096419	-117.3659995	San Bernardino County
312645	Non-Physician Medical Practitioner	None	1033625397	0	0	ROCKS, SARAH PA	5/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	00	06000	33.861339	-118.281473	Los Angeles County
312647	Non-Physician Medical Practitioner	None	1417556705	0	0	RUIZ, MALINA J CNP	3/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
312685	Non-Physician Medical Practitioner	None	1184960684	0	0	RIVERA, CHRISTINE A NP	10/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2440 EAST NORMANDY DR	None	ANAHEIM	CA	92806	3626	00	06000	33.84214739	-117.881679	Orange County
312693	Non-Physician Medical Practitioner	None	1023194750	0	0	REAVES, FREDERICK C	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2727 WINKLER AVE	None	FORT MYERS	FL	33901	9358	00	06000	26.606358	-81.858375	Lee County
312700	Non-Physician Medical Practitioner	None	1891201968	0	0	RASHTI, STEFANIE L NP	12/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	00	06000	34.42739162	-119.7253175	Santa Barbara County
312730	Non-Physician Medical Practitioner	None	1962770636	0	0	RADMAN, MIRKA A NP	5/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 SAN ELIJO ST	None	SAN DIEGO	CA	92106	3465	00	06000	32.70826435	-117.2401531	San Diego County
312748	Non-Physician Medical Practitioner	None	1255878898	0	0	REYNOSO, JIHAN P NP	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27465 HONEYDEW CT	None	SANTA CLARITA	CA	91350	5764	00	06000	34.4344645	-118.497633	Los Angeles County
312808	Non-Physician Medical Practitioner	None	1881875805	0	0	RODRIGUEZ, MONICA NP	11/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 OLD RIVER RD	250	BAKERSFIELD	CA	93311	9515	00	06000	35.35127492	-119.1142991	Kern County
312850	Non-Physician Medical Practitioner	None	1407517493	0	0	REYES, MIA C PA	4/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
312867	Non-Physician Medical Practitioner	None	1558735340	0	0	ROWELL-CONNORS, SANDRA D NP	1/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6750 GOLDEN PHEASANT	PARKWAY	CRESTON	CA	93432	9707	00	06000	35.50215369	-120.5228842	San Luis Obispo County
312905	Non-Physician Medical Practitioner	None	1114349446	0	0	ROBERTS, STEFANIE S NP	10/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	407 N OAK STREET	None	RICHLAND	IA	52585	9702	00	06000	41.188131	-91.99322647	Keokuk County
312917	Non-Physician Medical Practitioner	None	1831333459	0	0	REGANRAINEY, MARGARET A NP	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4210 REVERE PL	None	CULVER CITY	CA	90232	3421	00	06000	34.01447737	-118.3941267	Los Angeles County
312922	Non-Physician Medical Practitioner	None	1316685258	0	0	RODRIGUEZ, MONA O PA-C	2/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
312941	Non-Physician Medical Practitioner	None	1063700441	0	0	RIAD, CHRISTINA MAHER	10/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE, STE	ATTN: CHRISTINA RIAD	LOS ANGELES	CA	90095	0000	00	06000	34.06373445	-118.443537	Los Angeles County
312947	Non-Physician Medical Practitioner	None	1508881376	0	0	REEDLEY COMMUNITY HOSPITAL	1/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 W EL MONTE WAY	None	DINUBA	CA	93618	1554	00	06000	36.54587921	-119.3967215	Tulare County
313004	Non-Physician Medical Practitioner	None	1124214382	0	0	ROSTAD-RUFFNER, RAGNA C.	11/19/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VLG COMMONS	None	CHICO	CA	95928	3979	00	06000	39.750084	-121.7934327	Butte County
313009	Non-Physician Medical Practitioner	None	1982250833	0	0	ROBERTS, STEPHANIE M NP	12/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12677 HESPERIA ROAD	SUITE 130	VICTORVILLE	CA	92395	7735	00	06000	34.48148078	-117.2906175	San Bernardino County
313049	Non-Physician Medical Practitioner	None	1801127170	0	0	ROMERO, RAFAEL	5/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	521 E PARK ST	None	ONTARIO	CA	91761	1724	00	06000	34.059132	-117.645165	San Bernardino County
313065	Non-Physician Medical Practitioner	None	1124584818	0	0	ROBAINA, ANISLEY NP	10/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
313066	Non-Physician Medical Practitioner	None	1083722540	0	0	ROSS, JILL C	9/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4229 E 6TH ST	None	LONG BEACH	CA	90814	1704	00	06000	33.77353478	-118.1430395	Los Angeles County
313103	Non-Physician Medical Practitioner	None	1699897165	0	0	ROSS, SUMMER LYNN	1/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2760 N. BALLS FERRY RD.	None	ANDERSON	CA	96007	3537	00	06000	40.45489921	-122.2878254	Shasta County
313117	Non-Physician Medical Practitioner	None	1598260671	0	0	RIES, JACOB W PA-C	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
313139	Non-Physician Medical Practitioner	None	1114288586	0	0	RIVERSIDE LIFE SERVICES, INC	1/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3727 MCCRAY ST	None	RIVERSIDE	CA	92506	2928	00	06000	33.948557	-117.3976041	Riverside County
313187	Non-Physician Medical Practitioner	None	1750582748	0	0	ROEDELL, JULIE TIMMERMAN	9/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	H2149, MC 5233	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313188	Non-Physician Medical Practitioner	None	1164522934	0	0	RYAN, KATHLEEN MARY	5/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
313224	Non-Physician Medical Practitioner	None	1891880811	0	0	RAUSCHER, BEVERLY D	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15265 FLAGSTAFF ST	None	VICTORVILLE	CA	92394	0820	00	06000	34.52601407	-117.3374055	San Bernardino County
313233	Non-Physician Medical Practitioner	None	1316042427	0	0	RITTER, MARY L PA	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
313262	Non-Physician Medical Practitioner	None	1033410717	0	0	ROSS, ANGELICA MARIA	5/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1226 N BROADWAY	None	SANTA ANA	CA	92701	3412	00	06000	33.75547362	-117.8697389	Orange County
313271	Non-Physician Medical Practitioner	None	1821507716	0	0	REVILLA, REINALD A NP	12/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	00	06000	33.691185	-117.9910425	Orange County
313279	Non-Physician Medical Practitioner	None	1891304218	0	0	RASBERRY, JOSEPH	11/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
313295	Non-Physician Medical Practitioner	None	1093029001	0	0	RENTERIA, DIANE VANG	2/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
313319	Non-Physician Medical Practitioner	None	1659965259	0	0	RANEY, JONATHAN PA	5/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
313348	Non-Physician Medical Practitioner	None	1295017523	0	0	ROHDE, GISELE R	12/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	466 BELLO ST	None	PISMO BEACH	CA	93449	2702	00	06000	35.14204699	-120.6364809	San Luis Obispo County
313352	Non-Physician Medical Practitioner	None	1538114301	0	0	RIGOR, STEVEN A	8/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	209 LIGHTHOUSE DRIVE	None	WATSONVILLE	CA	95076	7006	00	06000	36.90769011	-121.7739642	Santa Cruz County
313354	Non-Physician Medical Practitioner	None	1215456389	0	0	REDZOVIC, HALIL PA	7/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23931375	-121.8014189	Santa Clara County
313397	Non-Physician Medical Practitioner	None	1669617197	0	0	RADY CHILDREN'S HOSPITAL-SAN DIEGO	2/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
313405	Non-Physician Medical Practitioner	None	1003937194	0	0	RIVERA, JOSE ANTONIO	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7503 ATLANTIC AVE STE D	None	CUDAHY	CA	90201	0000	00	06000	33.96785429	-118.1876544	Los Angeles County
313411	Non-Physician Medical Practitioner	None	1518156371	0	0	RIVERA, SYLVIA A NP	3/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17732 TUDE CT	None	APPLE VALLEY	CA	92307	1260	00	06000	34.5484736	-117.2772577	San Bernardino County
313434	Non-Physician Medical Practitioner	None	1417972282	0	0	REEDLEY COMMUNITY HOSPITAL	1/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	155 S NEWMARK AVENUE	None	PARLIER	CA	93648	2531	00	06000	36.60675722	-119.5299369	Fresno County
313435	Non-Physician Medical Practitioner	None	1962033894	0	0	RUMBO, DIANA CNM	8/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
313437	Non-Physician Medical Practitioner	None	1124467659	0	0	RENE, PATERSON	2/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1525 ALCATRAZ AVENUE	APT 5	BERKELEY	CA	94703	2658	00	06000	37.8480734	-122.2767266	Alameda County
313445	Non-Physician Medical Practitioner	None	1578949954	0	0	RODRIGUEZ, JOSE T	1/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	396 S CALIFORNIA AVE	UNIT 2161	WEST COVINA	CA	91793	3486	00	06000	34.06936961	-117.9289189	Los Angeles County
313447	Non-Physician Medical Practitioner	None	1366984825	0	0	RUDDY, JAMIE L PA-C	7/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	938 N CHERRY ST	None	VISALIA	CA	93274	2210	00	06000	36.221211	-119.337643	Tulare County
313467	Non-Physician Medical Practitioner	None	1730832825	0	0	RAMOS, GRACE C CNM	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
313473	Non-Physician Medical Practitioner	None	1811172067	0	0	ROJAS, PABLO G PA	5/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
313495	Non-Physician Medical Practitioner	None	1992876429	0	0	ROSE, MIRIAM M.	8/9/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
313496	Non-Physician Medical Practitioner	None	1730429580	0	0	RUSSELL, LORI J NP	12/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11641 CROVELAND AVE	None	WHITTIER	CA	90604	3642	00	06000	33.92554223	-117.9874456	Los Angeles County
313509	Non-Physician Medical Practitioner	None	1841714136	0	0	RASMUSSEN, SARAH B NP	5/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5142 HOLLISTER AVE	APT 104	SANTA BARBARA	CA	93111	2526	00	06000	34.43501617	-119.8033699	Santa Barbara County
313594	Non-Physician Medical Practitioner	None	1598438699	0	0	REDDIC, SHALAINE NP	8/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
313630	Non-Physician Medical Practitioner	None	1841436185	0	0	REYES, RUBY P S NP	5/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4507 GRANITE MOUNTAIN CT	None	BAKERSFIELD	CA	93311	3082	00	06000	35.31398435	-119.1109025	Kern County
313702	Non-Physician Medical Practitioner	None	1386372035	0	0	ROE, CALEB P PA	1/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
313712	Non-Physician Medical Practitioner	None	1194292193	0	0	RHEE, JANET PA	10/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14443 CULVER DR	14443-A	IRVINE	CA	92604	0343	00	06000	33.70541708	-117.7871432	Orange County
313714	Non-Physician Medical Practitioner	None	1265967574	0	0	ROBERTS, HANNA E NP	6/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13209 BLODGETT AVE	None	DOWNEY	CA	90242	5203	00	06000	33.90955488	-118.1454331	Los Angeles County
313731	Non-Physician Medical Practitioner	None	1306220116	0	0	RAOOFI, MIZIANA RN	10/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	00	06000	38.65716	-121.1738175	Sacramento County
313768	Non-Physician Medical Practitioner	None	1386264893	0	0	RATANPAL, KARISSA CNM	4/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
313774	Non-Physician Medical Practitioner	None	1619147402	0	0	RAMIREZ, CLAUDIA P NP	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 VERNON AVE	None	VENICE	CA	90291	2607	00	06000	33.99598552	-118.4716677	Los Angeles County
313777	Non-Physician Medical Practitioner	None	1538547237	0	0	RAHIMI, FIROZA NP	6/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4229 PICKEREL DRIVE	None	UNION CITY	CA	94587	2586	00	06000	37.59240549	-122.082192	Alameda County
313794	Non-Physician Medical Practitioner	None	1477176063	0	0	REYES, MARIE E NP	1/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 CASTRO ST	175A	SAN FRANCISCO	CA	94114	1010	00	06000	37.76829732	-122.4357056	San Francisco County
313802	Non-Physician Medical Practitioner	None	1437483914	0	0	REUTER, GIANA D C NP	11/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10354 RUE FONTENAY	None	SAN DIEGO	CA	92131	2266	00	06000	32.90565913	-117.071569	San Diego County
313849	Non-Physician Medical Practitioner	None	1104976349	0	0	RHINELANDER, SUSAN L NP	8/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	443 PALM AVE	None	CORONADO	CA	92118	1722	00	06000	32.69506874	-117.1785062	San Diego County
313865	Non-Physician Medical Practitioner	None	1093018673	0	0	RUPPERT, ARTHUR S	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
313915	Non-Physician Medical Practitioner	None	1447552229	0	0	REYES, LYDIA A NP	11/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16841 QUAIL COUNTRY AVE	None	CHINO HILLS	CA	91709	6385	00	06000	33.94738253	-117.681304	San Bernardino County
313954	Non-Physician Medical Practitioner	None	1811368632	0	0	RAFF, ALICE C	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	460 S PARK RD	SUITE 210	HOLLYWOOD	CA	33021	1200	00	06000	26.00705148	-80.176995	Broward County
314004	Non-Physician Medical Practitioner	None	1073147963	0	0	ROSIL, GABRIELLA A NP	1/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N WESTERN AVE	STE 305	SAN BERNARDINO	CA	92411	1354	00	06000	34.1315778	-117.3182453	San Bernardino County
314012	Non-Physician Medical Practitioner	None	1700567948	0	0	RANADA, GIA GABRIELLE PA-C	7/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
314085	Non-Physician Medical Practitioner	None	1841915139	0	0	RYAN, AMBROSE T PA-C	10/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S BRISTOL ST	STE 16	SANTA ANA	CA	92704	3439	00	06000	33.731874	-117.8852195	Orange County
314101	Non-Physician Medical Practitioner	None	1366580466	0	0	RICHTER, TODD C	4/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
314166	Non-Physician Medical Practitioner	None	1366688418	0	0	REDWOOD COAST MEDICAL SERVICES, INC.	12/20/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	175 MAIN STREET	None	POINT ARENA	CA	95468	0000	00	06000	38.90858254	-123.6924008	Mendocino County
314179	Non-Physician Medical Practitioner	None	1053960955	0	0	REYES, ARMANDO J PA-C	6/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
314266	Non-Physician Medical Practitioner	None	1801522487	0	0	RODRIGUEZ, EUGENIA PA	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
314360	Non-Physician Medical Practitioner	None	1912280173	0	0	RAMIREZ, ELVIA	11/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	815 WASHINGTON BLVD	None	MONTEBELLO	CA	90640	6123	00	06000	33.99411697	-118.1169341	Los Angeles County
314401	Non-Physician Medical Practitioner	None	1225086556	0	0	REMILLARD, SANA NP	8/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
314424	Non-Physician Medical Practitioner	None	1649848268	0	0	RAMIREZ, ANNIE NP	11/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	00	06000	33.98921547	-118.2242565	Los Angeles County
314450	Non-Physician Medical Practitioner	None	1306258058	0	0	RUIZ, CHRISTOPHER	2/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	974 W FOOTHILL BLVD	None	UPLAND	CA	91786	3728	00	06000	34.106562	-117.6651435	San Bernardino County
314458	Non-Physician Medical Practitioner	None	1851359327	0	0	RAMIREZ, VICTOR	10/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17695 ARROW BLVD	CLINICA MEDICA FAMILIAR	FONTANA	CA	92335	4041	00	06000	34.09939175	-117.4184788	San Bernardino County
314462	Non-Physician Medical Practitioner	None	1043880750	0	0	REECE, CHARLA C NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	00	06000	32.99706	-117.05544	San Diego County
314466	Non-Physician Medical Practitioner	None	1780006700	0	0	RAMIREZ, JULIE A NP	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	61 SADDLE COURT	None	TRES PINOS	CA	95075	0000	00	06000	36.79988012	-121.3261598	San Benito County
314485	Non-Physician Medical Practitioner	None	1063736593	0	0	RIVAS, MARGARET E NP	4/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11001 NESTLE AVE	None	NORTHRIDGE	CA	91326	1607	00	06000	34.26981258	-118.5306785	Los Angeles County
314499	Non-Physician Medical Practitioner	None	1619281631	0	0	RIBERA, JESSICA L	11/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36909 42ND STREET EAST	None	PALMDALE	CA	93552	5147	00	06000	34.5521435	-118.0541819	Los Angeles County
314541	Non-Physician Medical Practitioner	None	1881760320	0	0	RAMIREZ, GARY S PA-C	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12214 LAKEWOOD BLVD	110	DOWNEY	CA	90242	2662	00	06000	33.92368787	-118.1326218	Los Angeles County
314555	Non-Physician Medical Practitioner	None	1598941825	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	811 E 11TH STREET	None	REEDLEY	CA	93654	2926	00	06000	36.60347345	-119.4404912	Fresno County
314556	Non-Physician Medical Practitioner	None	1588317937	0	0	RICE, VICTORIA R PA	2/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 TERRACINA BLVD	SUITE 102	REDLANDS	CA	92373	4865	00	06000	34.03858912	-117.2066515	San Bernardino County
314592	Non-Physician Medical Practitioner	None	1306205208	0	0	RUIZ, LORENA H NP	9/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3568 TIMOTHY WAY	None	RIVERSIDE	CA	92506	3019	00	06000	33.95059883	-117.390872	Riverside County
314624	Non-Physician Medical Practitioner	None	1982630885	0	0	ROBERTS, JENNIFER FELLINI	3/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 W BULLARD AVE	SUITE 124	CLOVIS	CA	93612	0861	00	06000	36.82308345	-119.714949	Fresno County
314649	Non-Physician Medical Practitioner	None	1790844116	0	0	REISS-KONCAR, DIANA	11/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 GLENWOOD CIR	APT 253	MONTEREY	CA	93940	7885	00	06000	36.58643872	-121.8874331	Monterey County
314668	Non-Physician Medical Practitioner	None	1831588060	0	0	RODRIGUEZ, MELISSA NP	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8715 CRENSHAW BLVD	None	INGLEWOOD	CA	90305	2332	00	06000	33.958431	-118.326516	Los Angeles County
314670	Non-Physician Medical Practitioner	None	1053018549	0	0	ROSALES, JACOB NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	00	06000	35.366706	-119.0959425	Kern County
314676	Non-Physician Medical Practitioner	None	1275965295	0	0	RODRIGUEZ CANOVA, MEGAN	8/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	00	06000	38.35581953	-121.9530257	Solano County
314684	Non-Physician Medical Practitioner	None	1902106214	0	0	RORIE, ANNE FRANCES	5/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	RM 62-182	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
314695	Non-Physician Medical Practitioner	None	1427622992	0	0	RAMIREZ, SANGGITHA K PA	8/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
314714	Non-Physician Medical Practitioner	None	1386199370	0	0	RUPPERT, BEVERLY S PA-C	9/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3273 CLAREMONT WAY	SUITE 100	NAPA	CA	94558	3306	00	06000	38.32062499	-122.3012501	Napa County
314782	Non-Physician Medical Practitioner	None	1619524626	0	0	ROMINE, HOLLY E NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
314806	Non-Physician Medical Practitioner	None	1922654300	0	0	RAMOS, ENID S NP	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47110 WASHINGTON ST STE	None	LA QUINTA	CA	92253	2186	00	06000	33.70698194	-116.2929821	Riverside County
314815	Non-Physician Medical Practitioner	None	1235154006	0	0	REEDLEY COMMUNITY HOSPITAL	1/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	00	06000	36.62466137	-119.3227461	Fresno County
314888	Non-Physician Medical Practitioner	None	1548435092	0	0	REIT, ILEANA S NP	12/31/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28151 HIGHRIDGE RD	APT 308	RANCHO PALOS VERD	CA	90275	3485	00	06000	33.77560292	-118.3834853	Los Angeles County
314941	Non-Physician Medical Practitioner	None	1164035374	0	0	ROELL, ERIKA L PA-C	9/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	00	06000	34.11101693	-117.5740616	San Bernardino County
314967	Non-Physician Medical Practitioner	None	1871972539	0	0	RAND, SARAH L S NP	7/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26232 LOS VIVEROS	STE C	MISSION VIEJO	CA	92691	2882	00	06000	33.62249542	-117.6724598	Orange County
314977	Non-Physician Medical Practitioner	None	1750044228	0	0	RAYES, RAZAN	6/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 HAGGIN OAKS BLVD	SUITE 202	BAKERSFIELD	CA	93311	1333	00	06000	35.341758	-119.1011105	Kern County
314980	Non-Physician Medical Practitioner	None	1841527744	0	0	RHEINWALD-JONES, ALEXIS F NP	1/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
314984	Non-Physician Medical Practitioner	None	1508256751	0	0	ROSELL, JIM S PA-C	8/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
315008	Non-Physician Medical Practitioner	None	1831943349	0	0	RAMOS, MIRNA O NP	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7151 LINCOLN AVE	STE B	BUENA PARK	CA	90620	4614	00	06000	33.83201852	-118.0080675	Orange County
315009	Non-Physician Medical Practitioner	None	1710167853	0	0	REINER, GAIL ELLEN	6/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9000	00	06000	32.7537975	-117.1658298	San Diego County
315019	Non-Physician Medical Practitioner	None	1558690651	0	0	ROBINSON, JAMES M NP	3/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
315021	Non-Physician Medical Practitioner	None	1992039572	0	0	ROSSI, SAYURI V NP	10/31/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3413 S LOWELL ST	None	SANTA ANA	CA	92707	3846	00	06000	33.70197835	-117.8791848	Orange County
315023	Non-Physician Medical Practitioner	None	1952819096	0	0	ROUTLEDGE, ERIN N NP	7/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
315024	Non-Physician Medical Practitioner	None	1174557284	0	0	REYES, CESAR A	6/12/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13001 SANDY LANE	None	DOWNEY	CA	90241	4411	00	06000	33.91363802	-118.1455359	Los Angeles County
315028	Non-Physician Medical Practitioner	None	1558531921	0	0	ROULIER, RACHELLE MARIE	2/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	19 MYRTLE ST	None	MEDFORD	OR	97504	7337	00	06000	42.32716309	-122.8629666	Jackson County
315095	Non-Physician Medical Practitioner	None	1770978660	0	0	RUMPELTES, CAROLYN J PA-C	10/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
315103	Non-Physician Medical Practitioner	None	1992012306	0	0	ROLLING HILLS CLINIC	3/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
315118	Non-Physician Medical Practitioner	None	1043947880	0	0	RUELAS, JOANNA NP	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1336 NATIVIDAD RD	None	SALINAS	CA	93906	3101	00	06000	36.69908763	-121.6352503	Monterey County
315177	Non-Physician Medical Practitioner	None	1821343757	0	0	ROCHA, JENNIFER A	9/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4655 HIDALGO AVE	None	ATASCADERO	CA	93422	3549	00	06000	35.50717186	-120.6651991	San Luis Obispo County
315183	Non-Physician Medical Practitioner	None	1245837095	0	0	RILEY, KIMBERLY A NP	2/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	00	06000	40.78052829	-124.1363953	Humboldt County
315199	Non-Physician Medical Practitioner	None	1366435083	0	0	ROSENBERG, STEFANIE M PA-C	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
315213	Non-Physician Medical Practitioner	None	1205228699	0	0	RIVERA, LOVELLE E	3/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18010 WEST ANNES CIR	APT 206	CANYON COUNTRY	CA	91387	6468	00	06000	34.41126563	-118.4512398	Los Angeles County
315238	Non-Physician Medical Practitioner	None	1093757064	0	0	RANCHEZ, JENNIFER R NP	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8277 MEDFORD STREET	None	VENTURA	CA	93004	4033	00	06000	34.2719908	-119.1821968	Ventura County
315245	Non-Physician Medical Practitioner	None	1104170844	0	0	REZAIE-HOMAMI, LALEH NP	12/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2084 JANICE DRIVE	None	PLEASANT HILL	CA	94523	3415	00	06000	37.94869879	-122.0535481	Contra Costa County
315260	Non-Physician Medical Practitioner	None	1205162823	0	0	ROOZROKH, AFSHID	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29525 CANWOOD ST	250	AGOURA HILLS	CA	91301	4233	00	06000	34.14724223	-118.7675471	Los Angeles County
315271	Non-Physician Medical Practitioner	None	1295549202	0	0	RICE, CHRISTINE NP	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	00	06000	33.98921547	-118.2242565	Los Angeles County
315276	Non-Physician Medical Practitioner	None	1609984442	0	0	REED-ELAM, JESSICA	7/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 N PALM CANYON DR ST	None	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
315283	Non-Physician Medical Practitioner	None	1679022628	0	0	RANGEL, LENA CNP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
315286	Non-Physician Medical Practitioner	None	1922662683	0	0	ROGERS, KATIE PA	7/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
315317	Non-Physician Medical Practitioner	None	1871333856	0	0	RANGEL, MELANIE PA-C	9/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
315334	Non-Physician Medical Practitioner	None	1326173295	0	0	RIOS, DONNA	1/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13515 GLADSTONE AVE	None	SYLMAR	CA	91342	2213	00	06000	34.31761996	-118.4371059	Los Angeles County
315352	Non-Physician Medical Practitioner	None	1194193110	0	0	REITON, CLAIRE A PA-C	10/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
315413	Non-Physician Medical Practitioner	None	1154905016	0	0	RUNYON, JANN B NP	9/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SANTA MONICA BLVD	580	SANTA MONICA	CA	90404	2000	00	06000	34.02901811	-118.4795396	Los Angeles County
315415	Non-Physician Medical Practitioner	None	1073259479	0	0	RICHARDSON, KATIE L PA	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21250 HAWTHORNE BLVD	SUITE 430	TORRANCE	CA	90503	5506	00	06000	33.83566432	-118.3531683	Los Angeles County
315439	Non-Physician Medical Practitioner	None	1427426568	0	0	ROURKE, ANNA L NP	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	219 NEWPORT AVE	APT 3	LONG BEACH	CA	90803	5935	00	06000	33.76404	-118.1513675	Los Angeles County
315452	Non-Physician Medical Practitioner	None	1720588908	0	0	RAGO, OLIVER NP	8/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 CHEVY CHASE DR	204	GLENDALE	CA	91206	4152	00	06000	34.15201194	-118.2322051	Los Angeles County
315457	Non-Physician Medical Practitioner	None	1932742376	0	0	RILEY, JEREN J NP	2/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10327 HOLE AVE	None	RIVERSIDE	CA	92505	1747	00	06000	33.91543085	-117.4653361	Riverside County
315458	Non-Physician Medical Practitioner	None	1346783651	0	0	REGWAN, KRISTINA M	3/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
315461	Non-Physician Medical Practitioner	None	1386073922	0	0	RAWAL, SUMEET K	2/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5389 N VALENTINE AVE	APT 120	FRESNO	CA	93711	4094	00	06000	36.81364973	-119.8535187	Fresno County
315473	Non-Physician Medical Practitioner	None	1326141623	0	0	REID, EMY	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14623 KILLION ST	None	SHERMAN OAKS	CA	91411	3734	00	06000	34.17122552	-118.4517495	Los Angeles County
315476	Non-Physician Medical Practitioner	None	1811161193	0	0	RODRIGUEZ, PRISCILLA R	6/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 SERENA AVE	None	CLOVIS	CA	93619	7567	00	06000	36.86611054	-119.704671	Fresno County
315498	Non-Physician Medical Practitioner	None	1750009650	0	0	RIVERA, KRISTINE NP	5/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
315516	Non-Physician Medical Practitioner	None	1992987259	0	0	REBIERO, KRISTINE ANN	2/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1990 N CALIFORNIA BLVD	STE 400	WALNUT CREEK	CA	94596	3742	00	06000	37.90671155	-122.066307	Contra Costa County
315553	Non-Physician Medical Practitioner	None	1568657872	0	0	RADFORD, HEATHER ANN	12/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	300 PASTEUR DRIVE, ROOM	STANFORD BLOOD AND MARRO	STANFORD	MD	94305	5623	00	06000	37.43304542	-122.1759654	Santa Clara County
315566	Non-Physician Medical Practitioner	None	1013419498	0	0	ROSENSTEIN, JORDAN D PA	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
315605	Non-Physician Medical Practitioner	None	1811517089	0	0	ROYSTER, KEYSHA NP	6/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	259 TERRACINA BLVD	None	REDLANDS	CA	92373	4847	00	06000	34.03768081	-117.2052723	San Bernardino County
315644	Non-Physician Medical Practitioner	None	1548926066	0	0	RUBIO, JANICE C OT	12/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5451 WALNUT AVE	None	CHINO	CA	91710	2609	00	06000	34.02626886	-117.6858645	San Bernardino County
315650	Non-Physician Medical Practitioner	None	1114751773	0	0	RACY, STEPNEY NP	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
315658	Non-Physician Medical Practitioner	None	1104593854	0	0	RAMIREZ, TANIA NP	11/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
315694	Non-Physician Medical Practitioner	None	1295415834	0	0	REAY, MACKENZIE E NP	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
315719	Non-Physician Medical Practitioner	None	1629090188	0	0	ROSSI, LANCE WADE	8/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	00	06000	38.76553806	-121.2497067	Placer County
315737	Non-Physician Medical Practitioner	None	1780055582	0	0	REES, JAIME R NP	1/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17963 GREENWOOD DR	None	LOS GATOS	CA	95033	8421	00	06000	37.14850574	-121.9781848	Santa Clara County
315766	Non-Physician Medical Practitioner	None	1790876332	0	0	REDMAN, ANN R	9/22/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	OB GYN	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
315789	Non-Physician Medical Practitioner	None	1598280596	0	0	RAGLAND, JAMEELAH K NP	3/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
315792	Non-Physician Medical Practitioner	None	1467727651	0	0	REA, ELISA PA-C	9/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	00	06000	38.421306	-121.408173	Sacramento County
315819	Non-Physician Medical Practitioner	None	1427025691	0	0	REEDLEY COMMUNITY HOSPITAL	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	00	06000	36.54552557	-119.3797841	Tulare County
315821	Non-Physician Medical Practitioner	None	1770988487	0	0	RIGOPOULOS, MORGAN NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
315857	Non-Physician Medical Practitioner	None	1568976306	0	0	ROMANS, HELENA NP	12/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
315890	Non-Physician Medical Practitioner	None	1871595215	0	0	RHAMIE, MARGARETTE M NP	5/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	181 FOX LANE	None	CALIMESA	CA	92320	2086	00	06000	33.98706915	-117.040795	Riverside County
315911	Non-Physician Medical Practitioner	None	1447300801	0	0	RAMSEY, JUDITH NP	6/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1675 NORTHCREST DR	None	CRESCENT CITY	CA	95531	8928	00	06000	41.77547021	-124.1998045	Del Norte County
315960	Non-Physician Medical Practitioner	None	1750780128	0	0	REYES-PUGAY, RONCES M NP	11/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12935 ALCOSTA BLVD	None	SAN RAMON	CA	94583	1306	00	06000	37.77945911	-121.9635528	Contra Costa County
315989	Non-Physician Medical Practitioner	None	1235340829	0	0	RUST, RYAN A PA	2/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
315995	Non-Physician Medical Practitioner	None	1497757181	0	0	RADIVAN, TODD A PA-C	1/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	888 S RANCHO DR	None	LAS VEGAS	NV	89106	3810	00	06000	36.16005073	-115.1728794	Clark County
316042	Non-Physician Medical Practitioner	None	1851913768	0	0	RAHMANIAN, MARYAM NP	8/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16119 VANOWEN STREET	None	VAN NUYS	CA	94106	4822	00	06000	34.19394152	-118.484424	Los Angeles County
316070	Ordering, Referring, Prescribing	N/A	1003049495	0	0	REESE, KIMBERLEE J LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76822	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	2543	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
316105	Ordering, Referring, Prescribing	N/A	1003123241	0	0	RODRIGUEZ, MARIA I LPCC	5/24/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC16624	N/A	N/A	N/A	N/A	N/A	2495 WEST MARCH LANE	SUITE 125	STOCKTON	CA	95207	8224	00	06000	37.98503238	-121.3384819	San Joaquin County
316114	Ordering, Referring, Prescribing	N/A	1003135666	0	0	RICHARDSON, JASON A PSYD	6/28/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24583	N/A	N/A	N/A	N/A	N/A	8950 VILLA LA JOLLA DR	B206	LA JOLLA	CA	92037	1714	00	06000	32.870934	-117.2338765	San Diego County
316144	Ordering, Referring, Prescribing	N/A	1003169723	0	0	RUBIO, JENIFFER M LCSW	1/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86955	N/A	N/A	N/A	N/A	N/A	1933 S BROADWAY	5TH FLOOR	LOS ANGELES	CA	90007	4501	00	06000	34.03102377	-118.2660738	Los Angeles County
316153	Ordering, Referring, Prescribing	N/A	1003187279	0	0	ROBINSON, TRACY L PHARMD	12/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66668	N/A	N/A	N/A	N/A	N/A	18651 VALLEY BLVD	UNIT C	BLOOMINGTON	CA	92316	1831	00	06000	34.07044952	-117.3974715	San Bernardino County
316165	Ordering, Referring, Prescribing	N/A	1003203944	0	0	REYNOSO, MARTA E LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28394	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	125C	OAKLAND	CA	94605	2403	00	06000	37.768221	-122.17608	Alameda County
316186	Ordering, Referring, Prescribing	N/A	1003232026	0	0	ROSA, ENA C	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99600	N/A	N/A	N/A	N/A	N/A	299 12TH ST	None	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
316231	Ordering, Referring, Prescribing	N/A	1003293507	0	0	RAJ, ASHA P DO	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15683	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
316264	Ordering, Referring, Prescribing	N/A	1003332909	0	0	RAFANAN, KENN NP	2/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006905	N/A	N/A	N/A	N/A	N/A	12750 CENTER COURT DR N	650	CERRITOS	CA	90701	0000	00	06000	33.86899266	-118.0612699	Los Angeles County
316329	Ordering, Referring, Prescribing	N/A	1003431172	0	0	REYES, SOLEDAD NP	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95014735	N/A	N/A	N/A	N/A	N/A	740 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94545502	-120.0492446	Madera County
316337	Ordering, Referring, Prescribing	N/A	1003438219	0	0	ROJAS, MARY E LMFT	12/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152312	N/A	N/A	N/A	N/A	N/A	2450 GRANT ST	None	CONCORD	CA	94520	2251	00	06000	37.98254085	-122.0367295	Contra Costa County
316350	Ordering, Referring, Prescribing	N/A	1003460460	0	0	ROTONDI, MELISA L NP	7/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012154	N/A	N/A	N/A	N/A	N/A	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	00	06000	37.06376226	-120.860675	Merced County
316363	Ordering, Referring, Prescribing	N/A	1003475807	0	0	RANDHAWA, HARDIP PHARMD	11/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68193	N/A	N/A	N/A	N/A	N/A	1080 PLEASANT GROVE BLVD	None	ROSEVILLE	CA	95678	6117	00	06000	38.77629256	-121.2910739	Placer County
316380	Ordering, Referring, Prescribing	N/A	1003515131	0	0	RAMOS, JACQUELYN R PA-C	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61545	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	0000	00	06000	32.80046744	-116.9522315	San Diego County
316382	Ordering, Referring, Prescribing	N/A	1003519109	0	0	RUBIN, SEAN DO	12/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23652	N/A	N/A	N/A	N/A	N/A	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1108	00	06000	37.2402111	-121.8021684	Santa Clara County
316383	Ordering, Referring, Prescribing	N/A	1003520867	0	0	RUSSELL, CLAIRE DDS	9/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109522	N/A	N/A	N/A	N/A	N/A	808 W. 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
316390	Ordering, Referring, Prescribing	N/A	1003538943	0	0	RAI, MANPREET	5/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146972	N/A	N/A	N/A	N/A	N/A	360 S HOPE AVE	SUITE C205	SANTA BARBARA	CA	93105	4017	00	06000	34.43483946	-119.7472231	Santa Barbara County
316427	Ordering, Referring, Prescribing	N/A	1003839176	0	0	RODRIGUEZ, DANA M NP	12/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95027907	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
316435	Ordering, Referring, Prescribing	N/A	1003906975	0	0	RAMIREZ, CORINA LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24379	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	2ND FLOOR	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
316437	Ordering, Referring, Prescribing	N/A	1003920117	0	0	ROSARIO, VERNON A MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66651	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	1102	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
316476	Ordering, Referring, Prescribing	N/A	1003985276	0	0	RANCK, NANCY A LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29688	N/A	N/A	N/A	N/A	N/A	123 W. GUTIERREZ	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
316495	Ordering, Referring, Prescribing	N/A	1013032366	0	0	RAFEEDIE, JENNIFER A PSYD	1/21/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16029	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MAILSTOP 53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
316536	Ordering, Referring, Prescribing	N/A	1013101708	0	0	RABITZ, MARY D NP	3/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	553650	N/A	N/A	N/A	N/A	N/A	7861 MURRAY AVE	None	GILROY	CA	95020	4604	00	06000	37.01628624	-121.5662273	Santa Clara County
316551	Ordering, Referring, Prescribing	N/A	1013136175	0	0	ROLFSEMA, DAVID H LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16614	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DR.	None	HANFORD	CA	93230	1111	00	06000	36.32726257	-119.6663418	Kings County
316578	Ordering, Referring, Prescribing	N/A	1013177005	0	0	ROSEN, SANDRA S LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW8452	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	SUITE 200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
316586	Ordering, Referring, Prescribing	N/A	1013197128	0	0	RUST, STEPHANIE A LCSW	1/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64786	N/A	N/A	N/A	N/A	N/A	242 N VILLA AVE	None	WILLOWS	CA	95988	2641	00	06000	39.52243848	-122.208844	Glenn County
316592	Ordering, Referring, Prescribing	N/A	1013208628	0	0	ROMAN, JORGE E NP	11/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20679	N/A	N/A	N/A	N/A	N/A	470 CASTRO STREET	None	SAN FRANCISCO	CA	94114	2061	00	06000	37.76132744	-122.4350734	San Francisco County
316617	Ordering, Referring, Prescribing	N/A	1013233550	0	0	ROLLER, CAROLYN L LMFT	8/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47067	N/A	N/A	N/A	N/A	N/A	785 OAK GROVE RD	E2242	CONCORD	CA	94518	3617	00	06000	37.93740134	-122.0238783	Contra Costa County
316636	Ordering, Referring, Prescribing	N/A	1013276443	0	0	ROSEL-BUCIO, MAYRA A LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106071	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
316658	Ordering, Referring, Prescribing	N/A	1013314335	0	0	ROSENBERG, PATTI LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117282	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT.	None	RIVERSIDE	CA	92507	2498	00	06000	34.00024862	-117.32403	Riverside County
316703	Ordering, Referring, Prescribing	N/A	1013379544	0	0	ROCHA, CARISSA LMFT	3/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123023	N/A	N/A	N/A	N/A	N/A	200 MICHIGAN AVE	None	VISTA	CA	92084	5424	00	06000	33.2038743	-117.2421678	San Diego County
316705	Ordering, Referring, Prescribing	N/A	1013380880	0	0	REHANYAN, ANAHIT	11/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	60528	N/A	N/A	N/A	N/A	N/A	20469 SHERMAN WAY	None	WINNETKA	CA	91306	3109	00	06000	34.20115253	-118.5793589	Los Angeles County
316758	Ordering, Referring, Prescribing	N/A	1013464171	0	0	ROLINE, WHITNEY PA	10/31/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54174	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
316764	Ordering, Referring, Prescribing	N/A	1013464890	0	0	RAMIREZ, BIANCA LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113461	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD., SUIT	None	IRWINDALE	CA	91706	9998	00	06000	34.07969659	-117.9895641	Los Angeles County
316778	Ordering, Referring, Prescribing	N/A	1013493816	0	0	ROBINSON, LATOYA D LMFT	2/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137758	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
316821	Ordering, Referring, Prescribing	N/A	1013590280	0	0	ROSS, JAHID CNP	2/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025461	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
316863	Ordering, Referring, Prescribing	N/A	1013952654	0	0	RINCON, FRANCISCO I MD	7/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45411	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
316866	Ordering, Referring, Prescribing	N/A	1013995695	0	0	ROWLANDS, VICTORIA I NP	5/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	609439	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
316913	Ordering, Referring, Prescribing	N/A	1023147360	0	0	RAMI, FALU G LMFT	11/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39025	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
316940	Ordering, Referring, Prescribing	N/A	1023203312	0	0	RANKIN, LESLIE A LCSW	6/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66189	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
316943	Ordering, Referring, Prescribing	N/A	1023205903	0	0	RINCON, NICOLE PA-C	8/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	19355	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
316951	Ordering, Referring, Prescribing	N/A	1023227279	0	0	ROEMMELT, ARTHUR F MD	12/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G165711	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD STE	STE 100	PACOIMA	CA	91331	1392	00	06000	34.27894489	-118.4044363	Los Angeles County
316969	Ordering, Referring, Prescribing	N/A	1023277787	0	0	RAMIREZ, CHRISTINA LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53819	N/A	N/A	N/A	N/A	N/A	1500 HUGHES WAY	C100	LONG BEACH	CA	90810	1864	00	06000	33.82860528	-118.2124528	Los Angeles County
316979	Ordering, Referring, Prescribing	N/A	1023299898	0	0	RODRIGUEZ-MASON, CARIDAD LMFT	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41636	N/A	N/A	N/A	N/A	N/A	225 ACADEMY AVE	None	SANGER	CA	93657	2128	00	06000	36.71298824	-119.5572284	Fresno County
316980	Ordering, Referring, Prescribing	N/A	1023295748	0	0	RAYAS, PENELOPE LMFT	6/29/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49734	N/A	N/A	N/A	N/A	N/A	1397 38TH AVE	A	SANTA CRUZ	CA	95062	3285	00	06000	36.9710524	-121.9674292	Santa Cruz County
317000	Ordering, Referring, Prescribing	N/A	1023338670	0	0	RITTENBACH, KIRSTEN J	8/28/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D58504	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
317032	Ordering, Referring, Prescribing	N/A	1023403482	0	0	ROSEN, AMANDA N LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105932	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
317051	Ordering, Referring, Prescribing	N/A	1023422292	0	0	RASMUSSEN, LISA N MD	8/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143161	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
317073	Ordering, Referring, Prescribing	N/A	1023467297	0	0	RICHARDS, LAUREN M	7/28/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	16335	N/A	N/A	N/A	N/A	N/A	1901 N. RICE AVENUE	SUITE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
317126	Ordering, Referring, Prescribing	N/A	1023546637	0	0	RUIZ, ANGELICA LMFT	2/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124272	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	SUITE 20	SAN BERNARDINO	CA	92408	2880	00	06000	34.07137738	-117.2702805	San Bernardino County
317138	Ordering, Referring, Prescribing	N/A	1023547064	0	0	RUGGLES, JEFF PHARMD	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54378	N/A	N/A	N/A	N/A	N/A	4029 43RD ST	None	SAN DIEGO	CA	92105	1111	00	06000	32.75012697	-117.1019424	San Diego County
317139	Ordering, Referring, Prescribing	N/A	1023565876	0	0	ROTHSCHILD, ISABEL A LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107248	N/A	N/A	N/A	N/A	N/A	6736 LAUREL CANYON BLVD.	SUITE 200	NORTH HOLLYWOOD	CA	91606	1576	00	06000	34.193493	-118.3964925	Los Angeles County
317156	Ordering, Referring, Prescribing	N/A	1023587748	0	0	RIVERS, ALLANAH MSW LCSW	2/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24057	N/A	N/A	N/A	N/A	N/A	33100 COUNTY ROAD 31	None	DAVIS	CA	95616	9523	00	06000	38.562426	-121.893282	Yolo County
317166	Ordering, Referring, Prescribing	N/A	1023625761	0	0	ROGERS, GEORGIE LMFT	6/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139927	N/A	N/A	N/A	N/A	N/A	2933 EL NIDO DR	None	ALTADENA	CA	91001	4529	00	06000	34.19549106	-118.1655134	Los Angeles County
317179	Ordering, Referring, Prescribing	N/A	1023654381	0	0	REYES SIGHINOLF, DANIEL F	1/21/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104587	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
317185	Ordering, Referring, Prescribing	N/A	1023656923	0	0	RAMIREZ-CAMPUZANO, JUDY LCSW	12/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29758	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST	SUITE 101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
317206	Ordering, Referring, Prescribing	N/A	1023699766	0	0	RUPPERT, RYAN	2/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186096	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
317236	Ordering, Referring, Prescribing	N/A	1023832060	0	0	ROBINSON, CHELSEA CNP	8/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031580	N/A	N/A	N/A	N/A	N/A	4998 64TH ST	None	SACRAMENTO	CA	95820	5852	00	06000	38.529972	-121.429863	Sacramento County
317252	Ordering, Referring, Prescribing	N/A	1033123070	0	0	REA, NAOMI L NP	7/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5786	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
317332	Ordering, Referring, Prescribing	N/A	1033302468	0	0	RODRIGUEZ, GLORIA R LCSW	5/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122844	N/A	N/A	N/A	N/A	N/A	222 S. HILL ST.	None	LOS ANGELES	CA	90012	3506	00	06000	34.0525918	-118.2482081	Los Angeles County
317338	Ordering, Referring, Prescribing	N/A	1033310867	0	0	RODRIGUEZ-COSTELLO, IRIS G LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105114	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDE DE LAS PULG	SUITE 200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
317370	Ordering, Referring, Prescribing	N/A	1033387725	0	0	RHINEHART, ANNA M LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52814	N/A	N/A	N/A	N/A	N/A	209 EAST 7TH STREET	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
317390	Ordering, Referring, Prescribing	N/A	1033426374	0	0	RABBAN, DIANA LCSW	10/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72987	N/A	N/A	N/A	N/A	N/A	1601 PRECISION PARK LANE	None	SAN DIEGO	CA	92173	1345	00	06000	32.56692	-117.0594273	San Diego County
317395	Ordering, Referring, Prescribing	N/A	1033431168	0	0	ROCHA-LOPEZ, YESSENIA LCSW	12/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74616	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	2ND FL	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
317402	Ordering, Referring, Prescribing	N/A	1033440276	0	0	ROGOSKI, CHRISTINE E LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69390	N/A	N/A	N/A	N/A	N/A	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	00	06000	34.05373818	-118.3839685	Los Angeles County
317437	Ordering, Referring, Prescribing	N/A	1033485222	0	0	RAMSINGHANI, NISHA DO	11/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12934	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
317448	Ordering, Referring, Prescribing	N/A	1033496203	0	0	RODRIGUEZ, YADIRA LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81341	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
317454	Ordering, Referring, Prescribing	N/A	1033500319	0	0	ROBERTS, BART OT	5/11/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	704	N/A	N/A	N/A	N/A	N/A	1601 PRECISION PARK LN	None	SAN DIEGO	CA	92173	1345	00	06000	32.56692	-117.0594273	San Diego County
317460	Ordering, Referring, Prescribing	N/A	1033504337	0	0	RUIZ, ALEXANDER LCSW	3/1/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121344	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
317469	Ordering, Referring, Prescribing	N/A	1033518329	0	0	ROSEN, ERIC M PHD	12/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97204	N/A	N/A	N/A	N/A	N/A	1925 E DAKOTA AVE	None	FRESNO	CA	93726	4821	00	06000	36.78683208	-119.7876584	Fresno County
317476	Ordering, Referring, Prescribing	N/A	1033521067	0	0	ROEL, RENZO	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112285	N/A	N/A	N/A	N/A	N/A	801 CORPORATE CENTER DR	202	POMONA	CA	91768	2628	00	06000	34.06418933	-117.8018692	Los Angeles County
317510	Ordering, Referring, Prescribing	N/A	1033585021	0	0	RODRIGUEZ, JOSE A LCSW	6/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94079	N/A	N/A	N/A	N/A	N/A	12625 HEACOCK ST	None	MORENO VALLEY	CA	92553	0538	00	06000	33.936957	-117.2438195	Riverside County
317531	Ordering, Referring, Prescribing	N/A	1033624036	0	0	RUSTIA, CORNELIO EMMANUEL B NP	9/27/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007135	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
317533	Ordering, Referring, Prescribing	N/A	1033625074	0	0	ROFAEIL, MENA R	4/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102221	N/A	N/A	N/A	N/A	N/A	351 FELICE DR	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
317548	Ordering, Referring, Prescribing	N/A	1033647557	0	0	RODRIGUEZ-APONTE, CARLOS R MD	7/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185805	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
317555	Ordering, Referring, Prescribing	N/A	1033645817	0	0	ROSENBERG, ERIC J LAC	1/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	17282	N/A	N/A	N/A	N/A	N/A	50 IVY WALESA	None	SAN FRANCISCO	CA	94102	4506	00	06000	37.77797898	-122.4185591	San Francisco County
317578	Ordering, Referring, Prescribing	N/A	1033684642	0	0	RANGEL, VILMA L NP	8/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022351	N/A	N/A	N/A	N/A	N/A	2101 TENAYA DRIVE	None	MODESTO	CA	95354	3930	00	06000	37.6324545	-120.956463	Stanislaus County
317642	Ordering, Referring, Prescribing	N/A	1033860861	0	0	RAY, KARINA LCSW	12/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23556	N/A	N/A	N/A	N/A	N/A	15300 VENTURA BLVD	205	SHERMAN OAKS	CA	91403	3103	00	06000	34.15387425	-118.4666626	Los Angeles County
317662	Ordering, Referring, Prescribing	N/A	1033993464	0	0	REAGAN, CHLOE J PA-C	7/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63054	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
317691	Ordering, Referring, Prescribing	N/A	1043326911	0	0	ROTHBERG, JACK MD	4/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G29894	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
317707	Ordering, Referring, Prescribing	N/A	1043349889	0	0	ROMAIN-STAVE, PAULETTE M PSYD	8/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18624	N/A	N/A	N/A	N/A	N/A	525 N CABRILLO PARK DR.	STE. 300	SANTA ANA	CA	92701	5017	00	06000	33.75047365	-117.8404984	Orange County
317714	Ordering, Referring, Prescribing	N/A	1043369986	0	0	ROJAS, JESSICA M LCSW	9/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88802	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD	None	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
317740	Ordering, Referring, Prescribing	N/A	1043406689	0	0	RODRIGUEZ, JUAN M PSYD	5/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26944	N/A	N/A	N/A	N/A	N/A	1701 OCEAN AVENUE	None	SAN FRANCISCO	CA	94112	1727	00	06000	37.72476918	-122.4604495	San Francisco County
317766	Ordering, Referring, Prescribing	N/A	1043466261	0	0	RICE, DARCI R LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116261	N/A	N/A	N/A	N/A	N/A	1255 KENDALL ROAD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
317777	Ordering, Referring, Prescribing	N/A	1043481443	0	0	ROMAN, KARLA M PHD	1/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25368	N/A	N/A	N/A	N/A	N/A	725 S. GRAND AVE	None	GLENDORA	CA	91740	0000	00	06000	34.125822	-117.8727585	Los Angeles County
317784	Ordering, Referring, Prescribing	N/A	1043501364	0	0	RAVI, DAVE MD	5/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A156663	N/A	N/A	N/A	N/A	N/A	330 MOSS ST	None	CHULA VISTA	CA	91911	2005	00	06000	32.61687155	-117.0714212	San Diego County
317793	Ordering, Referring, Prescribing	N/A	1043521487	0	0	RIZVI, ASIM A MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123831	N/A	N/A	N/A	N/A	N/A	10400 FRICOT CITY RD	None	SAN ANDREAS	CA	95249	9641	00	06000	38.17354088	-120.5345257	Calaveras County
317805	Ordering, Referring, Prescribing	N/A	1043559206	0	0	RUIZ, IVET C LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112303	N/A	N/A	N/A	N/A	N/A	2200 OUTLET CENTER DR	430	OXNARD	CA	93036	0611	00	06000	34.22164581	-119.1483723	Ventura County
317840	Ordering, Referring, Prescribing	N/A	1043611973	0	0	REEKSTIN, JESSICA M LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94699	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	223	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
317851	Ordering, Referring, Prescribing	N/A	1043622517	0	0	REIFF, TERRENCE P DDS	7/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	38906	N/A	N/A	N/A	N/A	N/A	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	00	06000	38.475585	-121.4285265	Sacramento County
317856	Ordering, Referring, Prescribing	N/A	1043629223	0	0	RIVERA, ANA LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107960	N/A	N/A	N/A	N/A	N/A	988 MCCOURTNEY RD	STE. 102	GRASS VALLEY	CA	95949	7400	00	06000	39.2089732	-121.0729043	Nevada County
317880	Ordering, Referring, Prescribing	N/A	1043677859	0	0	REYES, ERIKA C PA-C	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA53117	N/A	N/A	N/A	N/A	N/A	12442 LIMONITE AVE	205	EASTVALE	CA	91752	2467	00	06000	33.97511454	-117.5531895	Riverside County
317912	Ordering, Referring, Prescribing	N/A	1043715949	0	0	RIVAS, MARILYN E LCSW	8/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81992	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
317945	Ordering, Referring, Prescribing	N/A	1043760069	0	0	ROH, DONGYON NP	9/15/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	783646	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	STE 9A	BUENA PARK	CA	90621	4667	00	06000	33.85890953	-118.007244	Orange County
317972	Ordering, Referring, Prescribing	N/A	1043798440	0	0	RAGSDALE, GINA M NP	8/27/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	576171	N/A	N/A	N/A	N/A	N/A	49063 ROAD 426	STE C	OAKHURST	CA	93644	9487	00	06000	37.33186891	-119.6510247	Madera County
317984	Ordering, Referring, Prescribing	N/A	1043825235	0	0	ROCKLAND-MILLER, KYLA NP	7/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015432	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
317994	Ordering, Referring, Prescribing	N/A	1043844020	0	0	RUIZ, ANETTE LMFT	2/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116253	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
318005	Ordering, Referring, Prescribing	N/A	1043868870	0	0	RODRIGUEZ, RANDY R PA-C	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA57456	N/A	N/A	N/A	N/A	N/A	301 BRUNDAGE LN	None	BAKERSFIELD	CA	93304	3248	00	06000	35.35386839	-119.0055269	Kern County
318030	Ordering, Referring, Prescribing	N/A	1043917743	0	0	RAMBHIA, SONAM DDS	2/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108576	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
318034	Ordering, Referring, Prescribing	N/A	1043964513	0	0	REYES, CANDICE	3/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017456	N/A	N/A	N/A	N/A	N/A	15815 APPROACH AVE	None	CHINO	CA	91708	7614	00	06000	33.96608531	-117.6304034	San Bernardino County
318042	Ordering, Referring, Prescribing	N/A	1043991557	0	0	RODRIGUEZ, AGUSTIN LMFT	8/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122485	N/A	N/A	N/A	N/A	N/A	1126 W FOOTHILL BLVD STE	STE 110	UPLAND	CA	91786	3786	00	06000	34.10674652	-117.6680183	San Bernardino County
318044	Ordering, Referring, Prescribing	N/A	1043993108	0	0	RELAMPAGOS, FRANCES PA-C	9/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63354	N/A	N/A	N/A	N/A	N/A	1010 CRENSHAW BLVD	SUITE 100	TORRANCE	CA	90501	2056	00	06000	33.83752056	-118.3287036	Los Angeles County
318070	Ordering, Referring, Prescribing	N/A	1053096537	0	0	ROHANITAZANGI, GITA DMD	9/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108863	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	SUITE 100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
318120	Ordering, Referring, Prescribing	N/A	1053441568	0	0	RIVAS-LOPEZ, LORENA LMFT	1/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51564	N/A	N/A	N/A	N/A	N/A	10929 SOUTH ST	None	CERRITOS	CA	90703	5340	00	06000	33.85836353	-118.101204	Los Angeles County
318183	Ordering, Referring, Prescribing	N/A	1053531343	0	0	RAMOS, MARIA CNM	8/2/2018	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235969	N/A	N/A	N/A	N/A	N/A	204 E. BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
318252	Ordering, Referring, Prescribing	N/A	1053654384	0	0	ROSTAMIZADEH, MAHDI MD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	R2723	N/A	N/A	N/A	N/A	N/A	11500 STATE HIGHWAY 121	720	FRISCO	TX	75035	9345	00	06000	33.10705829	-96.77984815	Collin County
318283	Ordering, Referring, Prescribing	N/A	1053706283	0	0	RAHBAR, GELAREH J	1/30/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D42765	N/A	N/A	N/A	N/A	N/A	101 WEST COAST ROAD	#769	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
318286	Ordering, Referring, Prescribing	N/A	1053700989	0	0	RAMIREZ, GILBERTO L LMFT	11/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107632	N/A	N/A	N/A	N/A	N/A	16940 STATE HIGHWAY 14	None	MOJAVE	CA	93501	1238	00	06000	35.06906701	-118.1746517	Kern County
318327	Ordering, Referring, Prescribing	N/A	1053757211	0	0	REEDER, JAMIE K NP	2/29/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95070903	N/A	N/A	N/A	N/A	N/A	316 NORTH MAIN ST	None	SALINAS	CA	93901	2818	00	06000	36.682749	-121.6533777	Monterey County
318421	Ordering, Referring, Prescribing	N/A	1053892703	0	0	ROSARIO, SARAH B LCSW	11/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127079	N/A	N/A	N/A	N/A	N/A	11741 E TELEGRAPH RD	A-C	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
318428	Ordering, Referring, Prescribing	N/A	1053893859	0	0	RADLIFF, RICHARD R LMFT	2/28/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133072	N/A	N/A	N/A	N/A	N/A	891 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9713	00	06000	38.19035603	-120.6679939	Calaveras County
318441	Ordering, Referring, Prescribing	N/A	1053942961	0	0	RODRIGUEZ OCAMPO, ROBERTO LCSW	10/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW111032	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
318445	Ordering, Referring, Prescribing	N/A	1053966846	0	0	RAGAZZO, ANTHONY LMFT	7/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119944	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
318455	Ordering, Referring, Prescribing	N/A	1053984450	0	0	ROBINSON, LYNN LMFT	7/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	33757	N/A	N/A	N/A	N/A	N/A	750 33RD AVENUE	None	SAN FRANCISCO	CA	94121	3428	00	06000	37.77494378	-122.4929297	San Francisco County
318509	Ordering, Referring, Prescribing	N/A	1063161362	0	0	RODRIGUEZ-FIERRO, CHRISTINA MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189504	N/A	N/A	N/A	N/A	N/A	2501 MARENGO STREET	None	LOS ANGELES	CA	90033	1352	00	06000	34.05442401	-118.2006855	Los Angeles County
318524	Ordering, Referring, Prescribing	N/A	1063272920	0	0	RANGEL-ALVAREZ, BRYAN MD	8/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15225	N/A	N/A	N/A	N/A	N/A	501 J ST	320	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
318532	Ordering, Referring, Prescribing	N/A	1063414274	0	0	ROLDAN, MARY JANET C	3/27/2006	Taxonomy not applicable	NA	n/a	099	DENTIST	D50897	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
318556	Ordering, Referring, Prescribing	N/A	1063502839	0	0	ROSEN, FREDERICK S MD	7/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84955	N/A	N/A	N/A	N/A	N/A	2191 JOHNSON AVENUE	None	SAN LUIS OBISPO	CA	93401	4534	00	06000	35.27456614	-120.6466115	San Luis Obispo County
318557	Ordering, Referring, Prescribing	N/A	1063509388	0	0	RAMIREZ GRIGGS, SANDRA M LMFT	1/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT37143	N/A	N/A	N/A	N/A	N/A	3230 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96037915	-122.5019455	Marin County
318573	Ordering, Referring, Prescribing	N/A	1063538023	0	0	RESNICK, ELISE D DO	12/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7916	N/A	N/A	N/A	N/A	N/A	1738 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5131	00	06000	34.13076398	-117.2788051	San Bernardino County
318577	Ordering, Referring, Prescribing	N/A	1063536175	0	0	RUBIN, ROBERTA M PHD	7/11/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY12748	N/A	N/A	N/A	N/A	N/A	21445 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2684	00	06000	34.41114037	-118.5116354	Los Angeles County
318605	Ordering, Referring, Prescribing	N/A	1063569721	0	0	REICHERTER, DARYN S MD	7/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80353	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
318650	Ordering, Referring, Prescribing	N/A	1063662898	0	0	RAFIE, SALLY PHARMD	5/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61116	N/A	N/A	N/A	N/A	N/A	1105 ROSECRANS ST	None	SAN DIEGO	CA	92106	2929	00	06000	32.72175574	-117.2316409	San Diego County
318748	Ordering, Referring, Prescribing	N/A	1063811388	0	0	REYNA, CAROLINA LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120220	N/A	N/A	N/A	N/A	N/A	1031 25TH ST	None	SAN DIEGO	CA	92102	2102	00	06000	32.716404	-117.1402635	San Diego County
318788	Ordering, Referring, Prescribing	N/A	1063868008	0	0	RECHETOVA, OLGA A LCSW	3/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83753	N/A	N/A	N/A	N/A	N/A	411 EAST LAKE AVE	None	WATSONVILLE	CA	95076	4424	00	06000	36.91720138	-121.7507888	Santa Cruz County
318850	Ordering, Referring, Prescribing	N/A	1063943108	0	0	ROMERO, REBEKAH S LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121507	N/A	N/A	N/A	N/A	N/A	4468 E KINGS CANYON RD	None	FRESNO	CA	93702	3605	00	06000	36.732339	-119.750688	Fresno County
318851	Ordering, Referring, Prescribing	N/A	1063943025	0	0	ROBINSON, JOHN MD	4/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176312	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
318879	Ordering, Referring, Prescribing	N/A	1063997468	0	0	RICHARDSON, MYESHA D LMFT	4/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132182	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DRIVE	None	ANTIOCH	CA	94509	8984	00	06000	37.97021462	-121.7841321	Contra Costa County
318883	Ordering, Referring, Prescribing	N/A	1073009478	0	0	RUVALCABA, MELISSA R MSW LCSW	10/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105023	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	#203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
318894	Ordering, Referring, Prescribing	N/A	1073023297	0	0	RUIZ, JESSICA LCSW	1/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110168	N/A	N/A	N/A	N/A	N/A	2440 6TH ST	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
318912	Ordering, Referring, Prescribing	N/A	1073059226	0	0	ROIZEN, RACHEL ETTI S	6/5/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	100786	N/A	N/A	N/A	N/A	N/A	10811 GARVEY AVE	None	EL MONTE	CA	91733	2301	00	06000	34.06285951	-118.0390815	Los Angeles County
318914	Ordering, Referring, Prescribing	N/A	1073061784	0	0	ROY, RESHMA LCSW	8/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117685	N/A	N/A	N/A	N/A	N/A	19 E 6TH STREET	None	TRACY	CA	95376	4107	00	06000	37.73489581	-121.425137	San Joaquin County
318921	Ordering, Referring, Prescribing	N/A	1073064861	0	0	ROSENBLATT, EUGENIA N LMFT	5/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125825	N/A	N/A	N/A	N/A	N/A	3433 AMERICAN RIVER DR	SUITE A	SACRAMENTO	CA	95864	5742	00	06000	38.57022	-121.385277	Sacramento County
318974	Ordering, Referring, Prescribing	N/A	1073171658	0	0	RAMOS, BRADLEY F PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82465	N/A	N/A	N/A	N/A	N/A	2401 KEITH ST	None	SAN FRANCISCO	CA	94124	3231	00	06000	37.72600973	-122.3923769	San Francisco County
319027	Ordering, Referring, Prescribing	N/A	1073581856	0	0	RAO, CHERUKUPALLI S	11/21/2005	Taxonomy not applicable	NA	n/a	099	DENTIST	D49492	N/A	N/A	N/A	N/A	N/A	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	00	06000	39.02117456	-122.0619172	Colusa County
319033	Ordering, Referring, Prescribing	N/A	1073600565	0	0	RENTERIA, DAVID MSW LCSW	1/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113172	N/A	N/A	N/A	N/A	N/A	14535 E. WHITTIER BLVD.	None	WHITTIER	CA	90605	2130	00	06000	33.9531254	-118.0149338	Los Angeles County
319056	Ordering, Referring, Prescribing	N/A	1073658282	0	0	REYES-GUZMAN, ALMA L LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51201	N/A	N/A	N/A	N/A	N/A	1767 N ACACIA AVE	None	RIALTO	CA	92376	2934	00	06000	34.13177908	-117.3616881	San Bernardino County
319059	Ordering, Referring, Prescribing	N/A	1073662573	0	0	ROMAN, DAGOBERTO LMSW	2/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29425	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
319075	Ordering, Referring, Prescribing	N/A	1073695094	0	0	RUIZ, JAIME MD FAAP	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G80442	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
319128	Ordering, Referring, Prescribing	N/A	1073830436	0	0	RAMOS-LESTER, MARIA G LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60802	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE, 3RD FL	SUITE 155	LONG BEACH	CA	90806	9999	00	06000	33.806097	-118.151378	Los Angeles County
319176	Ordering, Referring, Prescribing	N/A	1073924684	0	0	RAMOS-MONTELONGO, FLOR E LCSW	12/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98983	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	2ND FL	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
319190	Ordering, Referring, Prescribing	N/A	1073954277	0	0	RUIZ, SERGIO	7/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC4629	N/A	N/A	N/A	N/A	N/A	3230 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96037915	-122.5019455	Marin County
319197	Ordering, Referring, Prescribing	N/A	1073968038	0	0	ROSE, CARTER E LMFT	9/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128433	N/A	N/A	N/A	N/A	N/A	212 CARMEN LN	None	SANTA MARIA	CA	93458	7769	00	06000	34.92481416	-120.4383025	Santa Barbara County
319217	Ordering, Referring, Prescribing	N/A	1073984076	0	0	RICHARDS, ANA M CCC-SLP	4/6/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	9022	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	STE. 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
319258	Ordering, Referring, Prescribing	N/A	1083031769	0	0	REICHERT, SUNEUN S DO	5/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	19660	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
319290	Ordering, Referring, Prescribing	N/A	1083078851	0	0	RIGALI, SARAH LMFT	10/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119238	N/A	N/A	N/A	N/A	N/A	3636 CAMINO DEL RIO N	150	SAN DIEGO	CA	92108	1703	00	06000	32.778982	-117.1164717	San Diego County
319300	Ordering, Referring, Prescribing	N/A	1083095111	0	0	ROBENIOL, DON R NP	8/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015157	N/A	N/A	N/A	N/A	N/A	200 PINE AVE	SUITE 400	LONG BEACH	CA	90802	3039	00	06000	33.76962	-118.1923435	Los Angeles County
319308	Ordering, Referring, Prescribing	N/A	1083104426	0	0	RAGSDALE-AVILA, MIA	10/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006729	N/A	N/A	N/A	N/A	N/A	2500 N PALM CANYON DR	None	PALM SPRINGS	CA	92262	1868	00	06000	33.85264176	-116.551965	Riverside County
319316	Ordering, Referring, Prescribing	N/A	1083123954	0	0	RAMIREZ, SARA I LCSW	7/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107829	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
319325	Ordering, Referring, Prescribing	N/A	1083133276	0	0	ROMERO, KARLA E LMFT	1/21/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152787	N/A	N/A	N/A	N/A	N/A	1209 W TOKAY ST	5	LODI	CA	95240	3845	00	06000	38.12635934	-121.2874011	San Joaquin County
319343	Ordering, Referring, Prescribing	N/A	1083162184	0	0	RUDRAPRAKASHA, TEJASWINI DDS	7/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	100878	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
319350	Ordering, Referring, Prescribing	N/A	1083168074	0	0	RAMIREZ, CORINA LCSW	11/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98406	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY ST	E500	FREMONT	CA	94538	0006	00	06000	37.55123907	-121.9828956	Alameda County
319412	Ordering, Referring, Prescribing	N/A	1083297030	0	0	RAMEZANY, FARID PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84296	N/A	N/A	N/A	N/A	N/A	1810 FREEDOM BLVD	None	FREEDOM	CA	95019	3000	00	06000	36.93442012	-121.7726139	Santa Cruz County
319413	Ordering, Referring, Prescribing	N/A	1083296719	0	0	RAMIREZ, JORGE A LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143846	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
319445	Ordering, Referring, Prescribing	N/A	1083442123	0	0	RICCOBONI, JORDAN K PA-C	12/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65572	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST., STE 30	None	HAWTHORNE	CA	90250	2240	00	06000	33.92825048	-118.3539285	Los Angeles County
319455	Ordering, Referring, Prescribing	N/A	1083470439	0	0	RENATA, TEA A RN BS	6/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95075691	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
319476	Ordering, Referring, Prescribing	N/A	1083702310	0	0	RUSSELL-CURRY, PATRICIA	11/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	27481	N/A	N/A	N/A	N/A	N/A	2805 G ST	None	MERCED	CA	95340	2133	00	06000	37.31093636	-120.4695502	Merced County
319506	Ordering, Referring, Prescribing	N/A	1083768956	0	0	RODHEIM, BRETT G LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110766	N/A	N/A	N/A	N/A	N/A	301 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
319512	Ordering, Referring, Prescribing	N/A	1083792501	0	0	REVILLA, ANA R MD	6/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81029	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
319536	Ordering, Referring, Prescribing	N/A	1083839369	0	0	RICE, MICHAEL PHARMD	9/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	48472	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA STREET	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
319591	Ordering, Referring, Prescribing	N/A	1083953830	0	0	RODRIGUEZ, DEBORAH LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102391	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
319689	Ordering, Referring, Prescribing	N/A	1093107732	0	0	RODRIGUEZ, VICTOR E	4/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015577	N/A	N/A	N/A	N/A	N/A	330 E ORANGEWOOD AVE	None	ANAHEIM	CA	92802	4313	00	06000	33.79609851	-117.9035865	Orange County
319719	Ordering, Referring, Prescribing	N/A	1093163560	0	0	REHMANI, MUSTAFA S DO	12/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18419	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	#500	LOS ANGELES	CA	90010	1427	00	06000	34.06176363	-118.2932622	Los Angeles County
319728	Ordering, Referring, Prescribing	N/A	1093175192	0	0	RAZO, ALEJANDRA LCSW	11/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127381	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	STE. C-2	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
319750	Ordering, Referring, Prescribing	N/A	1093199812	0	0	RAZO, ROXANA C MSW LCSW	3/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108573	N/A	N/A	N/A	N/A	N/A	727 SHASTA STREET	None	REDWOOD CITY	CA	94063	1234	00	06000	37.47945362	-122.2230493	San Mateo County
319762	Ordering, Referring, Prescribing	N/A	1093213159	0	0	ROBERTSON, JACQUELINE LMFT	8/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125830	N/A	N/A	N/A	N/A	N/A	2025 CASTILLO STREET	APT C	SANTA BARBARA	CA	93105	4289	00	06000	34.42710763	-119.7198983	Santa Barbara County
319767	Ordering, Referring, Prescribing	N/A	1093215469	0	0	RENTERIA, ARISDELSY LMFT	11/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122979	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
319774	Ordering, Referring, Prescribing	N/A	1093237919	0	0	RESER, BELINDA LMFT	10/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135167	N/A	N/A	N/A	N/A	N/A	1751 CLOVERFIELD BLVD	None	SANTA MONICA	CA	90404	4007	00	06000	34.02567738	-118.4705857	Los Angeles County
319797	Ordering, Referring, Prescribing	N/A	1093268419	0	0	RICADO FRAIRE, TERESA M OT	2/15/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	17628	N/A	N/A	N/A	N/A	N/A	425 DIVISADERO ST	None	SAN FRANCISCO	CA	94117	2242	00	06000	37.77336026	-122.4375022	San Francisco County
319812	Ordering, Referring, Prescribing	N/A	1093291056	0	0	RHYNER, MICHELLE L NP	6/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009158	N/A	N/A	N/A	N/A	N/A	1014 N BROADWAY	None	SANTA ANA	CA	92701	3408	00	06000	33.75354748	-117.8697553	Orange County
319878	Ordering, Referring, Prescribing	N/A	1093530354	0	0	RAHWANJI, ALEXIS M	11/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032884	N/A	N/A	N/A	N/A	N/A	9415 MISSION BLVD	P	RIVERSIDE	CA	92509	2600	00	06000	34.01179145	-117.4903644	Riverside County
319917	Ordering, Referring, Prescribing	N/A	1093823221	0	0	ROOK, RONALD PHD	6/29/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY9906	N/A	N/A	N/A	N/A	N/A	1350 E DEVONSHIRE AVE	None	HEMET	CA	92544	8629	00	06000	33.75125933	-116.9577919	Riverside County
319918	Ordering, Referring, Prescribing	N/A	1093803512	0	0	RICH, CLAUDIA L LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37988	N/A	N/A	N/A	N/A	N/A	1201 W CIVIC CENTER DR	205	SANTA ANA	CA	92701	0000	00	06000	33.7515693	-117.8828609	Orange County
319919	Ordering, Referring, Prescribing	N/A	1093830044	0	0	RILEY, JUDITH A LMFT	12/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42471	N/A	N/A	N/A	N/A	N/A	209 E. 7TH ST.	None	MADERA	CA	90638	3780	00	06000	36.96069768	-120.0559841	Madera County
319927	Ordering, Referring, Prescribing	N/A	1093830770	0	0	RIOS, MARTHA A PHD	12/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21616	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE	None	LOS ANGELES	CA	90095	8342	00	06000	34.0605595	-118.4499527	Los Angeles County
319969	Ordering, Referring, Prescribing	N/A	1093904880	0	0	RODRIGUEZ, JANITZIA LMFT	8/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110925	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD	100	PLEASANT HILL	CA	94523	2294	00	06000	37.96119614	-122.070409	Contra Costa County
319983	Ordering, Referring, Prescribing	N/A	1093925919	0	0	ROOS, CASEY	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37700	N/A	N/A	N/A	N/A	N/A	2925 MCMILLAN AVE	STE 108	SAN LUIS OBISPO	CA	93401	6765	00	06000	35.263386	-120.648157	San Luis Obispo County
319987	Ordering, Referring, Prescribing	N/A	1093930109	0	0	RODY, ELIZABETH J MD	1/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G86385	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
320003	Ordering, Referring, Prescribing	N/A	1093965410	0	0	RHODES, KAREN B LCSW	4/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27384	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2317	00	06000	37.50572931	-122.2621879	San Mateo County
320004	Ordering, Referring, Prescribing	N/A	1093967994	0	0	REDFORD, SUSAN J LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43709	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
320027	Ordering, Referring, Prescribing	N/A	1104024140	0	0	REYNOSO, MONICA PSYD	6/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24714	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
320029	Ordering, Referring, Prescribing	N/A	1104031376	0	0	RATNESAR, RAJENDRA M MD	2/9/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A34529	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
320091	Ordering, Referring, Prescribing	N/A	1104167758	0	0	RIVERA-MITU, ELIZA B NP	4/8/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP23310	N/A	N/A	N/A	N/A	N/A	2390 CRENSHAW BLVD	STE. E - 254	TORRANCE	CA	90501	3300	00	06000	33.82221187	-118.328442	Los Angeles County
320147	Ordering, Referring, Prescribing	N/A	1104241470	0	0	RICO, EDGAR LCSW	2/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100177	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
320152	Ordering, Referring, Prescribing	N/A	1104253442	0	0	REFO, JACQUELINE N LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79426	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
320155	Ordering, Referring, Prescribing	N/A	1104256692	0	0	RUIZ, ROSALIE S LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104529	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
320163	Ordering, Referring, Prescribing	N/A	1104269901	0	0	ROBLES, ANAMARIA J MD	3/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134048	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
320167	Ordering, Referring, Prescribing	N/A	1104277870	0	0	RUELAS-RAMIREZ, MAYRA A LMFT	4/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132106	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
320181	Ordering, Referring, Prescribing	N/A	1104292705	0	0	RODGERS, MARTINE R NP	8/25/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	776213	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION ROAD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
320200	Ordering, Referring, Prescribing	N/A	1104333228	0	0	RODRIGUEZ, MELISSA LMFT	12/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126597	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	0000	00	06000	34.09813032	-118.2901794	Los Angeles County
320206	Ordering, Referring, Prescribing	N/A	1104338342	0	0	ROSEMAN, KIMBERLEE PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77810	N/A	N/A	N/A	N/A	N/A	8005 EL CAMINO REAL	None	ATASCADERO	CA	93422	5211	00	06000	35.47712859	-120.6559822	San Luis Obispo County
320208	Ordering, Referring, Prescribing	N/A	1104342997	0	0	RENTERIA, ELSA LMFT	5/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126164	N/A	N/A	N/A	N/A	N/A	2440 6TH ST	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
320233	Ordering, Referring, Prescribing	N/A	1104374925	0	0	RAMOS, GLORIA S NP	6/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013620	N/A	N/A	N/A	N/A	N/A	1760 TERMINO AVE	STE.100	LONG BEACH	CA	90804	2182	00	06000	33.78889871	-118.1458784	Los Angeles County
320260	Ordering, Referring, Prescribing	N/A	1104407741	0	0	REGIER, RYAN T	4/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146514	N/A	N/A	N/A	N/A	N/A	3845 N CLARK ST	201	FRESNO	CA	93726	4881	00	06000	36.788364	-119.785209	Fresno County
320273	Ordering, Referring, Prescribing	N/A	1104466952	0	0	RIVERA, JACQUELINE P LMFT	8/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141125	N/A	N/A	N/A	N/A	N/A	49211 GRAPEFRUIT BLVD.	SUITE 5 & 6	COACHELLA	CA	92236	0000	00	06000	33.69171437	-116.184351	Riverside County
320277	Ordering, Referring, Prescribing	N/A	1104471036	0	0	RAM, NATISHA	1/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57418	N/A	N/A	N/A	N/A	N/A	1451 SECRET RAVINE PKWY	SUITE 150	ROSEVILLE	CA	95661	6052	00	06000	38.7647101	-121.2431538	Placer County
320279	Ordering, Referring, Prescribing	N/A	1104476597	0	0	RAMOS SANTIAGO, JONATHAN LCSW	12/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127679	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	FIRST FLOOR	SAN PABLO	CA	94806	3863	00	06000	37.95651393	-122.3371491	Contra Costa County
320281	Ordering, Referring, Prescribing	N/A	1104464098	0	0	RAMOS, LILIANA L LMFT	10/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122378	N/A	N/A	N/A	N/A	N/A	2218 N 1ST ST	None	SAN JOSE	CA	95131	2007	00	06000	37.37769052	-121.9213491	Santa Clara County
320308	Ordering, Referring, Prescribing	N/A	1104590025	0	0	RANDALL, STEPHANIE T NP	6/30/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017990	N/A	N/A	N/A	N/A	N/A	2200 TYDD ST	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
320309	Ordering, Referring, Prescribing	N/A	1104591825	0	0	ROBERTS, MARQUIS NP	1/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95019607	N/A	N/A	N/A	N/A	N/A	400 E OAK AVE	None	VISALIA	CA	93291	5034	00	06000	36.332253	-119.288691	Tulare County
320325	Ordering, Referring, Prescribing	N/A	1104816933	0	0	ROFSKY, JAY E OD	3/26/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	10161	N/A	N/A	N/A	N/A	N/A	363 S MAIN ST	STE 204	ORANGE	CA	92868	3833	00	06000	33.782787	-117.8672715	Orange County
320342	Ordering, Referring, Prescribing	N/A	1104912880	0	0	RUNDALL, CHRISTINE	12/23/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16465	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	210	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
320399	Ordering, Referring, Prescribing	N/A	1114022076	0	0	ROBERTS, SUZANNE L	3/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63849	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
320458	Ordering, Referring, Prescribing	N/A	1114132610	0	0	REAGHARD, DEBORAH NP	5/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP9015	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
320463	Ordering, Referring, Prescribing	N/A	1114149150	0	0	RODRIGUEZ, SYLVIA	9/18/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17699	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVE	STE A	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
320507	Ordering, Referring, Prescribing	N/A	1114224540	0	0	RENDLA, SUDHAKAR MD	11/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130225	N/A	N/A	N/A	N/A	N/A	4341A GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	6260	00	06000	38.70594583	-120.8270239	El Dorado County
320518	Ordering, Referring, Prescribing	N/A	1114252822	0	0	RAMIREZ, GABRIEL PA-C	9/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	20568	N/A	N/A	N/A	N/A	N/A	5 MEDICAL PLAZA	STE 170	ROSEVILLE	CA	95661	2867	00	06000	38.76604411	-121.2466761	Placer County
320539	Ordering, Referring, Prescribing	N/A	1114300209	0	0	RAYOS, KAREN ANN MD	1/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158600	N/A	N/A	N/A	N/A	N/A	2116 E ORANGEBURG AVE	None	MODESTO	CA	95355	3370	00	06000	37.66354152	-120.958056	Stanislaus County
320543	Ordering, Referring, Prescribing	N/A	1114309556	0	0	RAZO-VEGA, MARIA M LMFT	4/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132359	N/A	N/A	N/A	N/A	N/A	3845 N. CLARK STREET	201	FRESNO	CA	93726	4812	00	06000	36.788364	-119.785209	Fresno County
320578	Ordering, Referring, Prescribing	N/A	1114352267	0	0	ROSE, AMBER LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80505	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
320609	Ordering, Referring, Prescribing	N/A	1114401031	0	0	RAMIREZ, YESICA LMFT	5/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132696	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
320610	Ordering, Referring, Prescribing	N/A	1114397882	0	0	RAMOS, CRISTINA LCSW	7/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90091	N/A	N/A	N/A	N/A	N/A	470 CHADBOURNE RD	SUITE A	FAIRFIELD	CA	94534	9600	00	06000	38.23474317	-122.0838031	Solano County
320697	Ordering, Referring, Prescribing	N/A	1114567146	0	0	REHMAN, MAHNOOR LMFT	7/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133975	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
320721	Ordering, Referring, Prescribing	N/A	1114641271	0	0	RICCI, KATHYANNE	11/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022849	N/A	N/A	N/A	N/A	N/A	2907 EL CAMINO REAL	None	REDWOOD CITY	CA	94061	4003	00	06000	37.46906354	-122.2114417	San Mateo County
320729	Ordering, Referring, Prescribing	N/A	1114667870	0	0	ROSS, ADAM	8/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189698	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
320741	Ordering, Referring, Prescribing	N/A	1114704145	0	0	ROSS, CHRISTOPHER A NP	12/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027576	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE.	SUITE 302	LONG BEACH	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles County
320753	Ordering, Referring, Prescribing	N/A	1114921673	0	0	RAHNEMUN, MARYAM MD	9/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53377	N/A	N/A	N/A	N/A	N/A	14150 CULVER DR	105	IRVINE	CA	92604	0315	00	06000	33.70834263	-117.7839373	Orange County
320764	Ordering, Referring, Prescribing	N/A	1114944980	0	0	RAMAN, SARAT C MD	4/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144373	N/A	N/A	N/A	N/A	N/A	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	00	06000	37.78221179	-122.1877	Alameda County
320784	Ordering, Referring, Prescribing	N/A	1124040357	0	0	RANKIN, JULIET L PHD	3/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20846	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
320818	Ordering, Referring, Prescribing	N/A	1124146444	0	0	RUIZ, GILBERT M LMFT	5/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119704	N/A	N/A	N/A	N/A	N/A	7365 CARNELIAN ST. STE #	None	RANCHO CUCAMONGA	CA	91730	1129	00	06000	34.12038413	-117.6160525	San Bernardino County
320837	Ordering, Referring, Prescribing	N/A	1124166012	0	0	REDDY, GIRIDHAR G MD	6/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78870	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
320878	Ordering, Referring, Prescribing	N/A	1124251723	0	0	RAEN, HILA LCSW	7/2/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83744	N/A	N/A	N/A	N/A	N/A	600 ANTON BLVD	1100	COSTA MESA	CA	92626	7100	00	06000	33.69023449	-117.882684	Orange County
320888	Ordering, Referring, Prescribing	N/A	1124276266	0	0	REICH, NILZA M MD	6/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7366	N/A	N/A	N/A	N/A	N/A	2122 W KETTLEMAN LN	None	LODI	CA	95242	4321	00	06000	38.11537452	-121.299291	San Joaquin County
320927	Ordering, Referring, Prescribing	N/A	1124341185	0	0	RAJYAGURU, HITESHKUMAR	7/31/2019	Taxonomy not applicable	NA	n/a	000	Unknown	70336	N/A	N/A	N/A	N/A	N/A	3805 SAN DIMAS ST	SUITE A	BAKERSFIELD	CA	93301	5725	00	06000	35.39508529	-119.0082516	Kern County
320939	Ordering, Referring, Prescribing	N/A	1124356829	0	0	RAMIREZ, JOEL F MD	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109791	N/A	N/A	N/A	N/A	N/A	124 S A ST	202	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
320989	Ordering, Referring, Prescribing	N/A	1124446224	0	0	RODRIGUEZ, THOMAS MD	1/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135485	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
320991	Ordering, Referring, Prescribing	N/A	1124453584	0	0	REYNOSO, STEPHANIE M LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82695	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
321046	Ordering, Referring, Prescribing	N/A	1124532395	0	0	ROYAL, TIFFANY N	1/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110705	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
321047	Ordering, Referring, Prescribing	N/A	1124534425	0	0	ROMERO, DIANA C LMFT	5/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132812	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
321050	Ordering, Referring, Prescribing	N/A	1124542238	0	0	RAMIREZ, BLANCA E LCSW	8/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110247	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BOULEVARD	None	EL MONTE	CA	91731	3229	00	06000	34.06953065	-118.0288485	Los Angeles County
321057	Ordering, Referring, Prescribing	N/A	1124555743	0	0	ROUGIER, GRACIELA M LCSW	11/25/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88419	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
321070	Ordering, Referring, Prescribing	N/A	1124572144	0	0	REYBET-DEGAT, VINCENT P LCSW	1/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99834	N/A	N/A	N/A	N/A	N/A	1890 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	00	06000	37.84893892	-122.2696251	Alameda County
321092	Ordering, Referring, Prescribing	N/A	1124594080	0	0	ROBERTS, DOMINICA NP	7/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031253	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
321106	Ordering, Referring, Prescribing	N/A	1124638713	0	0	REYNOSA, TESSA LMFT	10/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142534	N/A	N/A	N/A	N/A	N/A	832 FOLSOM ST	702	SAN FRANCISCO	CA	94107	4502	00	06000	37.78137302	-122.4020589	San Francisco County
321182	Ordering, Referring, Prescribing	N/A	1134189947	0	0	RUSSELL, JAMI J LCSW	12/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23980	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DR	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
321208	Ordering, Referring, Prescribing	N/A	1134242100	0	0	RYLAND, ANTHONY D LMFT	12/21/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38997	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
321223	Ordering, Referring, Prescribing	N/A	1134260557	0	0	REYES, RICARDO LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107428	N/A	N/A	N/A	N/A	N/A	9864 BALDWIN PL	None	EL MONTE	CA	91731	2202	00	06000	34.07063297	-118.054303	Los Angeles County
321264	Ordering, Referring, Prescribing	N/A	1134346802	0	0	RAMIREZ, DANICA A LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52032	N/A	N/A	N/A	N/A	N/A	411 E LAKE AVE	None	WATSONVILLE	CA	95076	4424	00	06000	36.91720138	-121.7507888	Santa Cruz County
321292	Ordering, Referring, Prescribing	N/A	1134416506	0	0	REY BALBUENA, INGRID LCSW	4/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87237	N/A	N/A	N/A	N/A	N/A	6736 LAUREL CANYON BLVD	STE 200	NORTH HOLLYWOOD	CA	91606	1538	00	06000	34.193493	-118.3964925	Los Angeles County
321303	Ordering, Referring, Prescribing	N/A	1134419526	0	0	REYNOSO, MALI M LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119885	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
321317	Ordering, Referring, Prescribing	N/A	1134477821	0	0	RAHEJA, SONIA MD	7/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131268	N/A	N/A	N/A	N/A	N/A	1888 MERIDIAN AVENUE	SUITE 150	SAN JOSE	CA	95125	5212	00	06000	37.28937754	-121.9134326	Santa Clara County
321325	Ordering, Referring, Prescribing	N/A	1134488216	0	0	ROJAS, JESSICA E LMFT	11/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102929	N/A	N/A	N/A	N/A	N/A	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
321335	Ordering, Referring, Prescribing	N/A	1134497472	0	0	REEB, ADAM J LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96817	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
321341	Ordering, Referring, Prescribing	N/A	1134499940	0	0	RABLE, CHARMAINE M LMFT	1/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46828	N/A	N/A	N/A	N/A	N/A	2255 CHALLENGER WAY	STE 107	SANTA ROSA	CA	95407	5423	00	06000	38.424924	-122.7512565	Sonoma County
321359	Ordering, Referring, Prescribing	N/A	1134534407	0	0	RICO RAMIREZ, MOISES LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89604	N/A	N/A	N/A	N/A	N/A	1270 NATIVIDAD RD	None	SALINAS	CA	93906	3144	00	06000	36.69733474	-121.6370383	Monterey County
321360	Ordering, Referring, Prescribing	N/A	1134523913	0	0	RILEY, ELIZABETH NP	10/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005487	N/A	N/A	N/A	N/A	N/A	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
321365	Ordering, Referring, Prescribing	N/A	1134538192	0	0	ROTH, SHARON A	9/22/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA51728	N/A	N/A	N/A	N/A	N/A	553 E PALMDALE BLVD	SUITE A-1	PALMDALE	CA	93550	2375	00	06000	34.57964928	-118.119079	Los Angeles County
321390	Ordering, Referring, Prescribing	N/A	1134556509	0	0	RUIZ, MICHAEL PSYD	2/9/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32381	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE	A	LOS ANGELES	CA	90142	2211	00	06000	34.04323075	-118.2485358	Los Angeles County
321417	Ordering, Referring, Prescribing	N/A	1134625965	0	0	RAMIREZ, VANESSA E MD	3/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164040	N/A	N/A	N/A	N/A	N/A	1357 OAKLAND CT	None	WALNUT CREEK	CA	94596	4337	00	06000	37.89772006	-122.0704393	Contra Costa County
321424	Ordering, Referring, Prescribing	N/A	1134632722	0	0	RABHI, ARIJE LMFT	7/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127504	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
321428	Ordering, Referring, Prescribing	N/A	1134638729	0	0	ROCHA, CLAUDIA MD	4/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177392	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
321473	Ordering, Referring, Prescribing	N/A	1134706997	0	0	ROSENBERG, MICHAEL LMFT	1/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144544	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
321476	Ordering, Referring, Prescribing	N/A	1134720824	0	0	RPTCHIAN, AZADOUHI PHARMD	11/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83633	N/A	N/A	N/A	N/A	N/A	23850 COPPER HILL DR	None	VALENCIA	CA	91354	1701	00	06000	34.46315853	-118.5566175	Los Angeles County
321507	Ordering, Referring, Prescribing	N/A	1134786098	0	0	REYES, GABRIEL A LCSW	2/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113141	N/A	N/A	N/A	N/A	N/A	1750 5TH AVE	None	SAN DIEGO	CA	92101	2754	00	06000	32.72358991	-117.1602657	San Diego County
321534	Ordering, Referring, Prescribing	N/A	1144050865	0	0	RODRIGUEZ, ALEJANDRA PA-C	12/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65542	N/A	N/A	N/A	N/A	N/A	1150 S. CHEROKEE LANE	None	LODI	CA	95240	5918	00	06000	38.11908338	-121.2601852	San Joaquin County
321550	Ordering, Referring, Prescribing	N/A	1144231010	0	0	READ, MARY E MD	11/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63780	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	BUILDING D5.5	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
321555	Ordering, Referring, Prescribing	N/A	1144254566	0	0	RADETSKY, MARTHA LMFT	12/24/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36377	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL RD	#307	RICHMOND	CA	94806	1947	00	06000	37.97819764	-122.329244	Contra Costa County
321584	Ordering, Referring, Prescribing	N/A	1144344722	0	0	ROBISON, AMBER R LCSW	5/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29011	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
321603	Ordering, Referring, Prescribing	N/A	1144382987	0	0	REEG, JESSICA LMFT	2/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124306	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
321615	Ordering, Referring, Prescribing	N/A	1144412941	0	0	ROSENBERG, CORI	12/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22955	N/A	N/A	N/A	N/A	N/A	1720 YOSEMITE STREET	None	SEASIDE	CA	93955	3914	00	06000	36.61232653	-121.8280153	Monterey County
321635	Ordering, Referring, Prescribing	N/A	1144453754	0	0	RIEGO, SUZANNE N NP	1/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	660877	N/A	N/A	N/A	N/A	N/A	3750 CONVOY ST	STE 312	SAN DIEGO	CA	92111	3741	00	06000	32.81201122	-117.1531108	San Diego County
321638	Ordering, Referring, Prescribing	N/A	1144462037	0	0	REYNOLDS, SARA A NP	2/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012831	N/A	N/A	N/A	N/A	N/A	303 C ST	None	LOMPOC	CA	93436	7305	00	06000	34.64226582	-120.4514394	Santa Barbara County
321660	Ordering, Referring, Prescribing	N/A	1144511668	0	0	ROUND, PAUL E DO	7/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13034	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
321684	Ordering, Referring, Prescribing	N/A	1144571878	0	0	REINSBERG, KRISTIN S LMFT	5/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39018	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	BLDG 5, UNIT 6B	SAN FRANCISCO	CA	94110	3594	00	06000	37.75548534	-122.4065362	San Francisco County
321800	Ordering, Referring, Prescribing	N/A	1144727355	0	0	REFUGIO, OLIVER NEIL T MD	7/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166041	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
321807	Ordering, Referring, Prescribing	N/A	1144732975	0	0	REYES, CANA PHYLICIA C PHARMD	7/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77710	N/A	N/A	N/A	N/A	N/A	18515 DEVONSHIRE ST	None	NORTHRIDGE	CA	91324	6754	00	06000	34.25728349	-118.536615	Los Angeles County
321808	Ordering, Referring, Prescribing	N/A	1144730318	0	0	REYNOLDS, SUSANNAH R LMFT	12/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123791	N/A	N/A	N/A	N/A	N/A	42455 10TH ST W	103	LANCASTER	CA	93534	7060	00	06000	34.65438079	-118.1478341	Los Angeles County
321818	Ordering, Referring, Prescribing	N/A	1144753393	0	0	RODRIGUEZ ACOSTA, YODAISY MD	6/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172978	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS BLVD	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
321838	Ordering, Referring, Prescribing	N/A	1144778200	0	0	RAMIREZ, VERONICA L NP	5/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004774	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	300	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
321847	Ordering, Referring, Prescribing	N/A	1144781733	0	0	ROACH, MONIQUE LCSW	3/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88290	N/A	N/A	N/A	N/A	N/A	250 SOUTH G STREET	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
321882	Ordering, Referring, Prescribing	N/A	1144837501	0	0	REYES, JESSICA LOURDES	1/31/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152944	N/A	N/A	N/A	N/A	N/A	2000 E 4TH ST	STE 201	SANTA ANA	CA	92705	3907	00	06000	33.74807154	-117.838566	Orange County
321886	Ordering, Referring, Prescribing	N/A	1144843251	0	0	RODRIGUEZ, JOHN	10/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	127979	N/A	N/A	N/A	N/A	N/A	730 POLK ST, 4TH FLOOR	None	SAN FRANCISCO	CA	94109	7813	00	06000	37.78379532	-122.4192766	San Francisco County
321939	Ordering, Referring, Prescribing	N/A	1144998865	0	0	RODRIGUEZ, HEATHER L LMFT	8/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127809	N/A	N/A	N/A	N/A	N/A	4910 E ASHLAN AVE	118	FRESNO	CA	93726	3020	00	06000	36.79411387	-119.7309194	Fresno County
321941	Ordering, Referring, Prescribing	N/A	1154016129	0	0	RUZICKA, SARAH	11/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RDH29114	N/A	N/A	N/A	N/A	N/A	2965 EAST ST	None	ANDERSON	CA	96007	3481	00	06000	40.45154834	-122.2986846	Shasta County
321949	Ordering, Referring, Prescribing	N/A	1154043958	0	0	RAGER, KAYTHRYN L PHARMD	9/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86895	N/A	N/A	N/A	N/A	N/A	1421 MANHATTAN AVE	None	FULLERTON	CA	92831	5221	00	06000	33.85701	-117.902438	Orange County
322023	Ordering, Referring, Prescribing	N/A	1154442077	0	0	ROSE, DIANE T LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39722	N/A	N/A	N/A	N/A	N/A	1700 MCHENRY VILLAGE WAY	None	MODESTO	CA	95350	4308	00	06000	37.668096	-120.9900045	Stanislaus County
322026	Ordering, Referring, Prescribing	N/A	1154449171	0	0	ROSE, AYANA LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT48356	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	SUITE 200	PACOIMA	CA	91331	1001	00	06000	34.27814981	-118.4055414	Los Angeles County
322052	Ordering, Referring, Prescribing	N/A	1154500601	0	0	RIVERA, EDGAR LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71090	N/A	N/A	N/A	N/A	N/A	22471 ASPAN ST	103	LAKE FOREST	CA	92630	1642	00	06000	33.63624985	-117.7119697	Orange County
322086	Ordering, Referring, Prescribing	N/A	1154572139	0	0	RIBEIRO, CASSANDRE C CRNA	7/9/2019	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95000368	N/A	N/A	N/A	N/A	N/A	825 N SAN VICENTE BLVD	None	WEST HOLLYWOOD	CA	90069	4505	00	06000	34.0855723	-118.3845783	Los Angeles County
322100	Ordering, Referring, Prescribing	N/A	1154591659	0	0	RAY, LUCINDA B LCSW	10/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81022	N/A	N/A	N/A	N/A	N/A	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
322102	Ordering, Referring, Prescribing	N/A	1154598704	0	0	RODRIGUEZ, MARIA E NP	10/5/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	415092	N/A	N/A	N/A	N/A	N/A	650 N FULTON	None	FRESNO	CA	93728	3404	00	06000	36.75213	-119.800333	Fresno County
322104	Ordering, Referring, Prescribing	N/A	1154602407	0	0	RODAS, NANCY LCSW	11/27/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81219	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST.	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
322122	Ordering, Referring, Prescribing	N/A	1154627651	0	0	RAMSTROM, KAREN C DO	11/16/2017	Taxonomy not applicable	NA	n/a	000	Unknown	20A6824	N/A	N/A	N/A	N/A	N/A	26650 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5500269	-122.383368	Shasta County
322159	Ordering, Referring, Prescribing	N/A	1154674992	0	0	REITZ, KURTIS A DDS	1/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	61790	N/A	N/A	N/A	N/A	N/A	670 COUNTY ROAD 83	None	CANBY	CA	96015	9722	00	06000	41.44344745	-120.8718025	Modoc County
322171	Ordering, Referring, Prescribing	N/A	1154717213	0	0	ROHIT, ARORA DO	6/22/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15219	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
322187	Ordering, Referring, Prescribing	N/A	1154701373	0	0	RAMIREZ, HILARIO E	11/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105563	N/A	N/A	N/A	N/A	N/A	17707 S. STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
322217	Ordering, Referring, Prescribing	N/A	1154795987	0	0	RAMIREZ, EMILIO LMFT	11/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112464	N/A	N/A	N/A	N/A	N/A	3301 37TH AVE	None	SACRAMENTO	CA	95824	2418	00	06000	38.519739	-121.471992	Sacramento County
322225	Ordering, Referring, Prescribing	N/A	1154812485	0	0	ROMO, DAVID J LCSW	8/30/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	12461	N/A	N/A	N/A	N/A	N/A	6061 EAST AVE.	None	ETIWANDA	CA	91739	2218	00	06000	34.14421719	-117.514554	San Bernardino County
322239	Ordering, Referring, Prescribing	N/A	1154836831	0	0	RAMIREZ, MONICA LMFT	10/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122664	N/A	N/A	N/A	N/A	N/A	14535 SHERMAN CIR	None	VAN NUYS	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
322245	Ordering, Referring, Prescribing	N/A	1154841245	0	0	RAMSDEN-STEIN, BENJAMIN DO	8/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16801	N/A	N/A	N/A	N/A	N/A	1430 FREEDOM BLVD	None	WATSONVILLE	CA	95076	2780	00	06000	36.92713051	-121.7652145	Santa Cruz County
322274	Ordering, Referring, Prescribing	N/A	1154880656	0	0	ROBINSON, TA'SHARIAH M PA	10/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	56648	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
322277	Ordering, Referring, Prescribing	N/A	1154884484	0	0	RIZK, LAUDY NP	1/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010952	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
322347	Ordering, Referring, Prescribing	N/A	1164034625	0	0	RAFFO, MINA E	12/8/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105318	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
322392	Ordering, Referring, Prescribing	N/A	1164124004	0	0	RENAUD, ALICE E MD	7/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197983	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
322400	Ordering, Referring, Prescribing	N/A	1164149621	0	0	REVELES, MARY ANN E NP	9/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022758	N/A	N/A	N/A	N/A	N/A	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1428	00	06000	34.2395322	-118.3939944	Los Angeles County
322443	Ordering, Referring, Prescribing	N/A	1164509485	0	0	RIAZ, YASIR	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51673	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	PHARMACY CLIN OPS	STOCKTON	CA	95210	0000	00	06000	38.017701	-121.297869	San Joaquin County
322505	Ordering, Referring, Prescribing	N/A	1164614400	0	0	RANADE, RAJDEEP V MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105766	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
322556	Ordering, Referring, Prescribing	N/A	1164719407	0	0	REBBOAH, CHRISTOPHE E	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50735	N/A	N/A	N/A	N/A	N/A	290 IOOF AVENUE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
322586	Ordering, Referring, Prescribing	N/A	1164772158	0	0	RAMIREZ, ANNY C	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96403	N/A	N/A	N/A	N/A	N/A	2933 EL NIDO DR	None	ALTADENA	CA	91001	4529	00	06000	34.19549106	-118.1655134	Los Angeles County
322608	Ordering, Referring, Prescribing	N/A	1164807699	0	0	RODRIGUEZ, IVETTE LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92932	N/A	N/A	N/A	N/A	N/A	2750 E WASHINGTON BLVD	230	PASADENA	CA	91107	1448	00	06000	34.1680038	-118.0943955	Los Angeles County
322665	Ordering, Referring, Prescribing	N/A	1164913133	0	0	ROLEY, JASON S MD	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165015	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1062	00	06000	37.48873991	-122.2339433	San Mateo County
322676	Ordering, Referring, Prescribing	N/A	1164926424	0	0	REDDY, RENUKA K	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163830	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
322749	Ordering, Referring, Prescribing	N/A	1174049035	0	0	RIMER, BLAINE LMFT	10/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128805	N/A	N/A	N/A	N/A	N/A	1196 THIRD AVE	None	CHULA VISTA	CA	91911	3131	00	06000	32.61031228	-117.067833	San Diego County
322769	Ordering, Referring, Prescribing	N/A	1174083836	0	0	RAI, PHILIPPA PA	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56698	N/A	N/A	N/A	N/A	N/A	7526 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92111	1504	00	06000	32.83275147	-117.157122	San Diego County
322770	Ordering, Referring, Prescribing	N/A	1174079222	0	0	RUBIO, ORALIA LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99274	N/A	N/A	N/A	N/A	N/A	150 W 7TH ST	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
322782	Ordering, Referring, Prescribing	N/A	1174107098	0	0	RAWSON, DELANEY MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194241	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
322787	Ordering, Referring, Prescribing	N/A	1174106835	0	0	ROSSOPOULOS, THANOS G MD	2/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182392	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
322816	Ordering, Referring, Prescribing	N/A	1174155485	0	0	ROSS, MARIA S RN	5/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	95096064	N/A	N/A	N/A	N/A	N/A	1500 MEREDITH AVE	None	GUSTINE	CA	95322	1701	00	06000	37.24930699	-121.0111954	Merced County
322826	Ordering, Referring, Prescribing	N/A	1174177679	0	0	RICHARDSON, MEGAN NP	12/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011389	N/A	N/A	N/A	N/A	N/A	320 EL CERRITO PLZ	None	EL CERRITO	CA	94530	4004	00	06000	37.89921493	-122.2981973	Contra Costa County
322837	Ordering, Referring, Prescribing	N/A	1174233142	0	0	RUIZ, JULISA A NP	6/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020716	N/A	N/A	N/A	N/A	N/A	215 W BEAMER ST	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
322873	Ordering, Referring, Prescribing	N/A	1174534069	0	0	RAO, ANURADHA MD	5/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54982	N/A	N/A	N/A	N/A	N/A	9001 SOUTH H STREET	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
322889	Ordering, Referring, Prescribing	N/A	1174605067	0	0	RICHTER, KENNETH E DO	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10813	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
322895	Ordering, Referring, Prescribing	N/A	1174634307	0	0	ROLDAN, XENIA A MD	6/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55237	N/A	N/A	N/A	N/A	N/A	8787 HALL ROAD	None	LAMONT	CA	93241	1953	00	06000	35.25969451	-118.908099	Kern County
322897	Ordering, Referring, Prescribing	N/A	1174643761	0	0	RHODAS, MARITZA H LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29810	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVE	SUITE A	SOUTH PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
322939	Ordering, Referring, Prescribing	N/A	1174710073	0	0	REICH, DEBRA L LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37895	N/A	N/A	N/A	N/A	N/A	2300 MARKET STREET	None	RIVERSIDE	CA	92501	0001	00	06000	33.99771526	-117.3709956	Riverside County
322943	Ordering, Referring, Prescribing	N/A	1174713556	0	0	ROBERTS, QUIANA N LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117685	N/A	N/A	N/A	N/A	N/A	15095 AMARGOSA RD	201	VICTORVILLE	CA	92394	1879	00	06000	34.52479785	-117.3303132	San Bernardino County
322945	Ordering, Referring, Prescribing	N/A	1174713911	0	0	RUBAL, JORGE MD	11/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99592	N/A	N/A	N/A	N/A	N/A	362 THIRD ST	None	LAGUNA BEACH	CA	92651	2307	00	06000	33.54392197	-117.780894	Orange County
322969	Ordering, Referring, Prescribing	N/A	1174729040	0	0	RODRIGUEZ, JAVIER PA	12/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA19041	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
322975	Ordering, Referring, Prescribing	N/A	1174791511	0	0	ROBINSON, STACY L LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28473	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE.	125C	OAKLAND	CA	94605	2454	00	06000	37.768221	-122.17608	Alameda County
323023	Ordering, Referring, Prescribing	N/A	1174871933	0	0	RYAN, MARILYSE A	2/28/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA22490	N/A	N/A	N/A	N/A	N/A	729 SUNRISE AVE	STE 900	ROSEVILLE	CA	95661	4525	00	06000	38.73444822	-121.2720033	Placer County
323055	Ordering, Referring, Prescribing	N/A	1174909626	0	0	RUIZ, JESSICA LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111115	N/A	N/A	N/A	N/A	N/A	2502 HUNTINGTON DR	None	DUARTE	CA	91010	2221	00	06000	34.13967149	-117.9511686	Los Angeles County
323079	Ordering, Referring, Prescribing	N/A	1174940944	0	0	RAMIREZ, JUAN S LMFT	9/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121617	N/A	N/A	N/A	N/A	N/A	680 LANGSDORF DR	#200	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
323095	Ordering, Referring, Prescribing	N/A	1174949879	0	0	RIEGE, ALAYNE MSW LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75882	N/A	N/A	N/A	N/A	N/A	1224 VINE STREET	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
323104	Ordering, Referring, Prescribing	N/A	1174964472	0	0	RAMOS, KARINA LMFT	12/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92357	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
323108	Ordering, Referring, Prescribing	N/A	1174978969	0	0	REYES, ASHLEYLAUREN LMFT	8/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121323	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
323111	Ordering, Referring, Prescribing	N/A	1174978704	0	0	RIVERA, CELINE LMFT	3/20/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145896	N/A	N/A	N/A	N/A	N/A	1126 N GRAND AVE	None	COVINA	CA	91724	1551	00	06000	34.100082	-117.8724825	Los Angeles County
323133	Ordering, Referring, Prescribing	N/A	1174998322	0	0	REYES, MARIGOLD ROS A	2/16/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	100009	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
323157	Ordering, Referring, Prescribing	N/A	1184036667	0	0	RAYIKANTI, RUTH S	9/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144700	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
323189	Ordering, Referring, Prescribing	N/A	1184079287	0	0	RICE, KERRILYNN G MD MPH	4/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150941	N/A	N/A	N/A	N/A	N/A	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
323199	Ordering, Referring, Prescribing	N/A	1184090235	0	0	ROMERO, ROWENA L	9/21/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64924	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
323206	Ordering, Referring, Prescribing	N/A	1184097495	0	0	RODRIGUEZ, MAYRA LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88831	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
323254	Ordering, Referring, Prescribing	N/A	1184168692	0	0	RBIBO, ESTHER LMFT	1/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130554	N/A	N/A	N/A	N/A	N/A	11316 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2441	00	06000	34.1721216	-118.3769057	Los Angeles County
323300	Ordering, Referring, Prescribing	N/A	1184264053	0	0	RAHMAN, MOHAMMAD R PHARMD	10/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81831	N/A	N/A	N/A	N/A	N/A	1377 N FAIR OAKS AVE	None	PASADENA	CA	91103	2101	00	06000	34.169598	-118.1507175	Los Angeles County
323303	Ordering, Referring, Prescribing	N/A	1184264582	0	0	RAIKHY, AMANDEEP S PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81620	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
323354	Ordering, Referring, Prescribing	N/A	1184386419	0	0	ROBLES, MA REGINA BLANCA C LAC	10/23/2021	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19279	N/A	N/A	N/A	N/A	N/A	1011 CAMINO DEL RIO S	100	SAN DIEGO	CA	92108	3531	00	06000	32.7641924	-117.1544937	San Diego County
323380	Ordering, Referring, Prescribing	N/A	1184649212	0	0	RODARTE, GABRIEL MD	4/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87906	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
323396	Ordering, Referring, Prescribing	N/A	1184725665	0	0	ROEMHILD, JOSEPHINE A LCSW	3/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27844	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL	H	SANTA ANA	CA	92701	5002	00	06000	33.74986153	-117.8429355	Orange County
323403	Ordering, Referring, Prescribing	N/A	1184747602	0	0	REDDOCH-HO, MEREDITH H LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84013	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
323416	Ordering, Referring, Prescribing	N/A	1184756124	0	0	REINHART, LINDA G LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT28045	N/A	N/A	N/A	N/A	N/A	327 SOUTH K STREET	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
323448	Ordering, Referring, Prescribing	N/A	1184828964	0	0	REGIS, LOUELLA MD	11/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101548	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
323463	Ordering, Referring, Prescribing	N/A	1184858250	0	0	REED, JENNIFER M PSYD	4/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22559	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD.	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
323478	Ordering, Referring, Prescribing	N/A	1184887507	0	0	REDDY, SMITA S MD	12/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C152910	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
323526	Ordering, Referring, Prescribing	N/A	1184951881	0	0	RIOS-PARADA, RAMON Y LCSW	4/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86670	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVENUE, HAY	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
323528	Ordering, Referring, Prescribing	N/A	1184970600	0	0	ROOKS, HOLLY C LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90981	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
323559	Ordering, Referring, Prescribing	N/A	1194010306	0	0	RATKEVICH, KARI PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH43485	N/A	N/A	N/A	N/A	N/A	115 TECHNOLOGY DR	None	IRVINE	CA	92618	2408	00	06000	33.660243	-117.745596	Orange County
323600	Ordering, Referring, Prescribing	N/A	1194099580	0	0	ROCKLIN, OLGA LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80562	N/A	N/A	N/A	N/A	N/A	821 IRVING STREET	225104	SAN FRANCISCO	CA	94122	2310	00	06000	37.76400339	-122.4666709	San Francisco County
323623	Ordering, Referring, Prescribing	N/A	1194136903	0	0	ROSA, ARLENE LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114104	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	223	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
323636	Ordering, Referring, Prescribing	N/A	1194157198	0	0	RUBEY, ERIC LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110186	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
323663	Ordering, Referring, Prescribing	N/A	1194207829	0	0	ROARK, RUFUS J LMFT	7/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140398	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
323802	Ordering, Referring, Prescribing	N/A	1194747170	0	0	RESTIVO, GENELL L LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52551	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
323831	Ordering, Referring, Prescribing	N/A	1194850164	0	0	RODRIGUEZ, RAUL LMFT	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44122	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD.	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
323863	Ordering, Referring, Prescribing	N/A	1194883900	0	0	RUBIN, DANIEL A PSYD	11/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32142	N/A	N/A	N/A	N/A	N/A	928 BROADWAY	None	SAN DIEGO	CA	92101	5514	00	06000	32.71575045	-117.1560915	San Diego County
323869	Ordering, Referring, Prescribing	N/A	1194896837	0	0	ROMA, MATTHEW DDS	11/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	102495	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	C AND D	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
323872	Ordering, Referring, Prescribing	N/A	1194912774	0	0	RIVERA, MIGUEL LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113314	N/A	N/A	N/A	N/A	N/A	5740 RALSTON ST	100	VENTURA	CA	93003	6051	00	06000	34.26070802	-119.213699	Ventura County
323880	Ordering, Referring, Prescribing	N/A	1194920108	0	0	ROLLINS, RAQUEL A LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52555	N/A	N/A	N/A	N/A	N/A	4500 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3275	00	06000	33.78808863	-118.1399827	Los Angeles County
323904	Ordering, Referring, Prescribing	N/A	1194975003	0	0	RHOADES, CLAUDETTE NP	5/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21518	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
323910	Ordering, Referring, Prescribing	N/A	1194980060	0	0	ROSHANRAVAN, ERIKA M	8/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C157894	N/A	N/A	N/A	N/A	N/A	215 WEST BEAMER ST	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
323912	Ordering, Referring, Prescribing	N/A	1194988428	0	0	RIOS, JOSE G LCSW	8/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110205	N/A	N/A	N/A	N/A	N/A	370 S. CRENSHAW BLVD	E100	TORRANCE	CA	90503	1702	00	06000	33.84549	-118.3287415	Los Angeles County
323957	Ordering, Referring, Prescribing	N/A	1205104551	0	0	RUGALA PERSICONE, JENNIFER N LCSW	3/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25768	N/A	N/A	N/A	N/A	N/A	1300 W. FLORIDA AVENUE	SUITE C	HEMET	CA	92543	2648	00	06000	33.74755149	-116.98533	Riverside County
323974	Ordering, Referring, Prescribing	N/A	1205118908	0	0	RANKIN, DAVID Y PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55119	N/A	N/A	N/A	N/A	N/A	13390 POWAY RD	None	POWAY	CA	92064	4626	00	06000	32.95654343	-117.0412404	San Diego County
323998	Ordering, Referring, Prescribing	N/A	1205153798	0	0	ROSSELL, NEFERTARI LMFT	8/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98170	N/A	N/A	N/A	N/A	N/A	427 PAJARO ST.	SUITES 1-3	SALINAS	CA	93901	4495	00	06000	36.67129432	-121.6519553	Monterey County
324016	Ordering, Referring, Prescribing	N/A	1205212206	0	0	RILEY, ANNA L PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75886	N/A	N/A	N/A	N/A	N/A	450 E CYPRESS AVE	None	REDLANDS	CA	92373	6115	00	06000	34.04965529	-117.1723119	San Bernardino County
324044	Ordering, Referring, Prescribing	N/A	1205255817	0	0	RELINGO, SONIA F	10/7/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64149	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
324049	Ordering, Referring, Prescribing	N/A	1205265329	0	0	RIVAS, CHRISTEE M LMFT	7/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139433	N/A	N/A	N/A	N/A	N/A	530 KINGS COUNTY DR	106	HANFORD	CA	93230	3579	00	06000	36.33019889	-119.66862	Kings County
324075	Ordering, Referring, Prescribing	N/A	1205311123	0	0	REED, KIRA M LCSW	10/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111380	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2948	00	06000	34.41078438	-118.510775	Los Angeles County
324099	Ordering, Referring, Prescribing	N/A	1205332897	0	0	REYES, BEVERLY LMFT	3/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105442	N/A	N/A	N/A	N/A	N/A	871 ENBORG LANE	100	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
324104	Ordering, Referring, Prescribing	N/A	1205345733	0	0	RAMIREZ, EMILIA PSYD	6/9/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32292	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
324107	Ordering, Referring, Prescribing	N/A	1205344231	0	0	RUSSO, LAURA A LCSW	12/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113905	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
324126	Ordering, Referring, Prescribing	N/A	1205378155	0	0	RODARTE-SALDANA, ELIZABETH LCSW	11/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98397	N/A	N/A	N/A	N/A	N/A	9864 BALDWIN PL	None	EL MONTE	CA	91731	2202	00	06000	34.07063297	-118.054303	Los Angeles County
324150	Ordering, Referring, Prescribing	N/A	1205418480	0	0	RANU, SUNPREET K NP	10/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016728	N/A	N/A	N/A	N/A	N/A	1800 HEIGHT ST	None	BAKERSFIELD	CA	93305	2871	00	06000	35.39390547	-118.972818	Kern County
324156	Ordering, Referring, Prescribing	N/A	1205440377	0	0	RODRIGUEZ-ZINN, CLAUDIA A NP	8/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	850396	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE.	SUITE 107	NEWPORT BEACH	CA	92663	3307	00	06000	33.62631386	-117.9310576	Orange County
324158	Ordering, Referring, Prescribing	N/A	1205433661	0	0	RIVERA, HENRY DC	10/16/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC34901	N/A	N/A	N/A	N/A	N/A	2237 W. BALL ROAD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
324162	Ordering, Referring, Prescribing	N/A	1205457330	0	0	ROSTRAN, ETHEL M LMFT	5/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147104	N/A	N/A	N/A	N/A	N/A	1510 CAPITOLA RD	None	SANTA CRUZ	CA	95062	2912	00	06000	36.97627773	-121.9846375	Santa Cruz County
324163	Ordering, Referring, Prescribing	N/A	1205465218	0	0	ROBERTSON, LAURA B MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL5634	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
324170	Ordering, Referring, Prescribing	N/A	1205473402	0	0	RIZK, MOAMEN OD	2/27/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34455	N/A	N/A	N/A	N/A	N/A	8900 SEPULVEDA WESTWAY	None	LOS ANGELES	CA	90045	3619	00	06000	33.955812	-118.398154	Los Angeles County
324223	Ordering, Referring, Prescribing	N/A	1205836996	0	0	ROBERTS, ARIELLA C MD	3/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97295	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400, SUITE 202	SALINAS	CA	93906	3195	00	06000	36.696987	-121.633164	Monterey County
324245	Ordering, Referring, Prescribing	N/A	1205928520	0	0	ROBINSON, FRANCIS J LCSW	4/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24363	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
324249	Ordering, Referring, Prescribing	N/A	1205931532	0	0	ROMAN, PAMELA LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35808	N/A	N/A	N/A	N/A	N/A	10 N SAN PEDRO RD	None	SAN RAFAEL	CA	94903	4178	00	06000	37.99529182	-122.5300426	Marin County
324281	Ordering, Referring, Prescribing	N/A	1205986346	0	0	ROLDAN, VANESSA M LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105699	N/A	N/A	N/A	N/A	N/A	300 E LELAND RD	None	PITTSBURG	CA	94565	4960	00	06000	38.01129897	-121.8878132	Contra Costa County
324299	Ordering, Referring, Prescribing	N/A	1215023411	0	0	ROSSO, RONALD F MD	4/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79401	N/A	N/A	N/A	N/A	N/A	3400 W. LOMITA BLVD.	306	TORRANCE	CA	90505	4909	00	06000	33.81309744	-118.3448635	Los Angeles County
324304	Ordering, Referring, Prescribing	N/A	1215053632	0	0	ROH, YUNI Y LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48731	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	1	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
324313	Ordering, Referring, Prescribing	N/A	1215062542	0	0	RAMOS, ESTELA M LCSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24634	N/A	N/A	N/A	N/A	N/A	1445 VETERANS MEMORIAL C	None	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
324318	Ordering, Referring, Prescribing	N/A	1215067426	0	0	RICE, CLAUDIA I LMFT	12/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50979	N/A	N/A	N/A	N/A	N/A	760 MOUNTAIN VIEW ST	None	ALTADENA	CA	91001	4925	00	06000	34.19178664	-118.1657029	Los Angeles County
324325	Ordering, Referring, Prescribing	N/A	1215081450	0	0	RIETJENS, JILL K	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43252	N/A	N/A	N/A	N/A	N/A	1989 VICENTE DR	None	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
324358	Ordering, Referring, Prescribing	N/A	1215142443	0	0	ROCHEFORT, JULIE C NP	1/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	409829	N/A	N/A	N/A	N/A	N/A	2501 W EL SEGUNDO BLVD	STE B	HAWTHORNE	CA	90250	3317	00	06000	33.91648148	-118.3206645	Los Angeles County
324369	Ordering, Referring, Prescribing	N/A	1215191184	0	0	RUIZ, ERICA M MD	5/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104555	N/A	N/A	N/A	N/A	N/A	47110 WASHINGTON ST	SUITE 203	LA QUINTA	CA	92253	2186	00	06000	33.70698194	-116.2929821	Riverside County
324405	Ordering, Referring, Prescribing	N/A	1215229281	0	0	ROGADO, GERALD E MD	4/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137777	N/A	N/A	N/A	N/A	N/A	810 E D ST	None	LEMOORE	CA	93245	9545	00	06000	36.30069303	-119.7694815	Kings County
324419	Ordering, Referring, Prescribing	N/A	1215256870	0	0	RYDALCH, JOANNA M LCSW	7/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100015	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
324444	Ordering, Referring, Prescribing	N/A	1215305685	0	0	REYES, JESSICA LCSW	12/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92602	N/A	N/A	N/A	N/A	N/A	14624 SHERMAN WAY	SUITE 508	VAN NUYS	CA	91405	2241	00	06000	34.20078354	-118.450843	Los Angeles County
324452	Ordering, Referring, Prescribing	N/A	1215317862	0	0	REYES, VANESSA D S MD	12/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145991	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
324464	Ordering, Referring, Prescribing	N/A	1215329305	0	0	REYES, CHRISTINE M NP	3/16/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	837550	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	STE 105	ANAHEIM	CA	92805	2928	00	06000	33.83508976	-117.9177981	Orange County
324469	Ordering, Referring, Prescribing	N/A	1215332044	0	0	RENTERIA, BRIANDA I LCSW	12/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85151	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
324507	Ordering, Referring, Prescribing	N/A	1215389564	0	0	REYNA, CAROLINE A LMFT	2/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118288	N/A	N/A	N/A	N/A	N/A	16350 MOJAVE DRIVE	None	VICTORVILLE	CA	92395	3655	00	06000	34.52901353	-117.3063285	San Bernardino County
324510	Ordering, Referring, Prescribing	N/A	1215390869	0	0	REYNOSO, TANYA E LCSW	12/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100503	N/A	N/A	N/A	N/A	N/A	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
324525	Ordering, Referring, Prescribing	N/A	1215410568	0	0	RAMIREZ, LICETH LMFT	7/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127092	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
324532	Ordering, Referring, Prescribing	N/A	1215446984	0	0	RADA, AMELIA LMFT	12/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123392	N/A	N/A	N/A	N/A	N/A	3626 BALBOA STREET	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
324555	Ordering, Referring, Prescribing	N/A	1215480603	0	0	RIVERA, DIANA C LCSW	10/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104869	N/A	N/A	N/A	N/A	N/A	6400 LAUREL CANYON BLVD.	SUITE 500	NORTH HOLLYWOOD	CA	91606	1562	00	06000	34.18698871	-118.3964897	Los Angeles County
324653	Ordering, Referring, Prescribing	N/A	1215711254	0	0	RINCON ESTRELLA, EDGAR PA	11/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63651	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
324696	Ordering, Referring, Prescribing	N/A	1225118029	0	0	RUGO, NANCY A NP	3/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005527	N/A	N/A	N/A	N/A	N/A	5519 E DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	00	06000	33.8471395	-118.1244195	Los Angeles County
324699	Ordering, Referring, Prescribing	N/A	1225122039	0	0	REDDY, RAVITA MD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	A85458	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL	BUILDING H	SANTA ANA	CA	92701	5002	00	06000	33.74986153	-117.8429355	Orange County
324747	Ordering, Referring, Prescribing	N/A	1225205099	0	0	RYMAN, MISTY LMFT	1/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49945	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
324758	Ordering, Referring, Prescribing	N/A	1225227028	0	0	ROBBINS, ROBIN K NP	2/24/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	416968	N/A	N/A	N/A	N/A	N/A	28780 SINGLE OAK DR	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
324765	Ordering, Referring, Prescribing	N/A	1225236342	0	0	REUS, CECILIA A LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47652	N/A	N/A	N/A	N/A	N/A	747 - 52ND STREET	None	OAKLAND,	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
324778	Ordering, Referring, Prescribing	N/A	1225261548	0	0	REDGRAVE, SARAH L LCSW	1/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81957	N/A	N/A	N/A	N/A	N/A	10956 DONNER PASS RD	FLOOR 2	TRUCKEE	CA	96161	4861	00	06000	39.32625521	-120.2012059	Nevada County
324798	Ordering, Referring, Prescribing	N/A	1225316151	0	0	RHEE, JAYNE E MD	5/31/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G67067	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
324802	Ordering, Referring, Prescribing	N/A	1225324148	0	0	RENTERIA, LAURA L LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114670	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
324823	Ordering, Referring, Prescribing	N/A	1225358997	0	0	ROBERTSON, BRIAN A MD	4/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD60550228	N/A	N/A	N/A	N/A	N/A	1201 S MILLER ST	None	WENATCHEE	WA	98801	3201	00	06000	47.406591	-120.3208875	Chelan County
324835	Ordering, Referring, Prescribing	N/A	1225391576	0	0	RAMESAR, JOLIE S MD	11/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152773	N/A	N/A	N/A	N/A	N/A	1041 ROSE AVE	None	SELMA	CA	93662	3240	00	06000	36.56879252	-119.596257	Fresno County
324850	Ordering, Referring, Prescribing	N/A	1225403124	0	0	ROCCHIO, JENNA M PHARMD	8/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74182	N/A	N/A	N/A	N/A	N/A	14100 BLOSSOM HILL RD	None	LOS GATOS	CA	95032	5118	00	06000	37.23621854	-121.914054	Santa Clara County
324852	Ordering, Referring, Prescribing	N/A	1225404908	0	0	RAZEGHI, JASMINE Y PHARMD	1/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52147	N/A	N/A	N/A	N/A	N/A	3901 LAS POSAS RD, SUITE	SUITE 101	CAMARILLO	CA	93010	1505	00	06000	34.2415821	-119.0183756	Ventura County
324861	Ordering, Referring, Prescribing	N/A	1225418924	0	0	ROBINSON, SARAH PSYD	1/28/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32355	N/A	N/A	N/A	N/A	N/A	1738 S TREMONT ST	None	OCEANSIDE	CA	92054	5309	00	06000	33.17510112	-117.3632319	San Diego County
324881	Ordering, Referring, Prescribing	N/A	1225460330	0	0	ROUGN, CHEATH LMFT	7/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107662	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
324903	Ordering, Referring, Prescribing	N/A	1225490733	0	0	REYNOLDS, REBECCA A LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105561	N/A	N/A	N/A	N/A	N/A	1393 BAILEY ST	None	HANFORD	CA	93230	5922	00	06000	36.32728474	-119.665912	Kings County
324907	Ordering, Referring, Prescribing	N/A	1225490659	0	0	RUBERMAN, SARAH E MD	5/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162392	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
324916	Ordering, Referring, Prescribing	N/A	1225491491	0	0	RIVERA, ERICA M LMFT	12/21/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109694	N/A	N/A	N/A	N/A	N/A	1301 PINE AVENUE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
324920	Ordering, Referring, Prescribing	N/A	1225512759	0	0	RENZAS, JENNIFER NP	1/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016776	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
324922	Ordering, Referring, Prescribing	N/A	1225512437	0	0	RODRIGUEZ, ALLISON L LCSW	3/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121053	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH ST.	SUITE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
324949	Ordering, Referring, Prescribing	N/A	1225553498	0	0	RAGUS, NATALIE C	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95312	N/A	N/A	N/A	N/A	N/A	1529 E PALMDALE BLVD	150	PALMDALE	CA	93550	2034	00	06000	34.57966052	-118.102275	Los Angeles County
324971	Ordering, Referring, Prescribing	N/A	1225573421	0	0	REGHABI, NASEEM PSYD	1/29/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21940	N/A	N/A	N/A	N/A	N/A	338 W LEXINGTON AVE	None	EL CAJON	CA	92020	4465	00	06000	32.79272653	-116.965152	San Diego County
324982	Ordering, Referring, Prescribing	N/A	1225589427	0	0	RECHKUNOVA-GOODSON, MARIA A ND	11/21/2016	Taxonomy not applicable	NA	n/a	000	Unknown	826	N/A	N/A	N/A	N/A	N/A	316 REDONDO AVE	None	LONG BEACH	CA	90814	2651	00	06000	33.76879342	-118.1523978	Los Angeles County
324992	Ordering, Referring, Prescribing	N/A	1225613060	0	0	RYDELL, STACEY LMFT	10/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142012	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	1500	00	06000	34.44760276	-119.2488095	Ventura County
324996	Ordering, Referring, Prescribing	N/A	1225619398	0	0	RAIYANI, PRIYANKA P DDS	10/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108305	N/A	N/A	N/A	N/A	N/A	300 HARTLE CT	None	NAPA	CA	94559	4078	00	06000	38.28326249	-122.2801759	Napa County
325002	Ordering, Referring, Prescribing	N/A	1225641327	0	0	ROWLAND, KAYLA M LCSW	3/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW128992	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
325013	Ordering, Referring, Prescribing	N/A	1225664527	0	0	RAHBAR, ISABEL	5/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014229	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
325023	Ordering, Referring, Prescribing	N/A	1225694300	0	0	ROSALES, MARIA CECILIA P CNP	4/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011725	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS BLVD	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
325056	Ordering, Referring, Prescribing	N/A	1235163411	0	0	RADOV, ANEITA	11/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	19712	N/A	N/A	N/A	N/A	N/A	3121 PARK AVENUE	SUITE I	SOQUEL	CA	95073	2920	00	06000	36.9896384	-121.9356617	Santa Cruz County
325058	Ordering, Referring, Prescribing	N/A	1235158817	0	0	RASHEED, FARHA N	4/10/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D51641	N/A	N/A	N/A	N/A	N/A	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	00	06000	37.88652418	-121.2820956	San Joaquin County
325081	Ordering, Referring, Prescribing	N/A	1235225020	0	0	RENTERIA-SOTO, CANDICE	2/28/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0598612	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
325086	Ordering, Referring, Prescribing	N/A	1235255308	0	0	ROGELBERG, ELLEN LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48952	N/A	N/A	N/A	N/A	N/A	15339 SATICOY STREET	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
325121	Ordering, Referring, Prescribing	N/A	1235324021	0	0	RUVALCABA, BERTHA P LCSW	11/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60574	N/A	N/A	N/A	N/A	N/A	2130 STOCKTON BLVD	100	SACRAMENTO	CA	95817	1337	00	06000	38.557593	-121.4616735	Sacramento County
325122	Ordering, Referring, Prescribing	N/A	1235323494	0	0	RAYA MARQUEZ, RIAN M LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49194	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
325204	Ordering, Referring, Prescribing	N/A	1235451501	0	0	RAPOPORT, KAREN E	4/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0572673	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
325209	Ordering, Referring, Prescribing	N/A	1235471798	0	0	ROGUEL, ARNOLD S	11/25/2013	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	CT0013053	N/A	N/A	N/A	N/A	N/A	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2089	00	06000	33.69070037	-117.9886896	Orange County
325222	Ordering, Referring, Prescribing	N/A	1235492489	0	0	RATANASEN, MITCH S MD	8/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128007	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 2100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
325253	Ordering, Referring, Prescribing	N/A	1235531567	0	0	ROBERTS, TREVOR N LCSW	11/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89718	N/A	N/A	N/A	N/A	N/A	4675 VILLAGE MILL WAY	None	RANCHO CORDOVA	CA	95742	8111	00	06000	38.536218	-121.2252345	Sacramento County
325260	Ordering, Referring, Prescribing	N/A	1235547514	0	0	RESAVY, ASHLEY C CNP	4/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017117	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST.	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
325275	Ordering, Referring, Prescribing	N/A	1235571399	0	0	RAMIREZ, EVA LMFT	9/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128218	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST.	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
325291	Ordering, Referring, Prescribing	N/A	1235584681	0	0	ROEPCKE, FAY MD	10/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158267	N/A	N/A	N/A	N/A	N/A	1357 OAKLAND BLVD	None	WALNUT CREEK	CA	94596	4303	00	06000	37.89795717	-122.0701674	Contra Costa County
325297	Ordering, Referring, Prescribing	N/A	1235607227	0	0	ROGERS, RONALD E PHARMD	3/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	79845	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
325304	Ordering, Referring, Prescribing	N/A	1235617655	0	0	RAMOS, AUDREY L LCSW	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	101860	N/A	N/A	N/A	N/A	N/A	7058 N WEST AVE	178	FRESNO	CA	93711	0462	00	06000	36.83826683	-119.8262426	Fresno County
325305	Ordering, Referring, Prescribing	N/A	1235620766	0	0	RODRIGUEZ, JARROD K NP	6/4/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	584065	N/A	N/A	N/A	N/A	N/A	1212 HANNA AVE	None	CORCORAN	CA	93212	2313	00	06000	36.09974853	-119.56293	Kings County
325317	Ordering, Referring, Prescribing	N/A	1235633744	0	0	ROBINSON, KARA M LMFT	3/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132067	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
325329	Ordering, Referring, Prescribing	N/A	1235649591	0	0	RITOLA, EMILY R PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70420	N/A	N/A	N/A	N/A	N/A	2100 DR MARTIN LUTHER KI	None	CHICO	CA	95928	4422	00	06000	39.721077	-121.811508	Butte County
325364	Ordering, Referring, Prescribing	N/A	1235714155	0	0	RANDOLPH, CHRISTINE	5/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	918	N/A	N/A	N/A	N/A	N/A	1001 PORTERO AVENUE	7M8	SAN FRANCISCO	CA	94110	3594	00	06000	37.75548534	-122.4065362	San Francisco County
325417	Ordering, Referring, Prescribing	N/A	1235911132	0	0	RIVERA, THALIA NP	6/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95025532	N/A	N/A	N/A	N/A	N/A	860 SEQUOIA AVE	None	LINDSAY	CA	93247	1425	00	06000	36.21418314	-119.096029	Tulare County
325452	Ordering, Referring, Prescribing	N/A	1245294586	0	0	RAMSEY, KEITH P DO	12/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17355	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	S103	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
325456	Ordering, Referring, Prescribing	N/A	1245295088	0	0	RUBEN, BETH S MD	10/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G70065	N/A	N/A	N/A	N/A	N/A	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	00	06000	37.78553106	-122.4399475	San Francisco County
325460	Ordering, Referring, Prescribing	N/A	1245307768	0	0	ROMAN, JANIS D LCSW	11/5/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	11870	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3 FL	LONG BEACH	CA	90806	9998	00	06000	33.806097	-118.151378	Los Angeles County
325472	Ordering, Referring, Prescribing	N/A	1245344258	0	0	RUGGLES, JAMES A MD	4/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C35361	N/A	N/A	N/A	N/A	N/A	430 N PILGRIM ST	None	STOCKTON	CA	95205	4428	00	06000	37.95964768	-121.2766746	San Joaquin County
325473	Ordering, Referring, Prescribing	N/A	1245331446	0	0	RANDOL, ELANA E LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68910	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 200	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
325476	Ordering, Referring, Prescribing	N/A	1245342377	0	0	REED, DORIAN J	7/27/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17649	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
325484	Ordering, Referring, Prescribing	N/A	1245359876	0	0	ROUAH, LESLEY J LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22603	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
325499	Ordering, Referring, Prescribing	N/A	1245378439	0	0	RAO, ARUNA D MD	11/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89130	N/A	N/A	N/A	N/A	N/A	489 5TH STREET	None	GUSTINE	CA	95322	9532	00	06000	37.2546798	-120.9995316	Merced County
325506	Ordering, Referring, Prescribing	N/A	1245372325	0	0	ROBLES, JOHN H LMSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29581	N/A	N/A	N/A	N/A	N/A	21250 B0X SPRINGS RD	None	MORENO VALLEY	CA	92557	8705	00	06000	33.989832	-117.2307857	Riverside County
325521	Ordering, Referring, Prescribing	N/A	1245423136	0	0	ROSSE, TOMASZ A MD	5/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92896	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
325528	Ordering, Referring, Prescribing	N/A	1245431188	0	0	RANDALL, JAMES MSW LCSW	6/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70134	N/A	N/A	N/A	N/A	N/A	5000 W SUNSET BLVD	SUITE 610	LOS ANGELES	CA	90027	5861	00	06000	34.0981066	-118.2986382	Los Angeles County
325549	Ordering, Referring, Prescribing	N/A	1245468933	0	0	ROBBINS, AYAKA K NP	5/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025340	N/A	N/A	N/A	N/A	N/A	390 N PACIFIC COAST HWY	SUITE 2060	EL SEGUNDO	CA	90245	4475	00	06000	33.92077214	-118.3960953	Los Angeles County
325560	Ordering, Referring, Prescribing	N/A	1245489665	0	0	RAMIREZ, LUIS A LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101775	N/A	N/A	N/A	N/A	N/A	1701 OCEAN AVENUE	None	SAN FRANCISCO	CA	94114	1727	00	06000	37.72476918	-122.4604495	San Francisco County
325561	Ordering, Referring, Prescribing	N/A	1245495803	0	0	RODRIGUEZ, SALINA N LMFT	5/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87997	N/A	N/A	N/A	N/A	N/A	2390 MARITIME DR.	STE100	ELK GROVE	CA	95758	3645	00	06000	38.411208	-121.4824365	Sacramento County
325575	Ordering, Referring, Prescribing	N/A	1245515493	0	0	RODRIGUEZ, SAMUEL PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46295	N/A	N/A	N/A	N/A	N/A	401 PARADISE RD	A	MODESTO	CA	95351	3163	00	06000	37.62692973	-121.0131742	Stanislaus County
325584	Ordering, Referring, Prescribing	N/A	1245523281	0	0	ROBERTS, MICHELLE L LCSW	7/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69505	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST.	A	SAN FRANCISCO	CA	94102	2543	00	06000	37.77327874	-122.4183559	San Francisco County
325585	Ordering, Referring, Prescribing	N/A	1245535087	0	0	ROMERO ARCEO, MARIA B	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80991	N/A	N/A	N/A	N/A	N/A	343 YOLO ST	None	ORLAND	CA	95963	1724	00	06000	39.7438725	-122.1940292	Glenn County
325607	Ordering, Referring, Prescribing	N/A	1245582568	0	0	RAMIREZ, MONICA C LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70215	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
325622	Ordering, Referring, Prescribing	N/A	1245603612	0	0	RAYA, REYNA PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73808	N/A	N/A	N/A	N/A	N/A	8770 W PICO BLVD	None	LOS ANGELES	CA	90035	2211	00	06000	34.05467857	-118.3832934	Los Angeles County
325629	Ordering, Referring, Prescribing	N/A	1245607043	0	0	RANDALL, NORA K LCSW	10/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88855	N/A	N/A	N/A	N/A	N/A	11080 W. OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1606	00	06000	34.04036814	-118.4376056	Los Angeles County
325649	Ordering, Referring, Prescribing	N/A	1245631597	0	0	RIVERA, JESSICA K	4/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101050	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
325718	Ordering, Referring, Prescribing	N/A	1245755784	0	0	RASSINER, MARGUERITE L	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42205	N/A	N/A	N/A	N/A	N/A	19307 SATICOY ST	None	RESEDA	CA	91344	2330	00	06000	34.20838149	-118.5542325	Los Angeles County
325726	Ordering, Referring, Prescribing	N/A	1245759638	0	0	REA, BRADLEE R PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76574	N/A	N/A	N/A	N/A	N/A	325 S WILLIS ST	None	VISALIA	CA	93291	6105	00	06000	36.327717	-119.2981005	Tulare County
325738	Ordering, Referring, Prescribing	N/A	1245764273	0	0	ROMAN, JENNIFER M NP	10/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013427	N/A	N/A	N/A	N/A	N/A	655 S. CENTRAL VALLEY HI	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
325783	Ordering, Referring, Prescribing	N/A	1245837228	0	0	RAPIZ, VIGIL BETH S PHARMD	9/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83089	N/A	N/A	N/A	N/A	N/A	2647 SPRINGS RD	None	VALLEJO	CA	94591	5712	00	06000	38.10591447	-122.2076385	Solano County
325791	Ordering, Referring, Prescribing	N/A	1245848621	0	0	RIMLINGER, ANNA M LCSW	9/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118027	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
325847	Ordering, Referring, Prescribing	N/A	1255011532	0	0	REHIMTOOLA, NERMEEN A NP	7/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026224	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
325851	Ordering, Referring, Prescribing	N/A	1255004933	0	0	RENELUS, REBECCA DDS	6/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108919	N/A	N/A	N/A	N/A	N/A	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	00	06000	38.35358835	-122.7073105	Sonoma County
325858	Ordering, Referring, Prescribing	N/A	1255046603	0	0	RIBOH, DANIEL PA-C	2/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64096	N/A	N/A	N/A	N/A	N/A	7451 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	00	06000	34.20616081	-118.3878161	Los Angeles County
325862	Ordering, Referring, Prescribing	N/A	1255042180	0	0	ROXAS, DESSIELYN NP	7/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024202	N/A	N/A	N/A	N/A	N/A	335 E AVENUE I	None	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
325869	Ordering, Referring, Prescribing	N/A	1255054953	0	0	ROSETE, ALLAN S PHARMD	11/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66518	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
325891	Ordering, Referring, Prescribing	N/A	1255336137	0	0	RAUF, MUHAMMAD A MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76384	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	B	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
325913	Ordering, Referring, Prescribing	N/A	1255432118	0	0	RUIZ, EVETTE MD	9/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55545	N/A	N/A	N/A	N/A	N/A	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	00	06000	33.96992365	-118.1629712	Los Angeles County
325924	Ordering, Referring, Prescribing	N/A	1255458220	0	0	RUTHERFORD, JAMES R LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42435	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	1510	00	06000	37.47945362	-122.2230493	San Mateo County
325936	Ordering, Referring, Prescribing	N/A	1255473609	0	0	RYAN, CHRISTOPHER PT	7/3/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	27234	N/A	N/A	N/A	N/A	N/A	640 MARKET STREET	None	COLUSA	CA	95932	0000	00	06000	39.21456168	-122.0101352	Colusa County
325941	Ordering, Referring, Prescribing	N/A	1255480406	0	0	RICHARDSON, JOHN VERNON D	8/15/1993	Taxonomy not applicable	NA	n/a	099	DENTIST	D39700	N/A	N/A	N/A	N/A	N/A	16928 11TH ST	# 790	HURON	CA	93234	0790	00	06000	36.20532278	-120.1027083	Fresno County
325966	Ordering, Referring, Prescribing	N/A	1255527784	0	0	RUIZ, SANDRA LMFT	7/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51635	N/A	N/A	N/A	N/A	N/A	155 E 4TH STREET	None	PERRIS	CA	92570	2124	00	06000	33.78233952	-117.2273265	Riverside County
325968	Ordering, Referring, Prescribing	N/A	1255530994	0	0	RUIZ, ELISSA C LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53714	N/A	N/A	N/A	N/A	N/A	9101 WHITTIER BLVD.	None	PICO RIVERA	CA	90660	2405	00	06000	34.00074139	-118.0822944	Los Angeles County
325983	Ordering, Referring, Prescribing	N/A	1255565867	0	0	RYAN, SHANNON P LMFT	10/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44076	N/A	N/A	N/A	N/A	N/A	540 MIDDLE RINCON RD	None	SANTA ROSA	CA	95409	3107	00	06000	38.471364	-122.6695725	Sonoma County
325999	Ordering, Referring, Prescribing	N/A	1255595989	0	0	ROUNDY, LUKE D LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79251	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
326030	Ordering, Referring, Prescribing	N/A	1255665063	0	0	REDINGER, NORLENE G LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39918	N/A	N/A	N/A	N/A	N/A	6838 SUNSET BLVD.	None	HOLLYWOOD	CA	90028	6102	00	06000	34.09794248	-118.340001	Los Angeles County
326033	Ordering, Referring, Prescribing	N/A	1255669438	0	0	RODRIGUEZ, RENE LCSW	5/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64026	N/A	N/A	N/A	N/A	N/A	223 W COLE BLVD	None	CALEXICO	CA	92231	9722	00	06000	32.69401949	-115.5029355	Imperial County
326077	Ordering, Referring, Prescribing	N/A	1255735395	0	0	RENSI, MATTHEW T LPCC	10/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC8682	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
326079	Ordering, Referring, Prescribing	N/A	1255738910	0	0	ROBELO, ALBERT J	6/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156419	N/A	N/A	N/A	N/A	N/A	1035 PLACER STREET	None	REDDING	CA	96001	4245	00	06000	40.58349378	-122.3853903	Shasta County
326104	Ordering, Referring, Prescribing	N/A	1255768867	0	0	ROCHA, MAXIMILIAN A LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS19977	N/A	N/A	N/A	N/A	N/A	770 53RD ST	None	OAKLAND	CA	94609	1814	00	06000	37.8380933	-122.2688598	Alameda County
326105	Ordering, Referring, Prescribing	N/A	1255775706	0	0	RABIN, RICHARD L MD	4/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138709	N/A	N/A	N/A	N/A	N/A	5773 GREENBACK LANE	None	SACRAMENTO	CA	98541	2013	00	06000	38.682576	-121.3271415	Sacramento County
326128	Ordering, Referring, Prescribing	N/A	1255819876	0	0	ROMAN, JASMIN LCSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120531	N/A	N/A	N/A	N/A	N/A	1215 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2815	00	06000	34.06877078	-117.9349578	Los Angeles County
326172	Ordering, Referring, Prescribing	N/A	1255883724	0	0	RIVERA, ILIANA LMFT	7/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147927	N/A	N/A	N/A	N/A	N/A	355 DOVER PKWY	None	DELANO	CA	93215	3440	00	06000	35.7610493	-119.2523273	Kern County
326189	Ordering, Referring, Prescribing	N/A	1255908992	0	0	RESENDIZ, ANTONIO LMFT	10/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135146	N/A	N/A	N/A	N/A	N/A	2026 W BEACON AVE	None	ANAHEIM	CA	92804	4406	00	06000	33.82030486	-117.9539867	Orange County
326191	Ordering, Referring, Prescribing	N/A	1255903282	0	0	ROCHA, WENDY DDS	1/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	106525	N/A	N/A	N/A	N/A	N/A	4415 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003413	-118.256519	Los Angeles County
326230	Ordering, Referring, Prescribing	N/A	1255988655	0	0	RODRIGUEZ, TINA D LMFT	9/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105453	N/A	N/A	N/A	N/A	N/A	5150 N 6TH ST	169	FRESNO	CA	93710	7510	00	06000	36.81127498	-119.7632093	Fresno County
326236	Ordering, Referring, Prescribing	N/A	1255993531	0	0	RONCI, MAY T NP	7/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012096	N/A	N/A	N/A	N/A	N/A	42135 10TH STREET WEST	SUITE 101	LANCASTER	CA	93534	7099	00	06000	34.648533	-118.1477975	Los Angeles County
326239	Ordering, Referring, Prescribing	N/A	1255996237	0	0	RAMIREZ, JOSE LPCC	12/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8966	N/A	N/A	N/A	N/A	N/A	1907 BOYS REPUBLIC DR	None	CHINO HILLS	CA	91709	5447	00	06000	33.993846	-117.725661	San Bernardino County
326266	Ordering, Referring, Prescribing	N/A	1265063416	0	0	ROMERO, AMBER L NP	9/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013546	N/A	N/A	N/A	N/A	N/A	82934 CIVIC CENTER DR	None	INDIO	CA	92201	4308	00	06000	33.71864703	-116.2178997	Riverside County
326287	Ordering, Referring, Prescribing	N/A	1265134613	0	0	REUSCH, RYAN MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197255	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
326288	Ordering, Referring, Prescribing	N/A	1265100945	0	0	ROSENBERG, LILIT M	9/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	3384	N/A	N/A	N/A	N/A	N/A	223 N JACKSON ST	None	GLENDALE	CA	91206	4334	00	06000	34.14893716	-118.2502138	Los Angeles County
326302	Ordering, Referring, Prescribing	N/A	1265167159	0	0	ROBINSON, KELLY M NP	7/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021717	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
326336	Ordering, Referring, Prescribing	N/A	1265474472	0	0	ROBERTS, JACOB A DO	8/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2008004927	N/A	N/A	N/A	N/A	N/A	525 BRANSON LANDING BLVD	None	BRANSON	MO	65616	2052	00	06000	36.65109796	-93.2204608	Taney County
326402	Ordering, Referring, Prescribing	N/A	1265619852	0	0	ROBINSON, ERIC Q LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100644	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
326416	Ordering, Referring, Prescribing	N/A	1265665541	0	0	RUIZ, CHRISTINE E LCSW	12/8/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77525	N/A	N/A	N/A	N/A	N/A	2020 J ST	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
326425	Ordering, Referring, Prescribing	N/A	1265680896	0	0	ROMERO, XIOMARA LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84330	N/A	N/A	N/A	N/A	N/A	2900 BRISTOL STREET SUIT	None	COSTA MESA	CA	92626	5981	00	06000	33.67689875	-117.8872016	Orange County
326462	Ordering, Referring, Prescribing	N/A	1265718035	0	0	ROSSI, BLAKE M PT	5/4/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	38667	N/A	N/A	N/A	N/A	N/A	162 S MAIN ST	None	BISHOP	CA	93514	3415	00	06000	37.3608019	-118.3951979	Inyo County
326504	Ordering, Referring, Prescribing	N/A	1265805105	0	0	RAVINDRANATH, PRIYA PHARMD	10/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	73871	N/A	N/A	N/A	N/A	N/A	1300 W SAN CARLOS ST	None	SAN JOSE	CA	95126	3444	00	06000	37.32340818	-121.911926	Santa Clara County
326556	Ordering, Referring, Prescribing	N/A	1265878508	0	0	RHODES, RACHEL MD	4/2/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23990	N/A	N/A	N/A	N/A	N/A	3400 DOUGLAS BLVD	SUITE 170	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
326560	Ordering, Referring, Prescribing	N/A	1265885743	0	0	RUNDE, ZACHARY R NP	4/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	201810073NPPP	N/A	N/A	N/A	N/A	N/A	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	06000	45.53179918	-122.6637358	Multnomah County
326595	Ordering, Referring, Prescribing	N/A	1265952550	0	0	RIVERA WOOLUM, DIGNA R LCSW	10/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91473	N/A	N/A	N/A	N/A	N/A	151 KALMUS DR	K2	COSTA MESA	CA	92626	5988	00	06000	33.67282141	-117.8824994	Orange County
326616	Ordering, Referring, Prescribing	N/A	1265985808	0	0	RIOS, NATALIE LMFT	6/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139817	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
326662	Ordering, Referring, Prescribing	N/A	1275076044	0	0	RENZI, JENNIFER A LCSW	11/15/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19404	N/A	N/A	N/A	N/A	N/A	1570 7TH ST	None	SANGER	CA	93657	2402	00	06000	36.70608966	-119.5596086	Fresno County
326693	Ordering, Referring, Prescribing	N/A	1275127144	0	0	ROJAS, LINDA	7/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116759	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
326696	Ordering, Referring, Prescribing	N/A	1275142440	0	0	ROBERSON, KENTORIA I	11/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015883	N/A	N/A	N/A	N/A	N/A	430 PALORA AVE	SUITE #G	YUBA CITY	CA	95991	0000	00	06000	39.1281222	-121.633371	Sutter County
326702	Ordering, Referring, Prescribing	N/A	1275158321	0	0	RANDHAWA, HARMANJIT PA-C	1/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60683	N/A	N/A	N/A	N/A	N/A	750 E. WALKER ST.	A	ORLAND	CA	95963	1241	00	06000	39.74723653	-122.1722213	Glenn County
326714	Ordering, Referring, Prescribing	N/A	1275182198	0	0	RODAS CASTANEDA, MARIELA S MSW LCSW	3/10/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW129066	N/A	N/A	N/A	N/A	N/A	155 N OCCIDENTAL BLVD	None	LOS ANGELES	CA	90026	4641	00	06000	34.07178779	-118.2787879	Los Angeles County
326720	Ordering, Referring, Prescribing	N/A	1275192395	0	0	RODRIGUEZ-JAQUEZ, DANIELA I	4/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56719	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	0000	00	06000	37.3373761	-121.9192532	Santa Clara County
326728	Ordering, Referring, Prescribing	N/A	1275207110	0	0	RODRIGUEZ, JASMINE LMFT	4/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146423	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
326742	Ordering, Referring, Prescribing	N/A	1275282139	0	0	RUBIN, REBECCA DO	4/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22750	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
326809	Ordering, Referring, Prescribing	N/A	1275659591	0	0	RUSHING, STANLEY D LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT33618	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
326814	Ordering, Referring, Prescribing	N/A	1275665069	0	0	RADEVA, ZLATINA A LCSW	8/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29270	N/A	N/A	N/A	N/A	N/A	947 COLE AVE.	None	LOS ANGELES	CA	90038	0000	00	06000	34.088499	-118.3299065	Los Angeles County
326822	Ordering, Referring, Prescribing	N/A	1275673329	0	0	ROBLES, YOLANDA LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26668	N/A	N/A	N/A	N/A	N/A	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
326837	Ordering, Referring, Prescribing	N/A	1275723850	0	0	RINITI, JO ANN PHD	11/19/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY12418	N/A	N/A	N/A	N/A	N/A	9099 SOQUEL DR	SUITE 11	APTOS	CA	95003	4033	00	06000	36.97559147	-121.886838	Santa Cruz County
326839	Ordering, Referring, Prescribing	N/A	1275727414	0	0	RAMIREZ, MIRANDA N LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27621	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
326849	Ordering, Referring, Prescribing	N/A	1275737850	0	0	RAO, NIKHIL G MD	4/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C140465	N/A	N/A	N/A	N/A	N/A	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	00	06000	38.35471913	-122.7076253	Sonoma County
326850	Ordering, Referring, Prescribing	N/A	1275739302	0	0	RAHMANI, MORTEZA MD	4/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119345	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
326859	Ordering, Referring, Prescribing	N/A	1275769598	0	0	ROSSO-BALCAZAR, MICHAELO	5/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106494	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	BUILDING 80	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
326870	Ordering, Referring, Prescribing	N/A	1275800567	0	0	RIZKALLA, GEORGE M	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61079	N/A	N/A	N/A	N/A	N/A	30015 DATE PALM DR	None	CATHEDRAL CITY	CA	92234	2822	00	06000	33.829983	-116.4582285	Riverside County
326874	Ordering, Referring, Prescribing	N/A	1275813008	0	0	ROTELLA, SARA A LCSW	7/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	75261	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
326897	Ordering, Referring, Prescribing	N/A	1275840530	0	0	RUBIO, ISABEL LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82007	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD.	SUITE A	IRWINDALE	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
326921	Ordering, Referring, Prescribing	N/A	1275881948	0	0	ROESE, HEATHER OT	3/16/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	11998	N/A	N/A	N/A	N/A	N/A	309 E MOUNTAIN VIEW ST	100	BARSTOW	CA	92311	2897	00	06000	34.89352417	-117.0239099	San Bernardino County
326936	Ordering, Referring, Prescribing	N/A	1275901241	0	0	RITH, PHANAT LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117280	N/A	N/A	N/A	N/A	N/A	4910 E. ASHLAN AVE	None	FRESNO	CA	93726	3021	00	06000	36.79411387	-119.7309194	Fresno County
326939	Ordering, Referring, Prescribing	N/A	1275903262	0	0	RIVOR, STEVEN J PHARMD	7/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72613	N/A	N/A	N/A	N/A	N/A	4130 LA JOLLA VILLAGE DR	103	LA JOLLA	CA	92037	9121	00	06000	32.87194345	-117.2173414	San Diego County
326943	Ordering, Referring, Prescribing	N/A	1275910283	0	0	RALPH, MARILYN D MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146365	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
326956	Ordering, Referring, Prescribing	N/A	1275922056	0	0	RAPALO GUTIERREZ, ELMER I LMFT	12/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123821	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	2ND FLOOR	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
326965	Ordering, Referring, Prescribing	N/A	1275936544	0	0	REICHHOLD, JOANNA LMFT	12/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136486	N/A	N/A	N/A	N/A	N/A	547 UREN ST	None	NEVADA CITY	CA	95959	2360	00	06000	39.26841435	-121.0124412	Nevada County
326989	Ordering, Referring, Prescribing	N/A	1275974156	0	0	RAY, SHEETAL D	5/20/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	101331	N/A	N/A	N/A	N/A	N/A	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4238	00	06000	34.045119	-117.6464565	San Bernardino County
326997	Ordering, Referring, Prescribing	N/A	1275987976	0	0	REMMERS, HEIDI LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91214	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
327026	Ordering, Referring, Prescribing	N/A	1285018705	0	0	ROJAS MARTINEZ, GLADIS R LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87219	N/A	N/A	N/A	N/A	N/A	180 VIA VERDE	200	SAN DIMAS	CA	91773	3993	00	06000	34.07767801	-117.8150295	Los Angeles County
327028	Ordering, Referring, Prescribing	N/A	1285020594	0	0	RANDELL, JESSICA A DO	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15435	N/A	N/A	N/A	N/A	N/A	12715 PIONEER BLVD	None	NORWALK	CA	90650	9998	00	06000	33.91524469	-118.081899	Los Angeles County
327032	Ordering, Referring, Prescribing	N/A	1285025668	0	0	ROSSI, ANGELICA LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116434	N/A	N/A	N/A	N/A	N/A	3727 SUNSET LANE SUITE 1	None	ANTIOCH	CA	94509	6134	00	06000	37.98376866	-121.8041894	Contra Costa County
327034	Ordering, Referring, Prescribing	N/A	1285029421	0	0	RENTERIA, SABRINA MD	8/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145894	N/A	N/A	N/A	N/A	N/A	3853 ROSECRANS ST	None	SAN DIEGO	CA	92110	3115	00	06000	32.75391982	-117.2024389	San Diego County
327042	Ordering, Referring, Prescribing	N/A	1285035253	0	0	RACE, CATHERINE PSYD	11/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31160	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
327045	Ordering, Referring, Prescribing	N/A	1285044073	0	0	RAJANI, MOHSIN DO	1/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14467	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
327095	Ordering, Referring, Prescribing	N/A	1285110635	0	0	ROSQUETE MENDEZ, RENIER MD	7/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173730	N/A	N/A	N/A	N/A	N/A	17840 VILLA CORTA ST	None	LA PUENTE	CA	91744	5342	00	06000	34.01804501	-117.9119303	Los Angeles County
327118	Ordering, Referring, Prescribing	N/A	1285157594	0	0	RUIZ LOPEZ, MIRIAM LMFT	8/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121368	N/A	N/A	N/A	N/A	N/A	16360 ROSCOE BLVD.	2ND FLOOR	VAN NUYS	CA	91406	1219	00	06000	34.22126852	-118.490805	Los Angeles County
327185	Ordering, Referring, Prescribing	N/A	1285261032	0	0	RATNAYAKE, SAMANTHA N MD	8/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180459	N/A	N/A	N/A	N/A	N/A	575 N THOMPSON RD	None	TIPTON	CA	93272	9756	00	06000	36.06399345	-119.3122406	Tulare County
327188	Ordering, Referring, Prescribing	N/A	1285272120	0	0	ROMAN, MANUEL S	3/9/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104588	N/A	N/A	N/A	N/A	N/A	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	00	06000	34.02394552	-118.187748	Los Angeles County
327197	Ordering, Referring, Prescribing	N/A	1285292094	0	0	RUBIN, EMILY LMFT	4/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132212	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
327198	Ordering, Referring, Prescribing	N/A	1285287169	0	0	RUFFING, ERIC LMFT	8/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LFMT127256	N/A	N/A	N/A	N/A	N/A	23461 S POINTE DRIVE	100	LAGUNA HILLS	CA	92653	1573	00	06000	33.62535142	-117.7206568	Orange County
327228	Ordering, Referring, Prescribing	N/A	1285387787	0	0	RIVERA VARGAS, RUBIMAR PA	7/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	60706	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
327229	Ordering, Referring, Prescribing	N/A	1285415323	0	0	ROSA, HEATHER M MSW LCSW	11/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127509	N/A	N/A	N/A	N/A	N/A	301 E 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29248035	-120.4730619	Merced County
327246	Ordering, Referring, Prescribing	N/A	1285629428	0	0	RICKELMAN, KRISTIN D NP	2/10/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN552017	N/A	N/A	N/A	N/A	N/A	520 COTTONWOOD	STE 10	WOODLAND	CA	95695	3603	00	06000	38.675016	-121.7933365	Yolo County
327293	Ordering, Referring, Prescribing	N/A	1285766600	0	0	ROMANS, KENNETH S PA	11/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10574	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
327311	Ordering, Referring, Prescribing	N/A	1285804708	0	0	RUIZ-RIOS, ELENA D MD	4/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97254	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
327317	Ordering, Referring, Prescribing	N/A	1285820522	0	0	RAMOS, LAURA LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28746	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	None	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
327330	Ordering, Referring, Prescribing	N/A	1285858613	0	0	RAMIREZ ZUNIGA, DIANA LMFT	9/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116840	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
327349	Ordering, Referring, Prescribing	N/A	1285894642	0	0	RAMIREZ, LUIS D. L PSYD	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49791	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	2301	00	06000	34.70150394	-118.1452081	Los Angeles County
327369	Ordering, Referring, Prescribing	N/A	1285922583	0	0	ROZEN, MICHAEL S	10/15/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D61424	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
327381	Ordering, Referring, Prescribing	N/A	1285933267	0	0	ROWSON, KALI G LCSW	12/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69520	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	SUITE 460	OAKLAND	CA	94607	4099	00	06000	37.80185548	-122.2726866	Alameda County
327390	Ordering, Referring, Prescribing	N/A	1285942029	0	0	RAMOS, LUELA M	3/19/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0727240	N/A	N/A	N/A	N/A	N/A	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
327405	Ordering, Referring, Prescribing	N/A	1285984419	0	0	REDFIELD, AUDREY PHD	8/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29496	N/A	N/A	N/A	N/A	N/A	3270 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96108677	-122.5017451	Marin County
327409	Ordering, Referring, Prescribing	N/A	1285987941	0	0	RAMIREZ, GRISELL NP	8/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22068	N/A	N/A	N/A	N/A	N/A	6327 N FRESNO ST	101	FRESNO	CA	93710	5236	00	06000	36.82875536	-119.781417	Fresno County
327410	Ordering, Referring, Prescribing	N/A	1285994855	0	0	RAHIMI-ARDABILY, LAYLA PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65743	N/A	N/A	N/A	N/A	N/A	370 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	00	06000	37.92786635	-122.0300899	Contra Costa County
327467	Ordering, Referring, Prescribing	N/A	1295107456	0	0	ROSENBERG, SHILO MD	1/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156707	N/A	N/A	N/A	N/A	N/A	105 E SYDNOR AVE	100	RIDGECREST	CA	93555	5546	00	06000	35.64096373	-117.6688699	Kern County
327473	Ordering, Referring, Prescribing	N/A	1295121077	0	0	RANGEL, SUSANA MD	1/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	541952	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
327532	Ordering, Referring, Prescribing	N/A	1295221471	0	0	RAGHIB, DANIELLE A LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100239	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 400	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
327576	Ordering, Referring, Prescribing	N/A	1295286326	0	0	RUAN, JAY J LCSW	7/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116239	N/A	N/A	N/A	N/A	N/A	9353 E VALLEY BLVD	C	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
327582	Ordering, Referring, Prescribing	N/A	1295294445	0	0	ROBERTS, KATHRYN M MD	8/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181558	N/A	N/A	N/A	N/A	N/A	8856 ARLINGTON AVE	None	RIVERSIDE	CA	92503	1365	00	06000	33.94647572	-117.4674078	Riverside County
327623	Ordering, Referring, Prescribing	N/A	1295389484	0	0	ROMAN, TIFFANY J LMFT	4/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146579	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
327643	Ordering, Referring, Prescribing	N/A	1295485043	0	0	RICARDO OJEDA, ERNESTO MD	7/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197975	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST.	STE 300	HAWTHORNE	CA	90250	2240	00	06000	33.92825048	-118.3539285	Los Angeles County
327658	Ordering, Referring, Prescribing	N/A	1295713386	0	0	ROXAS, LUISITO M MD	5/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48453	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
327665	Ordering, Referring, Prescribing	N/A	1295739845	0	0	REINA, ROBERT I MD	1/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54907	N/A	N/A	N/A	N/A	N/A	13975 MONO WAY	STE. G	SONORA	CA	95370	2824	00	06000	37.97831488	-120.3396851	Tuolumne County
327668	Ordering, Referring, Prescribing	N/A	1295746097	0	0	ROBINSON, MICHELLE MD	8/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78077	N/A	N/A	N/A	N/A	N/A	8421 AUBURN BLVD	BLDG 3	CITRUS HEIGHTS	CA	95610	0359	00	06000	38.719026	-121.291335	Sacramento County
327674	Ordering, Referring, Prescribing	N/A	1295756781	0	0	RYAN, NICK E LMFT	8/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC37693	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DR	A	RANCHO MIRAGE	CA	92270	2001	00	06000	33.786126	-116.406086	Riverside County
327695	Ordering, Referring, Prescribing	N/A	1295813780	0	0	RANASINGHE, LEONARD E MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63199	N/A	N/A	N/A	N/A	N/A	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
327698	Ordering, Referring, Prescribing	N/A	1295833648	0	0	ROSSI, ANDREA L LMFT	7/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT32740	N/A	N/A	N/A	N/A	N/A	331 N SANBORN RD	None	SALINAS	CA	93905	2220	00	06000	36.67873598	-121.6255027	Monterey County
327735	Ordering, Referring, Prescribing	N/A	1295919264	0	0	ROMAN, RUDY LMFT	3/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111373	N/A	N/A	N/A	N/A	N/A	3711 LONG BEACH BLVD.	SUITE 400	LONG BEACH	CA	90807	3315	00	06000	33.824583	-118.1893785	Los Angeles County
327744	Ordering, Referring, Prescribing	N/A	1295945681	0	0	RO, CHARLES Y MD	8/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2008025540	N/A	N/A	N/A	N/A	N/A	100 MERCY WY	None	JOPLIN	MO	64804	4524	00	06000	37.03591428	-94.50914669	Newton County
327778	Ordering, Referring, Prescribing	N/A	1306012836	0	0	ROHATGI, REINA MD	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93994	N/A	N/A	N/A	N/A	N/A	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	00	06000	38.642832	-121.3649325	Sacramento County
327803	Ordering, Referring, Prescribing	N/A	1306062179	0	0	RODRIGUEZ, DAVID LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51153	N/A	N/A	N/A	N/A	N/A	2450 S ATLANTIC BLVD	101	COMMERCE	CA	90040	1200	00	06000	34.00262503	-118.168284	Los Angeles County
327827	Ordering, Referring, Prescribing	N/A	1306120043	0	0	ROSENTHAL, KRITTAPORN N PHARMD	12/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57381	N/A	N/A	N/A	N/A	N/A	2660 PARK CENTER DR	None	SIMI VALLEY	CA	93065	6207	00	06000	34.28442036	-118.7968257	Ventura County
327924	Ordering, Referring, Prescribing	N/A	1306258959	0	0	RUHLAND, ELLIOT LMFT	12/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110508	N/A	N/A	N/A	N/A	N/A	1330 E COOLEY DR	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.305721	San Bernardino County
327952	Ordering, Referring, Prescribing	N/A	1306306857	0	0	RAMIREZ HARO, CHRISTIAN J MD	11/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179256	N/A	N/A	N/A	N/A	N/A	3420 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	7134	00	06000	32.74405281	-117.0538025	San Diego County
327982	Ordering, Referring, Prescribing	N/A	1306362686	0	0	REYNOLDS, BRADLEY W PHD	11/30/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32667	N/A	N/A	N/A	N/A	N/A	3100 BRISTOL ST	SUITE 150	COSTA MESA	CA	92626	3099	00	06000	33.6865398	-117.885491	Orange County
327984	Ordering, Referring, Prescribing	N/A	1306356829	0	0	RANK, ELIA R LPCC	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10208	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	None	CONCORD	CA	94520	7928	00	06000	37.97055112	-122.0492933	Contra Costa County
327988	Ordering, Referring, Prescribing	N/A	1306367032	0	0	REAGAN, KATHALEEN LPCC	6/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	7527	N/A	N/A	N/A	N/A	N/A	10755 APPLE VALLEY RD	None	APPLE VALLEY	CA	92308	3684	00	06000	34.444179	-117.2316915	San Bernardino County
327997	Ordering, Referring, Prescribing	N/A	1306404561	0	0	RIOS, LIZETH LCSW	5/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122391	N/A	N/A	N/A	N/A	N/A	1910 MAGNOLIA AVENUE	None	LOS ANGELES	CA	90007	1210	00	06000	34.039638	-118.2864045	Los Angeles County
328034	Ordering, Referring, Prescribing	N/A	1306489570	0	0	RAMOS, ELENA R PA-C	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57316	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
328079	Ordering, Referring, Prescribing	N/A	1306628540	0	0	RAINES, CHRISTINA E PA-C	4/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64414	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN.	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
328086	Ordering, Referring, Prescribing	N/A	1306800644	0	0	REYES, REYNALDO L PA	12/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58601	N/A	N/A	N/A	N/A	N/A	2743 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	7410	00	06000	32.66109542	-117.0920417	San Diego County
328087	Ordering, Referring, Prescribing	N/A	1306622915	0	0	RAVINDRA, SANJANA DDS	11/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109719	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
328100	Ordering, Referring, Prescribing	N/A	1306881917	0	0	RAGURAMAN, RAMAKRISHNAN MD	4/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C162017	N/A	N/A	N/A	N/A	N/A	2210 E ILLINOIS AVE	None	FRESNO	CA	93701	2125	00	06000	36.74500687	-119.7846885	Fresno County
328101	Ordering, Referring, Prescribing	N/A	1306869300	0	0	REDDY, JYOTHI J MD	1/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144069	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
328106	Ordering, Referring, Prescribing	N/A	1306901152	0	0	REYES, ALEJANDRO A LCSW	5/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78802	N/A	N/A	N/A	N/A	N/A	44199 MONROE ST	None	INDIO	CA	92201	3096	00	06000	33.727716	-116.233787	Riverside County
328111	Ordering, Referring, Prescribing	N/A	1306908140	0	0	RAMAKRISHNA, SUJATHA MD	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51210	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
328126	Ordering, Referring, Prescribing	N/A	1306933585	0	0	RICKARDS, MARIANNE LCSW	6/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS22463	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
328135	Ordering, Referring, Prescribing	N/A	1306962659	0	0	REES, JILL PSYD	9/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	23030	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
328152	Ordering, Referring, Prescribing	N/A	1306992680	0	0	REED, LORRAINE M NP	12/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	34	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
328162	Ordering, Referring, Prescribing	N/A	1316012677	0	0	ROBLES, FABIOLA LCSW	3/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81343	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD.	None	RIALTO	CA	92376	0100	00	06000	34.10679449	-117.3542535	San Bernardino County
328186	Ordering, Referring, Prescribing	N/A	1316061385	0	0	RHODES, MELANIE LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44636	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400, SUITE 202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
328194	Ordering, Referring, Prescribing	N/A	1316072937	0	0	RODRIGUEZ, MOISES W PHD	5/5/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22593	N/A	N/A	N/A	N/A	N/A	5000 W. SUNSET BLVD	None	LOS ANGELES	CA	90027	5861	00	06000	34.0981066	-118.2986382	Los Angeles County
328219	Ordering, Referring, Prescribing	N/A	1316139645	0	0	RAYMOND, KIMBERLY LMFT	2/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49392	N/A	N/A	N/A	N/A	N/A	4368 SPYRES WAY	None	MODESTO	CA	95356	9259	00	06000	37.702611	-120.998372	Stanislaus County
328288	Ordering, Referring, Prescribing	N/A	1316275605	0	0	RIVAS, CLAUDIA E LCSW	2/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75163	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
328293	Ordering, Referring, Prescribing	N/A	1316283948	0	0	ROSENBERG, MARK PHARMD	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87874	N/A	N/A	N/A	N/A	N/A	4733 E PALM CANYON DR	None	PALM SPRINGS	CA	92264	5219	00	06000	33.79304492	-116.4942569	Riverside County
328313	Ordering, Referring, Prescribing	N/A	1316317589	0	0	RAMIREZ LAROUCHE, MARY T LMFT	6/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126244	N/A	N/A	N/A	N/A	N/A	1060 MANOR RD	None	EL SOBRANTE	CA	94803	1307	00	06000	37.98283758	-122.3044728	Contra Costa County
328406	Ordering, Referring, Prescribing	N/A	1316452592	0	0	RANDLEMAN, MICHAEL LMFT	10/16/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99238	N/A	N/A	N/A	N/A	N/A	12340 SANTA MONICA BLVD.	343	LOS ANGELES	CA	90025	0348	00	06000	34.03928164	-118.4661237	Los Angeles County
328443	Ordering, Referring, Prescribing	N/A	1316495799	0	0	RUBIO, SARAI LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95082	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
328452	Ordering, Referring, Prescribing	N/A	1316508328	0	0	RADA, MELANIE NP	7/5/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012106	N/A	N/A	N/A	N/A	N/A	5440 THORNWOOD DR	None	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
328465	Ordering, Referring, Prescribing	N/A	1316531296	0	0	RUELAS, ADRIANA I NP	2/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95015804	N/A	N/A	N/A	N/A	N/A	31180 ROAD 72	None	VISALIA	CA	93291	9672	00	06000	36.35594779	-119.4124242	Tulare County
328483	Ordering, Referring, Prescribing	N/A	1316577182	0	0	ROSS, TORY D LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45537	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
328494	Ordering, Referring, Prescribing	N/A	1316590870	0	0	REIMERS, CHRISTINA CCC-SLP	3/21/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	22414	N/A	N/A	N/A	N/A	N/A	3722 KATELLA AVE	SUITE C	LOS ALAMITOS	CA	90720	3102	00	06000	33.8029617	-118.0678946	Orange County
328500	Ordering, Referring, Prescribing	N/A	1316588270	0	0	RITTENHOUSE, SARA NP	6/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017517	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD GRAS	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
328522	Ordering, Referring, Prescribing	N/A	1316685258	0	0	RODRIGUEZ, MONA	1/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	62114	N/A	N/A	N/A	N/A	N/A	6095 N 1ST ST	None	FRESNO	CA	93710	5444	00	06000	36.82524765	-119.7723922	Fresno County
328537	Ordering, Referring, Prescribing	N/A	1316773765	0	0	RAMIREZ, ALHELI	1/29/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65239	N/A	N/A	N/A	N/A	N/A	1444 S MAIN ST	None	SANTA ANA	CA	92707	1717	00	06000	33.727401	-117.8678195	Orange County
328546	Ordering, Referring, Prescribing	N/A	1316968266	0	0	RIPICH, STEFAN J NP	3/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5900	N/A	N/A	N/A	N/A	N/A	21337 BUSH STREET	None	MIDDLETOWN	CA	95461	0000	00	06000	38.74858031	-122.6176566	Lake County
328554	Ordering, Referring, Prescribing	N/A	1316997778	0	0	RUERUP, SHERRI CNM	12/21/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236426	N/A	N/A	N/A	N/A	N/A	71777 SAN JACINTO DR	202	RANCHO MIRAGE	CA	92270	3543	00	06000	33.74394755	-116.4124572	Riverside County
328588	Ordering, Referring, Prescribing	N/A	1326111972	0	0	RUFINO, RAEL A PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52832	N/A	N/A	N/A	N/A	N/A	3000 LAS POSITAS ROAD	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
328603	Ordering, Referring, Prescribing	N/A	1326149568	0	0	RICE, MICHAEL B	3/25/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D45964	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
328654	Ordering, Referring, Prescribing	N/A	1326230897	0	0	ROWLAND, JODY LCSW	10/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29096	N/A	N/A	N/A	N/A	N/A	1170 INDUSTRIAL ST.	None	REDDING	CA	96002	0734	00	06000	40.57474549	-122.3503065	Shasta County
328670	Ordering, Referring, Prescribing	N/A	1326263187	0	0	RAINS, JANN LMFT	10/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122551	N/A	N/A	N/A	N/A	N/A	716 OCEAN STREET	None	SANTA CRUZ	CA	95070	5788	00	06000	36.97862665	-122.0208242	Santa Cruz County
328683	Ordering, Referring, Prescribing	N/A	1326287798	0	0	ROZAK, TENNILLE M DDS PHP	9/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS57474	N/A	N/A	N/A	N/A	N/A	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
328699	Ordering, Referring, Prescribing	N/A	1326304304	0	0	RABINOVITCH, SARA M PHD	7/13/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30823	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3	LONG BEACH	CA	90815	1780	00	06000	33.806097	-118.151378	Los Angeles County
328708	Ordering, Referring, Prescribing	N/A	1326315896	0	0	RODRIGUEZ, VICTORIA L PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62329	N/A	N/A	N/A	N/A	N/A	40663 CALIFORNIA OAKS RD	None	MURRIETA	CA	92562	5729	00	06000	33.57229056	-117.2037807	Riverside County
328722	Ordering, Referring, Prescribing	N/A	1326323569	0	0	RIZKALLA, BAHAA R	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58290	N/A	N/A	N/A	N/A	N/A	80925 US HWY 111	None	INDIO	CA	92201	0000	00	06000	33.70724154	-116.2520865	Riverside County
328785	Ordering, Referring, Prescribing	N/A	1326418872	0	0	RUFO, ANDREA AMOR LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94349	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
328791	Ordering, Referring, Prescribing	N/A	1326427394	0	0	RUAYA, RENAN PT	3/29/2018	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT28816	N/A	N/A	N/A	N/A	N/A	14550 HAYNES ST	SECOND FLOOR	VAN NUYS	CA	91411	1613	00	06000	34.18967817	-118.4506446	Los Angeles County
328832	Ordering, Referring, Prescribing	N/A	1326485822	0	0	RABE, CYNTHIA J LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102390	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 200	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
328872	Ordering, Referring, Prescribing	N/A	1326569989	0	0	REYNAGA, ROCIA NP	1/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95092753	N/A	N/A	N/A	N/A	N/A	2505 MERCED ST	None	FRESNO	CA	93721	1811	00	06000	36.74081939	-119.7879808	Fresno County
328886	Ordering, Referring, Prescribing	N/A	1326592924	0	0	RUTHERFORD, CHRISTOPHER PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74766	N/A	N/A	N/A	N/A	N/A	1459 MAIN ST	None	RAMONA	CA	92065	2128	00	06000	33.03801505	-116.8758987	San Diego County
328924	Ordering, Referring, Prescribing	N/A	1326675414	0	0	REAL HERNANDEZ, MELISSA PA-C	8/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA58438	N/A	N/A	N/A	N/A	N/A	1555 SOUTH GAREY AVENUE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
328940	Ordering, Referring, Prescribing	N/A	1326695727	0	0	RUIZ, LYNETTE T LPCC	7/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17034	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
328946	Ordering, Referring, Prescribing	N/A	1326700469	0	0	ROSS, BRANDON J PHARMD	1/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84549	N/A	N/A	N/A	N/A	N/A	400 30TH ST	STE 300	OAKLAND	CA	94609	3306	00	06000	37.81907725	-122.2648838	Alameda County
328966	Ordering, Referring, Prescribing	N/A	1326750480	0	0	RAMEY, JORDYN NP	12/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023672	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
328979	Ordering, Referring, Prescribing	N/A	1326829391	0	0	RICO, CRYSTAL NP	4/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027584	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
329000	Ordering, Referring, Prescribing	N/A	1336204866	0	0	REDOBLADO, RONALD B	6/27/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D51642	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
329004	Ordering, Referring, Prescribing	N/A	1336208073	0	0	RAHMAN, SHOWKOT A MD	11/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87423	N/A	N/A	N/A	N/A	N/A	711 W FLORENCE AVE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
329039	Ordering, Referring, Prescribing	N/A	1336268499	0	0	RENTERIA, ANGELICA NP	6/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NP9298	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
329068	Ordering, Referring, Prescribing	N/A	1336346972	0	0	RIVERA, TANIA L MD	4/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126958	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
329085	Ordering, Referring, Prescribing	N/A	1336373117	0	0	RHOADES, MEAGAN S NP	3/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	561448	N/A	N/A	N/A	N/A	N/A	28999 OLD TOWN FRONT ST	104	TEMECULA	CA	92590	5805	00	06000	33.48395804	-117.1436329	Riverside County
329139	Ordering, Referring, Prescribing	N/A	1336490572	0	0	RUTLEDGE, JENNIFER V LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91985	N/A	N/A	N/A	N/A	N/A	1255 KENDALL ROAD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
329184	Ordering, Referring, Prescribing	N/A	1336536713	0	0	RAVINDRAN, NITHYA DO	5/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19958	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
329185	Ordering, Referring, Prescribing	N/A	1336537752	0	0	RYCROFT, JESSICA LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96694	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
329188	Ordering, Referring, Prescribing	N/A	1336540327	0	0	ROMAN, ZENELIA NP	1/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001191	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
329205	Ordering, Referring, Prescribing	N/A	1336559954	0	0	REISON, DOMINIQUE LPCC	4/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13786	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	SUITE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
329208	Ordering, Referring, Prescribing	N/A	1336554351	0	0	RAMIREZ, MANUEL O PA	10/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51736	N/A	N/A	N/A	N/A	N/A	223 W COLE BLVD	None	CALEXICO	CA	92231	9722	00	06000	32.69401949	-115.5029355	Imperial County
329216	Ordering, Referring, Prescribing	N/A	1336585603	0	0	RANA, SUNNY MD	11/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140018	N/A	N/A	N/A	N/A	N/A	4378 AUBURN BLVD	None	SACRAMENTO	CA	95841	4175	00	06000	38.645082	-121.3614315	Sacramento County
329222	Ordering, Referring, Prescribing	N/A	1336589696	0	0	RIEDEL, MARY LCSW	7/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96471	N/A	N/A	N/A	N/A	N/A	7001 EAST PARKWAY	SUITE 800	SACRAMENTO	CA	95823	2501	00	06000	38.497293	-121.4504235	Sacramento County
329226	Ordering, Referring, Prescribing	N/A	1336602408	0	0	RODRIGUEZ RAMOS, JOSE M	9/1/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105237	N/A	N/A	N/A	N/A	N/A	351 FELICE DR	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
329234	Ordering, Referring, Prescribing	N/A	1336613975	0	0	RODRIGUEZ, ROCHELL LMFT	1/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137401	N/A	N/A	N/A	N/A	N/A	8910 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1104	00	06000	32.83150953	-117.136431	San Diego County
329256	Ordering, Referring, Prescribing	N/A	1336647742	0	0	RUBIN, SHERLE G NP	2/12/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008350	N/A	N/A	N/A	N/A	N/A	540 N SAN JACINTO ST	P	HEMET	CA	92543	3154	00	06000	33.755229	-116.9586405	Riverside County
329257	Ordering, Referring, Prescribing	N/A	1336648922	0	0	RAMIREZ, SALVADOR M LCSW	12/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106362	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
329259	Ordering, Referring, Prescribing	N/A	1336651223	0	0	ROCHA, RENEE M	4/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007906	N/A	N/A	N/A	N/A	N/A	7400 DISTRICT BLVD	C	BAKERSFIELD	CA	93313	4817	00	06000	35.31317675	-119.0831837	Kern County
329269	Ordering, Referring, Prescribing	N/A	1336660992	0	0	RAMOS VERGARA, JARED A LMFT	7/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121959	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	None	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
329287	Ordering, Referring, Prescribing	N/A	1336687136	0	0	RODNEY, STEVE NP	2/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006611	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
329299	Ordering, Referring, Prescribing	N/A	1336706829	0	0	RODRIGUEZ, DIEGO A DDS	6/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS105177	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
329315	Ordering, Referring, Prescribing	N/A	1336752971	0	0	RUBIO, MAURICIO J	11/6/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105354	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
329316	Ordering, Referring, Prescribing	N/A	1336756022	0	0	ROQUE, HANNAH MINETTE M	1/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83267	N/A	N/A	N/A	N/A	N/A	7000 AUBURN BLVD	None	CITRUS HEIGHTS	CA	95621	4342	00	06000	38.689875	-121.2975585	Sacramento County
329421	Ordering, Referring, Prescribing	N/A	1346328721	0	0	RENDON, ANGEL N MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40056	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
329432	Ordering, Referring, Prescribing	N/A	1346342896	0	0	RILEY, TARRON D MSW LCSW	4/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23466	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
329437	Ordering, Referring, Prescribing	N/A	1346368008	0	0	RAPPAPORT, BARBARA L LMFT	2/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130673	N/A	N/A	N/A	N/A	N/A	66 HURLBUT AVENUE	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
329472	Ordering, Referring, Prescribing	N/A	1346417599	0	0	ROCCO, FRANCISCO	1/15/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20894	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
329477	Ordering, Referring, Prescribing	N/A	1346433778	0	0	RABOUBI, SAMI	8/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140980	N/A	N/A	N/A	N/A	N/A	4900 SERRANIA AVE	None	WOODLAND HILLS	CA	91364	3301	00	06000	34.15843077	-118.5882436	Los Angeles County
329496	Ordering, Referring, Prescribing	N/A	1346463411	0	0	ROBINSON SELWA, AKIAH T LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52341	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
329513	Ordering, Referring, Prescribing	N/A	1346511508	0	0	REEVES, SHONTE E MSW LCSW	1/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76161	N/A	N/A	N/A	N/A	N/A	1811 WEST 236TH STREET	None	TORRANCE	CA	90501	5742	00	06000	33.81128314	-118.3111109	Los Angeles County
329525	Ordering, Referring, Prescribing	N/A	1346522844	0	0	RUTTER, WESTLEY LCSW	4/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74968	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
329546	Ordering, Referring, Prescribing	N/A	1346555620	0	0	ROSE, JASON PA	5/20/2019	Taxonomy not applicable	NA	n/a	000	Unknown	21088	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
329555	Ordering, Referring, Prescribing	N/A	1346562352	0	0	RUEZGA, ANNA C LCSW	12/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59907	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
329575	Ordering, Referring, Prescribing	N/A	1346606050	0	0	RITTENMYER, JULIE A LMFT	9/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112403	N/A	N/A	N/A	N/A	N/A	1620 CUMMINS DR	None	MODESTO	CA	95358	6400	00	06000	37.658709	-121.036333	Stanislaus County
329608	Ordering, Referring, Prescribing	N/A	1346652997	0	0	REED, JAMIAN D DO	10/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14814	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST.	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
329626	Ordering, Referring, Prescribing	N/A	1346678976	0	0	RUIZ-CEDENO, DANIELA LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95904	N/A	N/A	N/A	N/A	N/A	222 W 6TH ST	230	SAN PEDRO	CA	90731	3332	00	06000	33.73876969	-118.2824628	Los Angeles County
329634	Ordering, Referring, Prescribing	N/A	1346700101	0	0	REDDY, SREE V	12/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20332	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
329646	Ordering, Referring, Prescribing	N/A	1346713849	0	0	RIOS, NAFISA H PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79992	N/A	N/A	N/A	N/A	N/A	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	00	06000	38.72827776	-121.2904066	Placer County
329654	Ordering, Referring, Prescribing	N/A	1346728862	0	0	ROJAS, LEONOR LCSW	7/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW124195	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
329740	Ordering, Referring, Prescribing	N/A	1346896826	0	0	RAMIREZ GOMEZ, CATHERINE L LMFT	2/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130850	N/A	N/A	N/A	N/A	N/A	1080 MARINA VILLAGE PKWY	100	ALAMEDA	CA	94501	6427	00	06000	37.78544731	-122.270323	Alameda County
329741	Ordering, Referring, Prescribing	N/A	1346894953	0	0	RUCKER, SYDNEY R LCSW	2/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113713	N/A	N/A	N/A	N/A	N/A	200 24TH ST	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
329745	Ordering, Referring, Prescribing	N/A	1346905189	0	0	REID, MONIQUE NP	9/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018750	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
329748	Ordering, Referring, Prescribing	N/A	1346915824	0	0	RENTFRO, HALEY	10/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60258	N/A	N/A	N/A	N/A	N/A	7275 EAST SOUTHGATE DRIV	STE. 204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
329791	Ordering, Referring, Prescribing	N/A	1356071369	0	0	RUBIO-HOYT, ERIKA M LPCC	6/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11691	N/A	N/A	N/A	N/A	N/A	3 CORPORATE PARK	170	IRVINE	CA	92606	5162	00	06000	33.69055394	-117.8260389	Orange County
329816	Ordering, Referring, Prescribing	N/A	1356333017	0	0	RIVIERA, DOLORES A NP	7/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	2922	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
329849	Ordering, Referring, Prescribing	N/A	1356447965	0	0	RAMIREZ, VICTOR N	6/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22784	N/A	N/A	N/A	N/A	N/A	14320 PALM DR	None	DESERT HOT SPRING	CA	92240	6874	00	06000	33.94460044	-116.5012511	Riverside County
329852	Ordering, Referring, Prescribing	N/A	1356444269	0	0	RINK-ROSAS, HEATHER J LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45004	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 301	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
329883	Ordering, Referring, Prescribing	N/A	1356530828	0	0	RADILLO HERNANDEZ, KATIA E LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29348	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
329912	Ordering, Referring, Prescribing	N/A	1356602510	0	0	REICH, NICOLE K LMFT	4/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36524	N/A	N/A	N/A	N/A	N/A	3304 IDLEWILD WAY	None	SAN DIEGO	CA	92117	3508	00	06000	32.82871296	-117.2159663	San Diego County
329920	Ordering, Referring, Prescribing	N/A	1356609119	0	0	RAB, SHAYAN MD	6/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127914	N/A	N/A	N/A	N/A	N/A	222 S HILL ST	FL 5	LOS ANGELES	CA	90012	3506	00	06000	34.0525918	-118.2482081	Los Angeles County
329934	Ordering, Referring, Prescribing	N/A	1356625958	0	0	RANDERIA, PURVISA P PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55010	N/A	N/A	N/A	N/A	N/A	3001 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	2714	00	06000	34.22747229	-118.2452305	Los Angeles County
329938	Ordering, Referring, Prescribing	N/A	1356634307	0	0	RICHMAN, SHEILA LCSW	11/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64696	N/A	N/A	N/A	N/A	N/A	445 TAFT AVE.	None	SEBASTOPOL	CA	95472	3431	00	06000	38.40603363	-122.8239451	Sonoma County
329966	Ordering, Referring, Prescribing	N/A	1356683635	0	0	RIVERO, ALEXANDER R MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A136256	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
329990	Ordering, Referring, Prescribing	N/A	1356714711	0	0	RODRIGUEZ, KARINA D LMFT	5/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126116	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
330058	Ordering, Referring, Prescribing	N/A	1356805030	0	0	REYES, NICOLETTE ANNE G PHARMD	5/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79826	N/A	N/A	N/A	N/A	N/A	1377 N FAIR OAKS AVE	None	PASADENA	CA	91103	2101	00	06000	34.169598	-118.1507175	Los Angeles County
330070	Ordering, Referring, Prescribing	N/A	1356836183	0	0	RODRIGUEZ, CINTIA MSW LCSW	5/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108128	N/A	N/A	N/A	N/A	N/A	790 E BONITA AVE	None	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
330075	Ordering, Referring, Prescribing	N/A	1356846281	0	0	RUIZ-RODRIGUEZ, MARIA S NP	9/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008359	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1902	00	06000	34.57915154	-117.414216	San Bernardino County
330076	Ordering, Referring, Prescribing	N/A	1356851760	0	0	RUSSELL, MARGARET LMFT	10/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115983	N/A	N/A	N/A	N/A	N/A	605 B STREET	None	SAN RAFAEL	CA	94901	3805	00	06000	37.96958726	-122.5300636	Marin County
330097	Ordering, Referring, Prescribing	N/A	1356884803	0	0	ROBERTS, VIRGINIA L LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29132	N/A	N/A	N/A	N/A	N/A	2730 SALVIO ST	None	CONCORD	CA	94519	2599	00	06000	37.98056223	-122.0282614	Contra Costa County
330113	Ordering, Referring, Prescribing	N/A	1356908230	0	0	RIVERA, LUIS PA-C	10/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	58762	N/A	N/A	N/A	N/A	N/A	400 E OAK AVE	None	VISALIA	CA	93291	5034	00	06000	36.332253	-119.288691	Tulare County
330139	Ordering, Referring, Prescribing	N/A	1356953020	0	0	ROYER, JORDAN	7/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025810	N/A	N/A	N/A	N/A	N/A	767 N HILL ST.	STE 400B	LOS ANGELES	CA	90012	2381	00	06000	34.06255157	-118.2397077	Los Angeles County
330158	Ordering, Referring, Prescribing	N/A	1366002917	0	0	ROGERS, MEGAN K LMFT	12/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129870	N/A	N/A	N/A	N/A	N/A	430 F ST	None	CHULA VISTA	CA	91910	3711	00	06000	32.63977028	-117.0851206	San Diego County
330174	Ordering, Referring, Prescribing	N/A	1366051633	0	0	RAMIREZ-LUNA, MIGUEL A LCSW	4/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122137	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	300	LOS ANGELES	CA	90017	1931	00	06000	34.05307427	-118.2651099	Los Angeles County
330218	Ordering, Referring, Prescribing	N/A	1366167546	0	0	RUMMELL, ALLISON PA-C	11/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63756	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST.	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
330245	Ordering, Referring, Prescribing	N/A	1366263196	0	0	RAMIREZ, BARBARA PA-C	2/7/2025	Taxonomy not applicable	NA	n/a	000	Unknown	PA65920	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
330280	Ordering, Referring, Prescribing	N/A	1366567901	0	0	ROJAS BERTRAND, IRIS I MSW LCSW	12/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70136	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE.	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
330281	Ordering, Referring, Prescribing	N/A	1366568859	0	0	RUSSELL, ELISA R	10/21/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D25276	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
330284	Ordering, Referring, Prescribing	N/A	1366568834	0	0	RELERFORD, RHYANA K LCSW	3/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29745	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	628	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
330316	Ordering, Referring, Prescribing	N/A	1366630832	0	0	RHEE, JEONG MIN LCSW	12/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24103	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
330352	Ordering, Referring, Prescribing	N/A	1366724866	0	0	RAMIREZ-PAVANO, MELISSA M PSYD	11/12/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30312	N/A	N/A	N/A	N/A	N/A	19231 VICTORY BLVD	STE. 110	RESEDA	CA	91335	6308	00	06000	34.18659852	-118.552221	Los Angeles County
330375	Ordering, Referring, Prescribing	N/A	1366769002	0	0	RABU, GABRIEL	11/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92400	N/A	N/A	N/A	N/A	N/A	38 ASH AVENUE	None	SAN ANSELMO	CA	94960	1803	00	06000	37.98461362	-122.5747644	Marin County
330380	Ordering, Referring, Prescribing	N/A	1366775793	0	0	REYNOLDS, STEFANIE A	12/2/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D58572	N/A	N/A	N/A	N/A	N/A	201 S HARBOR BLVD	None	LA HABRA	CA	90631	5654	00	06000	33.93029897	-117.9331306	Orange County
330389	Ordering, Referring, Prescribing	N/A	1366793150	0	0	ROSS, CHRISTA N NP	1/2/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN729995	N/A	N/A	N/A	N/A	N/A	14372 BEACH BLVD	SUITE B	WESTMINSTER	CA	92683	4578	00	06000	33.75341465	-117.989413	Orange County
330390	Ordering, Referring, Prescribing	N/A	1366797649	0	0	RANGEL, SENAIDA LCSW	10/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93393	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR.	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
330401	Ordering, Referring, Prescribing	N/A	1366814576	0	0	ROUNDS, KACIE M MD	11/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159372	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
330403	Ordering, Referring, Prescribing	N/A	1366817470	0	0	RUBIO, ERICK LCSW	12/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127671	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
330407	Ordering, Referring, Prescribing	N/A	1366819864	0	0	RUIZ, JANET LCSW	10/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97978	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR.	None	MODESTO	CA	95350	0100	00	06000	37.64722447	-120.9836925	Stanislaus County
330410	Ordering, Referring, Prescribing	N/A	1366826273	0	0	RODRIGUEZ, LATICIA M LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111854	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE	None	HEMET	CA	92543	4512	00	06000	33.74750951	-116.960463	Riverside County
330440	Ordering, Referring, Prescribing	N/A	1366864118	0	0	RENSHAW, DAWN NP	8/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026281	N/A	N/A	N/A	N/A	N/A	500 W HOSPITAL RD	SUITE # A, B AND C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
330444	Ordering, Referring, Prescribing	N/A	1366872582	0	0	ROTH, JENNIFER I LCSW	6/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86682	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
330467	Ordering, Referring, Prescribing	N/A	1366904195	0	0	RAGHUNATHAN, SNEHA MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	739	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
330471	Ordering, Referring, Prescribing	N/A	1366895211	0	0	RODRIGUEZ, JANETTE D LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95879	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
330487	Ordering, Referring, Prescribing	N/A	1366944605	0	0	ROTHSTEIN, ISABEL B LCSW	8/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109636	N/A	N/A	N/A	N/A	N/A	1801 PARKCOURT PL	BUILDING H	SANTA ANA	CA	92701	5028	00	06000	33.74986153	-117.8429355	Orange County
330497	Ordering, Referring, Prescribing	N/A	1366962391	0	0	RAMIREZ, CAMILLE LPCC	3/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC11346	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	SUITE 108	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
330501	Ordering, Referring, Prescribing	N/A	1366963217	0	0	RODRIGUEZ, JENNIFER LCSW	7/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102754	N/A	N/A	N/A	N/A	N/A	1812 W PARK AVE	None	REDLANDS	CA	92373	0002	00	06000	34.05931058	-117.216243	San Bernardino County
330502	Ordering, Referring, Prescribing	N/A	1366969404	0	0	ROBINSON, ALEXANDRA M PHD	9/8/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31997	N/A	N/A	N/A	N/A	N/A	1819 CLIFF DRIVE	SUITE F	SANTA BARBARA	CA	93109	0000	00	06000	34.40137954	-119.7214154	Santa Barbara County
330511	Ordering, Referring, Prescribing	N/A	1366979247	0	0	ROHANNI, PAROSTU MD	10/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170497	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	2090	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
330519	Ordering, Referring, Prescribing	N/A	1366992901	0	0	RHYU, MICHELLE LCSW	3/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89479	N/A	N/A	N/A	N/A	N/A	14112 S KINGSLEY DR	None	GARDENA	CA	90249	3018	00	06000	33.902901	-118.304243	Los Angeles County
330521	Ordering, Referring, Prescribing	N/A	1366996993	0	0	RICHMOND, CHANNING E LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120007	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
330531	Ordering, Referring, Prescribing	N/A	1376008250	0	0	RILEY, JOHN PA-C	4/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58656	N/A	N/A	N/A	N/A	N/A	630 S BRAWLEY AVE	4	BRAWLEY	CA	92227	3107	00	06000	32.97215183	-115.5425908	Imperial County
330533	Ordering, Referring, Prescribing	N/A	1376012278	0	0	RIX, LISA LCSW	12/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93607	N/A	N/A	N/A	N/A	N/A	123 F ST	SUITE F	EUREKA	CA	95501	0411	00	06000	40.80503195	-124.1666813	Humboldt County
330561	Ordering, Referring, Prescribing	N/A	1376066191	0	0	RIZZOTTI, ALESSANDRA LCSW	3/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS100466	N/A	N/A	N/A	N/A	N/A	947 COLE AVE	FL 2	LOS ANGELES	CA	90038	2610	00	06000	34.088499	-118.3299065	Los Angeles County
330563	Ordering, Referring, Prescribing	N/A	1376069740	0	0	RODRIGUEZ, EDNA LCSW	8/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102913	N/A	N/A	N/A	N/A	N/A	12100 VALLEY BLVD	STE 109A	EL MONTE	CA	91732	3161	00	06000	34.06130355	-118.0164048	Los Angeles County
330573	Ordering, Referring, Prescribing	N/A	1376082974	0	0	RADFORD, KEMISHA S LMFT	8/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127682	N/A	N/A	N/A	N/A	N/A	302 CHERRY LN STE 208	STE 208	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
330581	Ordering, Referring, Prescribing	N/A	1376110809	0	0	RODRIGUEZ, BRIAN M PA-C	10/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60165	N/A	N/A	N/A	N/A	N/A	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4411	00	06000	33.66050702	-117.3018956	Riverside County
330627	Ordering, Referring, Prescribing	N/A	1376198820	0	0	RAMIREZ, CHRISTOPHER A LMFT	6/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133293	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
330630	Ordering, Referring, Prescribing	N/A	1376224857	0	0	RICHARDSON, SACHI NP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025917	N/A	N/A	N/A	N/A	N/A	200 PORTER DR	200	SAN RAMON	CA	94583	1587	00	06000	37.77372204	-121.9911155	Contra Costa County
330641	Ordering, Referring, Prescribing	N/A	1376267492	0	0	RODRIGUEZ, ADRIAN PA-C	11/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63755	N/A	N/A	N/A	N/A	N/A	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	00	06000	33.849909	-117.9416115	Orange County
330659	Ordering, Referring, Prescribing	N/A	1376532531	0	0	RONQUILLO, FLORENTINA M NP	1/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8989	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
330674	Ordering, Referring, Prescribing	N/A	1376613661	0	0	RUSSELL, CRAIG DC	1/31/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	26585	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
330736	Ordering, Referring, Prescribing	N/A	1376727362	0	0	RUIZ, ESTER LCSW	11/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60942	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
330742	Ordering, Referring, Prescribing	N/A	1376741017	0	0	ROSENBERG, SHOSHANA J LCSW	9/4/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25559	N/A	N/A	N/A	N/A	N/A	920 ALLSTON WY	None	BERKELEY	CA	94710	2389	00	06000	37.86575915	-122.294211	Alameda County
330743	Ordering, Referring, Prescribing	N/A	1376737874	0	0	REYNOLDS, TYLER S MD	6/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101986	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
330762	Ordering, Referring, Prescribing	N/A	1376772673	0	0	ROBERTS, ELIZABETH D LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92430	N/A	N/A	N/A	N/A	N/A	1845 BUSINESS CENTER DRI	130	SAN BERNARDINO	CA	92408	0107	00	06000	34.06865027	-117.2832038	San Bernardino County
330764	Ordering, Referring, Prescribing	N/A	1376795377	0	0	RUIZ, MELISSA J MD	8/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137641	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
330776	Ordering, Referring, Prescribing	N/A	1376822346	0	0	RODRIGUEZ, ARTURO LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90882	N/A	N/A	N/A	N/A	N/A	1650 LAS PLUMAS AVE	K	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
330796	Ordering, Referring, Prescribing	N/A	1376859934	0	0	ROBERTS, CLIFFORD E LCSW	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73383	N/A	N/A	N/A	N/A	N/A	6762 LEXINGTON AVE	SUITE A	LOS ANGELES	CA	90038	1217	00	06000	34.09253848	-118.3378635	Los Angeles County
330813	Ordering, Referring, Prescribing	N/A	1376883827	0	0	RAINA, SHIVANI PHARMD	8/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	67458	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
330858	Ordering, Referring, Prescribing	N/A	1376951707	0	0	ROSTON-COOPER, SHANNAH LMFT	4/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139053	N/A	N/A	N/A	N/A	N/A	5135 SOLANO	None	RICHMOND	CA	94805	1411	00	06000	37.94292454	-122.3254772	Contra Costa County
330863	Ordering, Referring, Prescribing	N/A	1376957282	0	0	ROMULO, SHARON CNP	1/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016542	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93102	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
330866	Ordering, Referring, Prescribing	N/A	1376960336	0	0	RODRIGUEZ, MARA E LMFT	2/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130741	N/A	N/A	N/A	N/A	N/A	23311 DRACAEA AVE	None	MORENO VALLEY	CA	92553	3201	00	06000	33.92807348	-117.258489	Riverside County
330884	Ordering, Referring, Prescribing	N/A	1376987206	0	0	ROY, NIYATI G PSYD	3/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29053	N/A	N/A	N/A	N/A	N/A	1001 S GRAND AVE	SUITE B	SANTA ANA	CA	92705	4121	00	06000	33.73586511	-117.8502452	Orange County
330887	Ordering, Referring, Prescribing	N/A	1376992024	0	0	REGOLI, MATTHEW J PHARMD	8/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61967	N/A	N/A	N/A	N/A	N/A	2875 MAIN STREET	None	SUSANVILLE	CA	96130	0000	00	06000	40.41007292	-120.6355924	Lassen County
330901	Ordering, Referring, Prescribing	N/A	1386004661	0	0	ROBINSON, BENJAMIN D	1/28/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102443	N/A	N/A	N/A	N/A	N/A	2239 N SCHOOL ST	None	HONOLULU	HI	96819	2539	00	06000	21.34080803	-157.874389	Honolulu County
330918	Ordering, Referring, Prescribing	N/A	1386041259	0	0	RIVERS, GLENDA K LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104567	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
330922	Ordering, Referring, Prescribing	N/A	1386020923	0	0	REYES, CINDY I LCSW	1/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110395	N/A	N/A	N/A	N/A	N/A	815 DR. MARTIN LUTHER KI	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
330937	Ordering, Referring, Prescribing	N/A	1386056281	0	0	REBER, JASMINE PHARMD	5/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74964	N/A	N/A	N/A	N/A	N/A	2300 MIDDLEFIELD RD	PHARMACY	REDWOOD CITY	CA	94063	2854	00	06000	37.47986244	-122.2166029	San Mateo County
330944	Ordering, Referring, Prescribing	N/A	1386073922	0	0	RAWAL, SUMEET K PA	2/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	23282	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE# A	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
330955	Ordering, Referring, Prescribing	N/A	1386084481	0	0	ROONEY, KATHLEEN M NP	11/30/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23202	N/A	N/A	N/A	N/A	N/A	811 E 11TH ST	None	REEDLEY	CA	93654	2527	00	06000	36.60347345	-119.4404912	Fresno County
330959	Ordering, Referring, Prescribing	N/A	1386094316	0	0	REED, MOLLY LMFT	7/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90056	N/A	N/A	N/A	N/A	N/A	599 BELLEVUE AVENUE	SUITE G17	SANTA ROSA	CA	95407	7713	00	06000	38.405007	-122.734251	Sonoma County
330967	Ordering, Referring, Prescribing	N/A	1386112951	0	0	ROBINSON, JESSICA PHARMD	10/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79699	N/A	N/A	N/A	N/A	N/A	1050 NORTHGATE DR	None	SAN RAFAEL	CA	94903	2526	00	06000	38.00839453	-122.5435599	Marin County
330980	Ordering, Referring, Prescribing	N/A	1386133783	0	0	RODRIGUEZ, MICHELLE R LMFT	5/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132635	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
330997	Ordering, Referring, Prescribing	N/A	1386154532	0	0	REYES, GABRIELLE A	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77290	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
331032	Ordering, Referring, Prescribing	N/A	1386194546	0	0	RAMIREZ, ALICIA LCSW	5/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108019	N/A	N/A	N/A	N/A	N/A	314 E AVE K4 #104	None	LANCASTER	CA	93535	4689	00	06000	34.67128484	-118.1251028	Los Angeles County
331034	Ordering, Referring, Prescribing	N/A	1386197135	0	0	RAFAH-FAGIRI, WEDA LCSW	10/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70249	N/A	N/A	N/A	N/A	N/A	33 ENCINA AVE	None	PALO ALTO	CA	94301	2343	00	06000	37.43913037	-122.1608344	Santa Clara County
331053	Ordering, Referring, Prescribing	N/A	1386225514	0	0	RUSSELL, LAUREN V NP	6/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	28562	N/A	N/A	N/A	N/A	N/A	33100 COUNTY ROAD 31	None	DAVIS	CA	95616	9523	00	06000	38.562426	-121.893282	Yolo County
331065	Ordering, Referring, Prescribing	N/A	1386259422	0	0	ROGERS, REGINALD LMFT	12/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143448	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
331067	Ordering, Referring, Prescribing	N/A	1386278885	0	0	RAY, ANGELA MD	12/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8411	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
331083	Ordering, Referring, Prescribing	N/A	1386299931	0	0	RAMOS, DAVID R PHARMD	7/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82731	N/A	N/A	N/A	N/A	N/A	4150 REGENTS PARK ROW	155	LA JOLLA	CA	92037	9124	00	06000	32.87272099	-117.2175656	San Diego County
331136	Ordering, Referring, Prescribing	N/A	1386624294	0	0	ROSE, CHRISTINE L LMFT	7/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	19001	N/A	N/A	N/A	N/A	N/A	8333 FOOTHILL BLVD.,	201	RANCHO CUCAMONGA	CA	91730	3156	00	06000	34.1049632	-117.6233446	San Bernardino County
331137	Ordering, Referring, Prescribing	N/A	1386636348	0	0	RUDOLPH, CHARLES MD	5/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G60659	N/A	N/A	N/A	N/A	N/A	4510 EXECUTIVE DR	None	SAN DIEGO	CA	92121	3021	00	06000	32.87570943	-117.2100834	San Diego County
331138	Ordering, Referring, Prescribing	N/A	1386627263	0	0	RAMOS-MERCADO, FABIOLA B DMD	6/25/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102261	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
331145	Ordering, Referring, Prescribing	N/A	1386654598	0	0	REED, DAVID V	11/19/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D50714	N/A	N/A	N/A	N/A	N/A	1211 CORTINA DR	None	ORLAND	CA	95963	1699	00	06000	39.74167912	-122.201695	Glenn County
331155	Ordering, Referring, Prescribing	N/A	1386706117	0	0	RAMOS, CARLOS E	6/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24288	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
331161	Ordering, Referring, Prescribing	N/A	1386741072	0	0	REIFENBERGER, JODY PA	5/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	22669	N/A	N/A	N/A	N/A	N/A	220 ROTANZI ST	None	RAMONA	CA	92065	2583	00	06000	33.02892485	-116.889131	San Diego County
331221	Ordering, Referring, Prescribing	N/A	1386807600	0	0	RIVERA, DEBORAH L LCSW	2/22/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18087	N/A	N/A	N/A	N/A	N/A	1555 S GAREY AVE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
331284	Ordering, Referring, Prescribing	N/A	1386962686	0	0	REZAI, KAZI DO	11/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	12157	N/A	N/A	N/A	N/A	N/A	22310 WARDHAM AVE	None	HAWAIIAN GARDENS	CA	90716	1740	00	06000	33.82667708	-118.0650149	Los Angeles County
331285	Ordering, Referring, Prescribing	N/A	1386959351	0	0	RACHAL, ANGELA C NP	7/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014828	N/A	N/A	N/A	N/A	N/A	223 W COLE BLVD	None	CALEXICO	CA	92231	9722	00	06000	32.69401949	-115.5029355	Imperial County
331296	Ordering, Referring, Prescribing	N/A	1386990349	0	0	ROSE, NADIA E LCSW	2/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108092	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
331308	Ordering, Referring, Prescribing	N/A	1396002382	0	0	RAFFETTO, KATHERINE A	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0812452	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
331366	Ordering, Referring, Prescribing	N/A	1396053427	0	0	RODRIGUEZ, MELISSA LCSW	12/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68012	N/A	N/A	N/A	N/A	N/A	4701 CESAR CHAVEZ AVENUE	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
331451	Ordering, Referring, Prescribing	N/A	1396227542	0	0	RENO, KAREN L PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78759	N/A	N/A	N/A	N/A	N/A	1722 LAWTON ST	None	SAN FRANCISCO	CA	94122	3326	00	06000	37.75778263	-122.4814773	San Francisco County
331457	Ordering, Referring, Prescribing	N/A	1396239117	0	0	REBUJIO, RACHAEL PA-C	7/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA55748	N/A	N/A	N/A	N/A	N/A	121 S. LONG BEACH BLVD.	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
331466	Ordering, Referring, Prescribing	N/A	1396249397	0	0	RUCHELLI, GABRIELA	1/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176022	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95127	1439	00	06000	37.34293689	-121.9270392	Santa Clara County
331474	Ordering, Referring, Prescribing	N/A	1396271912	0	0	RODRIGUEZ-GARCIA, JOSE MD	3/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165278	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS BLVD	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
331479	Ordering, Referring, Prescribing	N/A	1396277703	0	0	REBOLLEDO, BIANCA MD	6/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157704	N/A	N/A	N/A	N/A	N/A	26967 BEAUMONT AVE	None	REDLANDS	CA	92373	4360	00	06000	34.03741027	-117.2157872	San Bernardino County
331486	Ordering, Referring, Prescribing	N/A	1396291332	0	0	RODRIGUEZ, IRAIS J LMFT	5/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126091	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
331505	Ordering, Referring, Prescribing	N/A	1396324851	0	0	RAPHEL, TIANA MD	7/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7723	N/A	N/A	N/A	N/A	N/A	10549 JEFFERSON BLVD	None	CULVER CITY	CA	90232	3513	00	06000	34.00659325	-118.3923586	Los Angeles County
331523	Ordering, Referring, Prescribing	N/A	1396350740	0	0	RUBIN, SARAH M PA-C	3/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60863	N/A	N/A	N/A	N/A	N/A	5 BON AIR RD	17	LARKSPUR	CA	94939	1143	00	06000	37.9438204	-122.5395357	Marin County
331531	Ordering, Referring, Prescribing	N/A	1396358024	0	0	REED, STEPHANIE J	10/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015647	N/A	N/A	N/A	N/A	N/A	2630 FIRST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
331534	Ordering, Referring, Prescribing	N/A	1396365938	0	0	RUBIO, LETICIA LCSW	5/25/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70055	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
331577	Ordering, Referring, Prescribing	N/A	1396470175	0	0	RAZAL, NEIL RYAN NP	2/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019950	N/A	N/A	N/A	N/A	N/A	15455 SAN FERNANDO MISSI	301	MISSION HILLS	CA	91345	1300	00	06000	34.27194157	-118.469079	Los Angeles County
331583	Ordering, Referring, Prescribing	N/A	1396493292	0	0	RODRIGUEZ, FLORA PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA60886	N/A	N/A	N/A	N/A	N/A	12586 AVENUE 408	None	OROSI	CA	93647	9454	00	06000	36.53030229	-119.2915122	Tulare County
331618	Ordering, Referring, Prescribing	N/A	1396801379	0	0	RODRIGUEZ-LASCOT, LAURA E LMFT	5/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38042	N/A	N/A	N/A	N/A	N/A	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
331639	Ordering, Referring, Prescribing	N/A	1396846572	0	0	REALE, STEPHEN MD	1/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G81738	N/A	N/A	N/A	N/A	N/A	15243 VANOWEN ST.	101	VAN NUYS	CA	91405	3636	00	06000	34.19394848	-118.4654115	Los Angeles County
331667	Ordering, Referring, Prescribing	N/A	1396879300	0	0	RUTHERFORD, JESSICA L MSW LCSW	3/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100379	N/A	N/A	N/A	N/A	N/A	900 E MAIN ST.	201	GRASS VALLEY	CA	95945	5853	00	06000	39.22827201	-121.0517684	Nevada County
331687	Ordering, Referring, Prescribing	N/A	1396918546	0	0	RAISANI, KAMAL	6/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C142206	N/A	N/A	N/A	N/A	N/A	31764 CASIN0 DR	None	LAKE ELSINORE	CA	92530	4571	00	06000	33.65724839	-117.29582	Riverside County
331692	Ordering, Referring, Prescribing	N/A	1396937868	0	0	READER, BEVERLY MD	10/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112747	N/A	N/A	N/A	N/A	N/A	25000 AVE STANFORD	167	VALENCIA	CA	91355	0800	00	06000	34.43847322	-118.5729968	Los Angeles County
331734	Ordering, Referring, Prescribing	N/A	1407020738	0	0	RAVNAN, MARCUS C PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47450	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
331738	Ordering, Referring, Prescribing	N/A	1407032501	0	0	ROBISON, KERRIE L PT	12/29/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	22024	N/A	N/A	N/A	N/A	N/A	1311 SANGUINETTI ROAD	C	SONORA	CA	95370	6210	00	06000	37.97447385	-120.3613052	Tuolumne County
331809	Ordering, Referring, Prescribing	N/A	1407200256	0	0	RICARD-CRUZ, MELISSA K LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110320	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
331860	Ordering, Referring, Prescribing	N/A	1407286719	0	0	RODRIGUEZ, MARIBEL LMFT	4/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138967	N/A	N/A	N/A	N/A	N/A	5284 ADOLFO RD	100	CAMARILLO	CA	93012	6787	00	06000	34.21515637	-118.9970881	Ventura County
331876	Ordering, Referring, Prescribing	N/A	1407305857	0	0	REED, REBECCA	12/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129800	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	2739	00	06000	37.36411044	-121.9052075	Santa Clara County
331893	Ordering, Referring, Prescribing	N/A	1407335672	0	0	ROMERO, CRISTINA E LCSW	5/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115403	N/A	N/A	N/A	N/A	N/A	5300 ANGELES VISTA BLVD	None	LOS ANGELES	CA	90043	1648	00	06000	33.99473949	-118.34271	Los Angeles County
331917	Ordering, Referring, Prescribing	N/A	1407356918	0	0	REYNAGA-VARGAS, REYNA A NP	5/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008645	N/A	N/A	N/A	N/A	N/A	8856 ARLINGTON AVE	None	RIVERSIDE	CA	92503	1365	00	06000	33.94647572	-117.4674078	Riverside County
331997	Ordering, Referring, Prescribing	N/A	1407578537	0	0	ROSDAIL, HEATHER S NP	10/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023102	N/A	N/A	N/A	N/A	N/A	18225 HALE AVENUE	None	MORGAN HILL	CA	95037	0000	00	06000	37.13761496	-121.6664813	Santa Clara County
332015	Ordering, Referring, Prescribing	N/A	1407809015	0	0	RAGHURAMAN, KARTHIK B	3/28/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D54025	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
332029	Ordering, Referring, Prescribing	N/A	1407836794	0	0	RIVAS, DAVID M DO	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6386	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
332062	Ordering, Referring, Prescribing	N/A	1407973159	0	0	RICHMOND, SARAH F LCSW	11/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW	N/A	N/A	N/A	N/A	N/A	11080 W. OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
332072	Ordering, Referring, Prescribing	N/A	1407987621	0	0	RIOS, LAURA LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46235	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD.	102	VAN NUYS	CA	91405	3937	00	06000	34.19649	-118.448787	Los Angeles County
332073	Ordering, Referring, Prescribing	N/A	1407987464	0	0	RETI, VICTORIA LMFT	11/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT44520	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST.	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
332136	Ordering, Referring, Prescribing	N/A	1417098138	0	0	ROTIN, CHRISTINE R	10/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	18517	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
332140	Ordering, Referring, Prescribing	N/A	1417106972	0	0	RIVERA, JESUS LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92769	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
332146	Ordering, Referring, Prescribing	N/A	1417113754	0	0	REYES, MONICA LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64804	N/A	N/A	N/A	N/A	N/A	10355 SLUSHER DR	None	SANTA FE SPRINGS	CA	90670	7353	00	06000	33.94228286	-118.0779517	Los Angeles County
332152	Ordering, Referring, Prescribing	N/A	1417131236	0	0	RUBIO, AGUSTIN S MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101372	N/A	N/A	N/A	N/A	N/A	811 E ELEVENTH ST	None	REEDLEY	CA	93654	2527	00	06000	36.60347345	-119.4404912	Fresno County
332161	Ordering, Referring, Prescribing	N/A	1417124108	0	0	RINCON ARREDONDO, LORENA LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108506	N/A	N/A	N/A	N/A	N/A	144 S L ST	None	DINUBA	CA	93618	2323	00	06000	36.54033313	-119.389607	Tulare County
332163	Ordering, Referring, Prescribing	N/A	1417148073	0	0	ROESCH, WILLIAM E NP	8/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	330400	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	BLDG K	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
332176	Ordering, Referring, Prescribing	N/A	1417181025	0	0	RODAS, SARA M LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78803	N/A	N/A	N/A	N/A	N/A	1157 LEMOYNE STREET	None	LOS ANGELES	CA	90026	3203	00	06000	34.07738174	-118.2596033	Los Angeles County
332209	Ordering, Referring, Prescribing	N/A	1417247412	0	0	REID, RACQUEL E MD	3/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151636	N/A	N/A	N/A	N/A	N/A	6400 LAUREL CANYON BLVD	500	NORTH HOLLYWOOD	CA	91606	1571	00	06000	34.18698871	-118.3964897	Los Angeles County
332227	Ordering, Referring, Prescribing	N/A	1417289869	0	0	RYAN, TRAVIS W DC	11/7/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	31511	N/A	N/A	N/A	N/A	N/A	1203 N CHERRY ST	None	TULARE	CA	93274	2233	00	06000	36.224964	-119.336946	Tulare County
332235	Ordering, Referring, Prescribing	N/A	1417299009	0	0	ROSATI, ANDREA D MD	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132044	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	BLDG 5, 7M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
332270	Ordering, Referring, Prescribing	N/A	1417338708	0	0	RUEGE, ANDREW J MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168929	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	120	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
332355	Ordering, Referring, Prescribing	N/A	1417474404	0	0	RUSSELL, BONITA LMFT	5/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126025	N/A	N/A	N/A	N/A	N/A	5150 EAST PACIFIC COAST	100	LONG BEACH	CA	90804	3311	00	06000	33.7831762	-118.1333125	Los Angeles County
332363	Ordering, Referring, Prescribing	N/A	1417494006	0	0	REMIGIO, REINA PHD	4/4/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28764	N/A	N/A	N/A	N/A	N/A	1141 HARBOR BAY PKWY	105	ALAMEDA	CA	94502	6596	00	06000	37.72684142	-122.2311003	Alameda County
332435	Ordering, Referring, Prescribing	N/A	1417654187	0	0	RAMIREZ, RUDY A NP	10/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022935	N/A	N/A	N/A	N/A	N/A	1150 E LERDO HWY	STE C	SHAFTER	CA	93263	9419	00	06000	35.49996992	-119.2613936	Kern County
332441	Ordering, Referring, Prescribing	N/A	1417669367	0	0	RAMIREZ, BRITTNNIE ALLISON A DC	7/19/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36479	N/A	N/A	N/A	N/A	N/A	3590 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2655	00	06000	33.93042906	-118.2056035	Los Angeles County
332510	Ordering, Referring, Prescribing	N/A	1427121003	0	0	RUIZ-RIVAS, SANDRA M LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80128	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
332535	Ordering, Referring, Prescribing	N/A	1427156173	0	0	REDDY, VEDHIRE S MD	6/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A46202	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST,2 ND FLOO	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
332545	Ordering, Referring, Prescribing	N/A	1427201458	0	0	ROCKEY, ELISE M LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85067	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
332575	Ordering, Referring, Prescribing	N/A	1427271402	0	0	ROPA, HEATHER LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT31450	N/A	N/A	N/A	N/A	N/A	14515 HAMLIN STREET	#200	VAN NUYS	CA	91411	1607	00	06000	34.18869729	-118.4492498	Los Angeles County
332585	Ordering, Referring, Prescribing	N/A	1427281815	0	0	ROBB, CAREENA L LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97857	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
332597	Ordering, Referring, Prescribing	N/A	1427317965	0	0	RODAS HURTADO, LINA T LCSW	2/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99951	N/A	N/A	N/A	N/A	N/A	5000 SUNSET BLVD	STE 540	LOS ANGELES	CA	90027	2700	00	06000	34.0981066	-118.2986382	Los Angeles County
332644	Ordering, Referring, Prescribing	N/A	1427411784	0	0	RAYNES, RYAN JUSTIN B RDH	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74512	N/A	N/A	N/A	N/A	N/A	4900 PANAMA LN	None	BAKERSFIELD	CA	93313	3479	00	06000	35.297802	-119.058516	Kern County
332648	Ordering, Referring, Prescribing	N/A	1427413913	0	0	RUSOFF, JASON J NP	11/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95019137	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
332661	Ordering, Referring, Prescribing	N/A	1427435841	0	0	RELLOSA, JERTY A LMFT	12/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129716	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD.	SUITE 102	VAN NUYS	CA	91405	3185	00	06000	34.19649	-118.448787	Los Angeles County
332721	Ordering, Referring, Prescribing	N/A	1427519297	0	0	ROSS, ANTHONY LMFT	12/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152262	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST.	103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
332726	Ordering, Referring, Prescribing	N/A	1427526755	0	0	REYES, TAMARA LCSW	8/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109822	N/A	N/A	N/A	N/A	N/A	250 EXECUTIVE PARK BLVD.	SUITE 4900	SAN FRANCISCO	CA	94134	3335	00	06000	37.71122789	-122.3917813	San Francisco County
332738	Ordering, Referring, Prescribing	N/A	1427546969	0	0	RALLS, SARA C LMFT	5/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115480	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS RD	200	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
332764	Ordering, Referring, Prescribing	N/A	1427584226	0	0	ROMERO, PATRICIA NP	10/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006601	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
332769	Ordering, Referring, Prescribing	N/A	1427589043	0	0	REDDY, SHIVANI MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162084	N/A	N/A	N/A	N/A	N/A	2438 N PONDEROSA DR	C-105	CAMARILLO	CA	93010	2465	00	06000	34.24219545	-119.0227012	Ventura County
332773	Ordering, Referring, Prescribing	N/A	1427597731	0	0	RENDON, GLADIS M LMFT	11/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135842	N/A	N/A	N/A	N/A	N/A	108 WEST VICTORIA ST.	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
332781	Ordering, Referring, Prescribing	N/A	1427602911	0	0	RAY GARG, REENA MD	1/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176249	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
332785	Ordering, Referring, Prescribing	N/A	1427621820	0	0	ROTHHAMMER-RUIZ, ANA M NP	3/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015884	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
332787	Ordering, Referring, Prescribing	N/A	1427629369	0	0	RAHGOZAR, SHAWN C	8/23/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106199	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
332792	Ordering, Referring, Prescribing	N/A	1427633940	0	0	REED, BRYAN D PA-C	10/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA59322	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE STE 10	STE 107	NEWPORT BEACH	CA	92663	3307	00	06000	33.62631386	-117.9310576	Orange County
332813	Ordering, Referring, Prescribing	N/A	1427700186	0	0	ROSALES, CRYSTAL G LMFT	8/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT149140	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
332825	Ordering, Referring, Prescribing	N/A	1427728922	0	0	RESNIK, LYDIA NP	10/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018647	N/A	N/A	N/A	N/A	N/A	5903 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4229	00	06000	34.11066158	-118.1906817	Los Angeles County
332844	Ordering, Referring, Prescribing	N/A	1427807288	0	0	ROSEMOND-SEWER, NATALIE LCSW	11/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119398	N/A	N/A	N/A	N/A	N/A	4221 WILSHIRE BLVD	400	LOS ANGELES	CA	90010	3512	00	06000	34.06177566	-118.320844	Los Angeles County
332851	Ordering, Referring, Prescribing	N/A	1427836337	0	0	RAMIREZ, JESSICA PHARMD	2/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	88552	N/A	N/A	N/A	N/A	N/A	642 PALOMAR ST	None	CHULA VISTA	CA	91911	2626	00	06000	32.60345042	-117.0817809	San Diego County
332868	Ordering, Referring, Prescribing	N/A	1437205390	0	0	RANDAL, ADRIAN	5/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106671	N/A	N/A	N/A	N/A	N/A	2400 LISA LN	None	PLEASANT HILL	CA	94523	3902	00	06000	37.94511904	-122.0512768	Contra Costa County
332872	Ordering, Referring, Prescribing	N/A	1437132412	0	0	RASTY, MARY E	8/26/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100085	N/A	N/A	N/A	N/A	N/A	2400 BELVIDERE RD	None	WAUKEGAN	IL	60089	6165	00	06000	42.351642	-87.8625765	Lake County
332889	Ordering, Referring, Prescribing	N/A	1437241957	0	0	RIM, CHERYL PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50460	N/A	N/A	N/A	N/A	N/A	9 EVENSEN	None	IRVINE	CA	92602	2403	00	06000	33.72139963	-117.7813921	Orange County
332903	Ordering, Referring, Prescribing	N/A	1437271905	0	0	ROBINSON, MELODY A LCSW	3/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74220	N/A	N/A	N/A	N/A	N/A	560 COHASSET RD	180	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
332908	Ordering, Referring, Prescribing	N/A	1437281003	0	0	RODRIGUEZ, MARISSA I LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105333	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	STE B	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
332920	Ordering, Referring, Prescribing	N/A	1437292653	0	0	RAMIREZ, ELIZABETH J NP	1/21/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	395412	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4513	00	06000	35.27488974	-120.6468257	San Luis Obispo County
332928	Ordering, Referring, Prescribing	N/A	1437303336	0	0	ROBERTSON, TAMARA L LCSW	6/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83068	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
332942	Ordering, Referring, Prescribing	N/A	1437333275	0	0	RAY, PERLA P LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49021	N/A	N/A	N/A	N/A	N/A	49211 GRAPEFRUIT BLVD SU	None	COACHELLA	CA	92236	1480	00	06000	33.69171437	-116.184351	Riverside County
332952	Ordering, Referring, Prescribing	N/A	1437353380	0	0	REINA, JESSICA PSYD	1/26/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27022	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE.	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
332958	Ordering, Referring, Prescribing	N/A	1437365764	0	0	RELIS, CHRISTINA E LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53317	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
333024	Ordering, Referring, Prescribing	N/A	1437464484	0	0	ROBERSON, JOYCE W PHD	6/21/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23711	N/A	N/A	N/A	N/A	N/A	44817 FERN AVE,	None	LANCASTER	CA	93534	3112	00	06000	34.69628372	-118.1444066	Los Angeles County
333047	Ordering, Referring, Prescribing	N/A	1437504503	0	0	RANU, JASKIRAN MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154420	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333062	Ordering, Referring, Prescribing	N/A	1437530615	0	0	ROBERTSON, JOHN PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62888	N/A	N/A	N/A	N/A	N/A	1459 MAIN ST	None	RAMONA	CA	92065	2128	00	06000	33.03801505	-116.8758987	San Diego County
333088	Ordering, Referring, Prescribing	N/A	1437566643	0	0	REIF, NICK PHARMD	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	66971	N/A	N/A	N/A	N/A	N/A	2555 HARRIS ST	None	EUREKA	CA	95503	4805	00	06000	40.78053517	-124.1380509	Humboldt County
333123	Ordering, Referring, Prescribing	N/A	1437610755	0	0	ROSENBLUM, MATTHEW K MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL749	N/A	N/A	N/A	N/A	N/A	747 52ND STREET	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
333125	Ordering, Referring, Prescribing	N/A	1437610979	0	0	RUIZ-RUIZ, CRISTIAN MD	4/16/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194199	N/A	N/A	N/A	N/A	N/A	1500 E ANAHEIM ST	100	LONG BEACH	CA	90813	3808	00	06000	33.78257848	-118.1727855	Los Angeles County
333147	Ordering, Referring, Prescribing	N/A	1437638194	0	0	RINALDI, ANNE E RN BS	11/5/2017	Taxonomy not applicable	NA	n/a	000	Unknown	789959	N/A	N/A	N/A	N/A	N/A	300 W WHITNEY AVE	None	WOODLAKE	CA	93286	1238	00	06000	36.4192683	-119.1013822	Tulare County
333148	Ordering, Referring, Prescribing	N/A	1437632973	0	0	RIOS, RACHEL I LCSW	3/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107275	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2667	00	06000	35.35413152	-119.058471	Kern County
333159	Ordering, Referring, Prescribing	N/A	1437658333	0	0	ROMERO, RITA M LMFT	9/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121610	N/A	N/A	N/A	N/A	N/A	47915 OASIS ST.	UNIT B	INDIO	CA	92201	0100	00	06000	33.701508	-116.220908	Riverside County
333180	Ordering, Referring, Prescribing	N/A	1437684917	0	0	RUF, ASHLY C MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158741	N/A	N/A	N/A	N/A	N/A	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7026	00	06000	38.91229842	-119.9978133	El Dorado County
333186	Ordering, Referring, Prescribing	N/A	1437699170	0	0	RAHMANIAN, PARISA PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72324	N/A	N/A	N/A	N/A	N/A	460 W FELICITA AVE	None	ESCONDIDO	CA	92025	6518	00	06000	33.10362671	-117.0751891	San Diego County
333191	Ordering, Referring, Prescribing	N/A	1437689502	0	0	RIVERA GONZALEZ, ANA C LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118607	N/A	N/A	N/A	N/A	N/A	815 DR. MARTIN LUTHER KI	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
333218	Ordering, Referring, Prescribing	N/A	1437747623	0	0	ROBERTS, LOGAN LMFT	6/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138138	N/A	N/A	N/A	N/A	N/A	294 GREEN VALLEY RD	None	WATSONVILLE	CA	95076	1359	00	06000	36.93991665	-121.7699818	Santa Cruz County
333228	Ordering, Referring, Prescribing	N/A	1437785169	0	0	ROGERS, KERRY LCSW	9/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102686	N/A	N/A	N/A	N/A	N/A	4605 LANKERSHIM BLVD	STE 545	NORTH HOLLYWOOD	CA	91602	1892	00	06000	34.15389329	-118.3679999	Los Angeles County
333238	Ordering, Referring, Prescribing	N/A	1437804069	0	0	RUSHING, KERI A LCSW	3/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76474	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	201	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
333244	Ordering, Referring, Prescribing	N/A	1437813029	0	0	REZVANI, GHOLAMREZA	10/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108309	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT.	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
333246	Ordering, Referring, Prescribing	N/A	1437809951	0	0	RICCARDI-ZHU, SIMON NING MD	4/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188527	N/A	N/A	N/A	N/A	N/A	3800 W CHAPMAN AVE	STE 500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
333248	Ordering, Referring, Prescribing	N/A	1437812260	0	0	RADIA, DIPALI P PA-C	3/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60917	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
333287	Ordering, Referring, Prescribing	N/A	1437992138	0	0	ROSALES, DANIEL P PHARMD	12/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH89136	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
333290	Ordering, Referring, Prescribing	N/A	1437988946	0	0	RAMONDA, ADDIE	7/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031090	N/A	N/A	N/A	N/A	N/A	2744 S COAST HWY	None	LAGUNA BEACH	CA	92651	0600	00	06000	33.52215838	-117.7631773	Orange County
333300	Ordering, Referring, Prescribing	N/A	1447039367	0	0	RAINE, MARIA	1/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107581	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
333313	Ordering, Referring, Prescribing	N/A	1447307467	0	0	REEDER, TILDEN MD	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C36969	N/A	N/A	N/A	N/A	N/A	136 VALDIVIA CIRCLE	None	SAN RAMON	CA	94583	2221	00	06000	37.76436238	-121.9697546	Contra Costa County
333317	Ordering, Referring, Prescribing	N/A	1447312178	0	0	ROARK, RANDALL A NP	9/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15996	N/A	N/A	N/A	N/A	N/A	1695 N SUNRISE WAY	202	PALM SPRINGS	CA	92262	3701	00	06000	33.844239	-116.5282075	Riverside County
333326	Ordering, Referring, Prescribing	N/A	1447328869	0	0	RATLIFF, MPHO M NP	2/18/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN320845	N/A	N/A	N/A	N/A	N/A	3166 COLLINS DRIVE	None	MERCED	CA	95348	3132	00	06000	37.320318	-120.476542	Merced County
333372	Ordering, Referring, Prescribing	N/A	1447418470	0	0	ROVIROSA, HIMILCE D	9/14/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D49203	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
333389	Ordering, Referring, Prescribing	N/A	1447477781	0	0	ROSENFARB, BARBARA F LCSW	1/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28590	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
333402	Ordering, Referring, Prescribing	N/A	1447498985	0	0	RIVERA, WILLIAM B	9/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111003	N/A	N/A	N/A	N/A	N/A	18144 US HWY 18	130	APPLE VALLEY	CA	92307	2212	00	06000	34.54085172	-117.2681464	San Bernardino County
333414	Ordering, Referring, Prescribing	N/A	1447518436	0	0	RISKIN, STUART S LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22300	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
333476	Ordering, Referring, Prescribing	N/A	1447644729	0	0	REYES, ARTURO T LMFT	1/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124135	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
333512	Ordering, Referring, Prescribing	N/A	1447687827	0	0	RODRIGUEZ, IVY A OT	5/26/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	13378	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
333526	Ordering, Referring, Prescribing	N/A	1447701677	0	0	RUPANI, POOJA PSYD	5/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30222	N/A	N/A	N/A	N/A	N/A	1333 WILLOW PASS RD	102	CONCORD	CA	94520	7930	00	06000	37.96924618	-122.051411	Contra Costa County
333538	Ordering, Referring, Prescribing	N/A	1447730205	0	0	RAZA, SABEENA R	8/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78002	N/A	N/A	N/A	N/A	N/A	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	0000	00	06000	37.43920432	-122.162109	Santa Clara County
333590	Ordering, Referring, Prescribing	N/A	1447817945	0	0	RIVERA-VARGAS, ANA E LCSW	10/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18145	N/A	N/A	N/A	N/A	N/A	2585 S. ARCHIBALD AVE.	None	ONTARIO	CA	91761	6510	00	06000	34.027092	-117.5927265	San Bernardino County
333633	Ordering, Referring, Prescribing	N/A	1447935093	0	0	RAO, EMILY MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197227	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
333637	Ordering, Referring, Prescribing	N/A	1447953849	0	0	RAM, KANHA NP	2/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029022	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
333666	Ordering, Referring, Prescribing	N/A	1457079154	0	0	RAMOS, RONALD A PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86442	N/A	N/A	N/A	N/A	N/A	101 N BEACH BLVD	None	LA HABRA	CA	90631	4468	00	06000	33.9322713	-117.9680281	Orange County
333672	Ordering, Referring, Prescribing	N/A	1457096232	0	0	REYES, CHRISTIAN A NP	5/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019982	N/A	N/A	N/A	N/A	N/A	520 W I ST	None	LOS BANOS	CA	93635	3419	00	06000	37.06346603	-120.8593647	Merced County
333699	Ordering, Referring, Prescribing	N/A	1457367815	0	0	REISMAN, RICHARD A MD FACOG	10/31/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G29760	N/A	N/A	N/A	N/A	N/A	2795 LOMA VISTA RD	None	VENTURA	CA	93003	1544	00	06000	34.27524405	-119.2586712	Ventura County
333721	Ordering, Referring, Prescribing	N/A	1457458135	0	0	RUIZ, CARA B MD	7/8/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68455	N/A	N/A	N/A	N/A	N/A	1920 E. KATELLA AVENUE	SUITE M	ORANGE	CA	92867	5146	00	06000	33.80935	-117.8339093	Orange County
333725	Ordering, Referring, Prescribing	N/A	1457473118	0	0	ROMPESKY, JOAN M	12/5/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA13123	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	SUITE 220	SAN DIEGO	CA	92126	2363	00	06000	32.91416051	-117.1437943	San Diego County
333732	Ordering, Referring, Prescribing	N/A	1457477473	0	0	RILEY, DANA M PSYD	2/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20798	N/A	N/A	N/A	N/A	N/A	4440 N FIRST ST	None	FRESNO	CA	93726	2304	00	06000	36.79900426	-119.7722187	Fresno County
333743	Ordering, Referring, Prescribing	N/A	1457494122	0	0	RODRIGUEZ, ARISVE LCSW	12/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27151	N/A	N/A	N/A	N/A	N/A	828 S BASCOM AVE	None	SAN JOSE	CA	95128	2651	00	06000	37.31225204	-121.9317854	Santa Clara County
333753	Ordering, Referring, Prescribing	N/A	1457512535	0	0	RIVERA, ROSALBA LCSW	8/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28069	N/A	N/A	N/A	N/A	N/A	705 W PECAN AVE	None	MENDOTA	CA	93637	6254	00	06000	36.941103	-120.06729	Madera County
333760	Ordering, Referring, Prescribing	N/A	1457521049	0	0	RICOKAAINOA, DIANN L LCSW	12/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23824	N/A	N/A	N/A	N/A	N/A	1933 S. BROADWAY	None	LOS ANGELES	CA	90007	4501	00	06000	34.03102377	-118.2660738	Los Angeles County
333771	Ordering, Referring, Prescribing	N/A	1457549321	0	0	RIOS, NOREEN J LMFT	10/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	14888	N/A	N/A	N/A	N/A	N/A	4990 WILLIAMS AVE	None	LA MESA	CA	91942	7409	00	06000	32.76933362	-117.0371085	San Diego County
333802	Ordering, Referring, Prescribing	N/A	1457632846	0	0	REDDY, BLESSY M PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62893	N/A	N/A	N/A	N/A	N/A	6400 HAVEN AVE	None	RANCHO CUCAMONGA	CA	91737	3823	00	06000	34.138377	-117.575997	San Bernardino County
333819	Ordering, Referring, Prescribing	N/A	1457653875	0	0	RICHARDSON, EDWARD PHARMD	8/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54951	N/A	N/A	N/A	N/A	N/A	1070 E CYPRESS AVE	None	REDDING	CA	96002	1114	00	06000	40.57107349	-122.3512425	Shasta County
333829	Ordering, Referring, Prescribing	N/A	1457666703	0	0	RADJINDRIN, ALAMELOU DDS	5/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59281	N/A	N/A	N/A	N/A	N/A	1133 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05124618	-119.0425626	Tulare County
333858	Ordering, Referring, Prescribing	N/A	1457726242	0	0	ROSSEEL, SOPHIE L MD	12/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159454	N/A	N/A	N/A	N/A	N/A	1749 14TH STREET	None	SANTA MONICA	CA	90404	4342	00	06000	34.01877575	-118.4794554	Los Angeles County
333865	Ordering, Referring, Prescribing	N/A	1457729980	0	0	RODRIGUEZ, CRISTINA LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94658	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
333873	Ordering, Referring, Prescribing	N/A	1457748543	0	0	RODRIGUEZ, BRENDA LCSW	1/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77026	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
333874	Ordering, Referring, Prescribing	N/A	1457757064	0	0	REBOLLAR, MELISSA A LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117260	N/A	N/A	N/A	N/A	N/A	1800 SOLAR DR	FL 3	OXNARD	CA	93030	2655	00	06000	34.21748414	-119.1449177	Ventura County
333913	Ordering, Referring, Prescribing	N/A	1457801516	0	0	RODRIGUEZ, GLORIA M LMFT	4/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118894	N/A	N/A	N/A	N/A	N/A	8320 IOWA ST	201	DOWNEY	CA	90241	4928	00	06000	33.93738458	-118.1339974	Los Angeles County
334033	Ordering, Referring, Prescribing	N/A	1457987455	0	0	RECHLER, WILLI MD FAAP	8/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186567	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	SHARK CLINIC	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
334040	Ordering, Referring, Prescribing	N/A	1457994881	0	0	RODRIGUEZ, ADRIAN CNP	10/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012360	N/A	N/A	N/A	N/A	N/A	2042 KERN ST	None	FRESNO	CA	93721	2008	00	06000	36.73339969	-119.7882967	Fresno County
334052	Ordering, Referring, Prescribing	N/A	1467011957	0	0	ROUM, MICHAEL DPM	7/11/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5591	N/A	N/A	N/A	N/A	N/A	880 N STATE ST	None	HEMET	CA	92543	1459	00	06000	33.76159592	-116.9717828	Riverside County
334056	Ordering, Referring, Prescribing	N/A	1467035469	0	0	RACITI, CHRISTOPHER MD	3/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194337	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
334070	Ordering, Referring, Prescribing	N/A	1467067637	0	0	RANA, RABIA PHARMD	9/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81706	N/A	N/A	N/A	N/A	N/A	5437 CLAYTON RD	None	CLAYTON	CA	94517	1039	00	06000	37.95146238	-121.955678	Contra Costa County
334071	Ordering, Referring, Prescribing	N/A	1467077768	0	0	RENNIE, KATHRYN LMFT	2/20/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153372	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
334091	Ordering, Referring, Prescribing	N/A	1467093294	0	0	RAI, RAJINDER K PHARMD	1/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48873	N/A	N/A	N/A	N/A	N/A	442 N. MOORPARK ROAD	None	THOUSAND OAKS	CA	91360	3702	00	06000	34.18446292	-118.8752362	Ventura County
334096	Ordering, Referring, Prescribing	N/A	1467117226	0	0	REHARD, CARLEY C LCSW	8/25/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110132	N/A	N/A	N/A	N/A	N/A	864 E SANTA CLARA ST	None	VENTURA	CA	93001	2939	00	06000	34.27952351	-119.287537	Ventura County
334119	Ordering, Referring, Prescribing	N/A	1467234500	0	0	RIVERA, GILLEANN NP	5/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025326	N/A	N/A	N/A	N/A	N/A	1357 OAKLAND CT	None	WALNUT CREEK	CA	94596	4337	00	06000	37.89772006	-122.0704393	Contra Costa County
334130	Ordering, Referring, Prescribing	N/A	1467435073	0	0	RODRIGUEZ, RAYMOND G	6/19/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D36695	N/A	N/A	N/A	N/A	N/A	696 WALNUT AVE	STE 1	GREENFIELD	CA	93927	4928	00	06000	36.32805072	-121.2463519	Monterey County
334148	Ordering, Referring, Prescribing	N/A	1467460055	0	0	ROUSE, RANDALL J MD	5/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	35813	N/A	N/A	N/A	N/A	N/A	701 DELLWOOD ST S	None	CAMBRIDGE	MN	55008	1920	00	06000	45.56607424	-93.22929387	Isanti County
334156	Ordering, Referring, Prescribing	N/A	1467526384	0	0	RACY, TALISHA L LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41875	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	SUITE 240	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
334161	Ordering, Referring, Prescribing	N/A	1467536706	0	0	RUVALCABA, MAYRA A LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29551	N/A	N/A	N/A	N/A	N/A	3730 HOPYARD RD	None	PLEASANTON	CA	94588	8562	00	06000	37.68061724	-121.9038915	Alameda County
334163	Ordering, Referring, Prescribing	N/A	1467534073	0	0	ROBBINS, KIMBERLY S LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT28690	N/A	N/A	N/A	N/A	N/A	120 S STATE COLLEGE BLVD	None	BREA	CA	92821	5834	00	06000	33.92111797	-117.8828786	Orange County
334238	Ordering, Referring, Prescribing	N/A	1467703678	0	0	RETTER, JEFFREY G PHARMD	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	67855	N/A	N/A	N/A	N/A	N/A	845 S MAIN ST	None	WILLITS	CA	95490	3915	00	06000	39.40290364	-123.3506795	Mendocino County
334241	Ordering, Referring, Prescribing	N/A	1467718601	0	0	ROBINSON, LAQUESHA S LMFT	12/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97654	N/A	N/A	N/A	N/A	N/A	2008 W CARSON ST	203	TORRANCE	CA	90501	3242	00	06000	33.83139833	-118.3168915	Los Angeles County
334246	Ordering, Referring, Prescribing	N/A	1467728444	0	0	ROBINSON, KHADIJA S	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0712911	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
334249	Ordering, Referring, Prescribing	N/A	1467734152	0	0	RUJIRAVIRIYAPINYO, ALISA PHARMD	1/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54077	N/A	N/A	N/A	N/A	N/A	21800 VICTORY BLVD	None	WOODLAND HILLS	CA	91367	2227	00	06000	34.18735254	-118.603418	Los Angeles County
334287	Ordering, Referring, Prescribing	N/A	1467794206	0	0	ROGERS, LISA M LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99767	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DR.	None	HANFORD	CA	93230	8212	00	06000	36.32726257	-119.6663418	Kings County
334313	Ordering, Referring, Prescribing	N/A	1467830588	0	0	RODRIGUEZ, NEREIDA	1/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121822	N/A	N/A	N/A	N/A	N/A	1500 41ST AVE	238	CAPITOLA	CA	95010	2900	00	06000	36.972108	-121.964831	Santa Cruz County
334319	Ordering, Referring, Prescribing	N/A	1467828954	0	0	ROSSI, TINA LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88500	N/A	N/A	N/A	N/A	N/A	29222 RANCHO VIEJO RD	123	SAN JUAN CAPISTRA	CA	92675	1041	00	06000	33.53905045	-117.6736364	Orange County
334324	Ordering, Referring, Prescribing	N/A	1467840314	0	0	RINDLISBACHER, SUZANNE M LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81126	N/A	N/A	N/A	N/A	N/A	109 PARMAC RD	1, 2A	CHICO	CA	95926	2294	00	06000	39.75358764	-121.8505893	Butte County
334346	Ordering, Referring, Prescribing	N/A	1467878793	0	0	RODRIGUEZ, GRACIELA LCSW	3/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29761	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	105	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
334423	Ordering, Referring, Prescribing	N/A	1467974915	0	0	RAI, GEORGINA	9/2/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54629	N/A	N/A	N/A	N/A	N/A	7526 CLAIREMONT MESA	BLVD	SAN DIEGO	CA	92111	1504	00	06000	32.83275147	-117.157122	San Diego County
334453	Ordering, Referring, Prescribing	N/A	1477033629	0	0	RICE, ROSEMARY LMFT	7/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126152	N/A	N/A	N/A	N/A	N/A	14 E CARRILLO ST	None	SANTA BARBARA	CA	93101	6727	00	06000	34.42168751	-119.7016163	Santa Barbara County
334484	Ordering, Referring, Prescribing	N/A	1477091361	0	0	ROBINSON, JENNIFER LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115271	N/A	N/A	N/A	N/A	N/A	7474 EL CAJON BLVD	None	LA MESA	CA	91942	7420	00	06000	32.76850004	-117.036802	San Diego County
334485	Ordering, Referring, Prescribing	N/A	1477089761	0	0	ROSAS, STELLA LMFT	1/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130667	N/A	N/A	N/A	N/A	N/A	222 W. 6TH ST. STE. 230	None	SAN PEDRO	CA	90731	3243	00	06000	33.73876969	-118.2824628	Los Angeles County
334518	Ordering, Referring, Prescribing	N/A	1477167666	0	0	RUSSELL, DAVID J NP	8/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015254	N/A	N/A	N/A	N/A	N/A	1830 SIERRA GARDENS DR	10	ROSEVILLE	CA	95661	2942	00	06000	38.7469982	-121.2600775	Placer County
334519	Ordering, Referring, Prescribing	N/A	1477170868	0	0	RAYGOZA, JOANNA	9/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149428	N/A	N/A	N/A	N/A	N/A	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	00	06000	33.81036565	-118.3466218	Los Angeles County
334617	Ordering, Referring, Prescribing	N/A	1477623924	0	0	RAMOS, EMILIA LCSW	10/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23545	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3 FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
334633	Ordering, Referring, Prescribing	N/A	1477648681	0	0	RAJPARIA, AMIT MD	8/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C140421	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
334639	Ordering, Referring, Prescribing	N/A	1477672855	0	0	RIVERA, CRISTINA LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52847	N/A	N/A	N/A	N/A	N/A	15339 SATICOY ST.	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
334644	Ordering, Referring, Prescribing	N/A	1477678522	0	0	ROGERS, KAREN C PHD	3/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20975	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
334655	Ordering, Referring, Prescribing	N/A	1477698520	0	0	RIANO, NANCY CNP	8/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12127	N/A	N/A	N/A	N/A	N/A	2525 GRAND AVE	None	LONG BEACH	CA	90815	1765	00	06000	33.8026265	-118.1480993	Los Angeles County
334670	Ordering, Referring, Prescribing	N/A	1477702702	0	0	ROBINSON-WILEY, TANISHA L PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56233	N/A	N/A	N/A	N/A	N/A	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	00	06000	37.75425686	-121.4567805	San Joaquin County
334683	Ordering, Referring, Prescribing	N/A	1477758514	0	0	RODRIGUEZ, NANCY LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29697	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
334687	Ordering, Referring, Prescribing	N/A	1477762599	0	0	RICHARDSON, LISA M MD	5/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63387	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
334722	Ordering, Referring, Prescribing	N/A	1477834943	0	0	RICO, LEAH M LCSW	5/15/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80919	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
334727	Ordering, Referring, Prescribing	N/A	1477831741	0	0	REED, MATTHEW G LMFT	10/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94171	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
334780	Ordering, Referring, Prescribing	N/A	1477920221	0	0	RUELAS, LESLIE J LCSW	1/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107564	N/A	N/A	N/A	N/A	N/A	157 E VALLEY PKWY	#200	ESCONDIDO	CA	92025	2762	00	06000	33.12315955	-117.0809067	San Diego County
334783	Ordering, Referring, Prescribing	N/A	1477928703	0	0	RIPA, ALFREDO T	6/19/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D65287	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
334825	Ordering, Referring, Prescribing	N/A	1477998870	0	0	RUIZ, FERRIN K MD	10/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132956	N/A	N/A	N/A	N/A	N/A	901 W WHITTIER BLVD	None	MONTEVELLO	CA	90640	4737	00	06000	34.01042334	-118.1099428	Los Angeles County
334862	Ordering, Referring, Prescribing	N/A	1487037529	0	0	ROSAS-ATKINS, YAFFAR D LMFT	12/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123391	N/A	N/A	N/A	N/A	N/A	660 S FAIR OAKS AVE	None	SUNNYVALE	CA	94086	7913	00	06000	37.36442862	-122.024102	Santa Clara County
334884	Ordering, Referring, Prescribing	N/A	1487058483	0	0	ROSS, KIMBERLY LMFT	10/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103276	N/A	N/A	N/A	N/A	N/A	1645 WEST MILL ST	None	ANDERSON	CA	96007	1234	00	06000	40.44743781	-122.3071931	Shasta County
334887	Ordering, Referring, Prescribing	N/A	1487067112	0	0	RODRIGUEZ, MARGARITA L PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68637	N/A	N/A	N/A	N/A	N/A	1811 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5605	00	06000	33.76873264	-116.9587477	Riverside County
334888	Ordering, Referring, Prescribing	N/A	1487065140	0	0	RIVAS, AGUEDA LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106022	N/A	N/A	N/A	N/A	N/A	160 S 7TH AVE	None	LA PUENTE	CA	91746	3211	00	06000	34.0335863	-117.9760093	Los Angeles County
334890	Ordering, Referring, Prescribing	N/A	1487071916	0	0	RUTHERFORD, ALEXANDRA C LMFT	9/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121968	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
334897	Ordering, Referring, Prescribing	N/A	1487078440	0	0	ROCKWOOD, JASON PHARMD	1/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70191	N/A	N/A	N/A	N/A	N/A	4905 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	6101	00	06000	34.10180109	-118.2963991	Los Angeles County
334909	Ordering, Referring, Prescribing	N/A	1487102091	0	0	RAMIREZ, MARIO A LCSW	3/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114245	N/A	N/A	N/A	N/A	N/A	679 S. NEW HAMPSHIRE AVE	400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
334928	Ordering, Referring, Prescribing	N/A	1487131884	0	0	RAFIE, DANIEL A MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169042	N/A	N/A	N/A	N/A	N/A	300 UCLA MEDICAL PLZ	SUITE 200	LOS ANGELES	CA	90095	8346	00	06000	34.06465655	-118.4461	Los Angeles County
334931	Ordering, Referring, Prescribing	N/A	1487139390	0	0	RUBINO, MIRIAM E LMFT	6/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126411	N/A	N/A	N/A	N/A	N/A	13925 SAN PABLO AVE	SUITE 203	SAN PABLO	CA	94806	3652	00	06000	37.96027199	-122.3423693	Contra Costa County
334941	Ordering, Referring, Prescribing	N/A	1487149225	0	0	REGALADO, VERONICA LMFT	7/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133610	N/A	N/A	N/A	N/A	N/A	2200 ORANGEWOOD AVE	212	ORANGE	CA	92868	0473	00	06000	33.79576054	-117.875655	Orange County
334953	Ordering, Referring, Prescribing	N/A	1487163713	0	0	ROJAS ACUNA, WENDY P	12/12/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	102136	N/A	N/A	N/A	N/A	N/A	2505 DIVISADERO ST	None	FRESNO	CA	93721	1401	00	06000	36.74334929	-119.7809344	Fresno County
334962	Ordering, Referring, Prescribing	N/A	1487177820	0	0	RODRIGUEZ, RUBEN R LCSW	12/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99037	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
334972	Ordering, Referring, Prescribing	N/A	1487194627	0	0	RANDT, JENNIFER L LMFT	5/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125941	N/A	N/A	N/A	N/A	N/A	13925 SAN PABLO AVENUE	SUITE 203	SAN PABLO	CA	94806	3601	00	06000	37.96027199	-122.3423693	Contra Costa County
335017	Ordering, Referring, Prescribing	N/A	1487276374	0	0	RAMIREZ, ROSALINDA	2/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144878	N/A	N/A	N/A	N/A	N/A	875 GEER RD	None	TURLOCK	CA	95380	3311	00	06000	37.50143162	-120.8489859	Stanislaus County
335018	Ordering, Referring, Prescribing	N/A	1487275467	0	0	RAZGONYAYEVA, YELENA CNP	1/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016400	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
335019	Ordering, Referring, Prescribing	N/A	1487274361	0	0	ROHM, LISA L NP	2/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014095	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
335022	Ordering, Referring, Prescribing	N/A	1487281960	0	0	RASEKHI, MAGGIE Z CNP	9/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014200	N/A	N/A	N/A	N/A	N/A	30257 SAN MARTINEZ RD	None	VAL VERDE	CA	91384	2472	00	06000	34.44738769	-118.6644399	Los Angeles County
335027	Ordering, Referring, Prescribing	N/A	1487297099	0	0	RAI, POONAM	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA58359	N/A	N/A	N/A	N/A	N/A	1631 CREEKSIDE DR	SUITE 100	FOLSOM	CA	95630	3820	00	06000	38.671425	-121.14747	Sacramento County
335102	Ordering, Referring, Prescribing	N/A	1487720975	0	0	RAVNAN, SUSAN L	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47611	N/A	N/A	N/A	N/A	N/A	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9721	00	06000	38.384523	-121.371318	Sacramento County
335117	Ordering, Referring, Prescribing	N/A	1487752614	0	0	REEDY, JESSICA F NP	1/31/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN305961	N/A	N/A	N/A	N/A	N/A	500 E ALMOND AVENUE	SUITE 1	MADERA	CA	93637	5600	00	06000	36.94548547	-120.0518941	Madera County
335127	Ordering, Referring, Prescribing	N/A	1487770178	0	0	ROBAINA, LOUISE M LCSW	3/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23092	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
335136	Ordering, Referring, Prescribing	N/A	1487783205	0	0	RUIZ, JENNIFER L LCSW	3/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25111	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
335150	Ordering, Referring, Prescribing	N/A	1487801585	0	0	RAMIREZ, ERICA LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97279	N/A	N/A	N/A	N/A	N/A	951 BLANCO CIR STE B	STE B	SALINAS	CA	93901	4451	00	06000	36.65589725	-121.6366313	Monterey County
335174	Ordering, Referring, Prescribing	N/A	1487880233	0	0	RODRIGUEZ, ELIZABETH A LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91216	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
335177	Ordering, Referring, Prescribing	N/A	1487877437	0	0	ROSE, MICHAEL DDS	2/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	26915	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
335200	Ordering, Referring, Prescribing	N/A	1487933602	0	0	ROJAS, RAYMOND G DC	12/31/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	31630	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
335284	Ordering, Referring, Prescribing	N/A	1497065510	0	0	RODRIGUEZ, LISA J LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42458	N/A	N/A	N/A	N/A	N/A	16350 FILBERT STREET	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
335311	Ordering, Referring, Prescribing	N/A	1497101281	0	0	RIUTZEL, KEVIN J DO	1/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16500	N/A	N/A	N/A	N/A	N/A	1414 S. GRAND AVE	380	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
335323	Ordering, Referring, Prescribing	N/A	1497130819	0	0	RUSSELL, KRISTINA LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99863	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
335376	Ordering, Referring, Prescribing	N/A	1497201545	0	0	RIVERA, JACQUELINE M LCSW	3/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100723	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
335397	Ordering, Referring, Prescribing	N/A	1497239313	0	0	ROBINSON-PAIZ, DANIELLE A LCSW	6/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116006	N/A	N/A	N/A	N/A	N/A	755 E GILBERT ST	None	SAN BERNARDINO	CA	92404	5413	00	06000	34.1267535	-117.27081	San Bernardino County
335398	Ordering, Referring, Prescribing	N/A	1497240865	0	0	RAYYAN, SHANNA L LCSW	5/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115421	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE ROAD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
335399	Ordering, Referring, Prescribing	N/A	1497241723	0	0	RUBIO, LANNETTE M	9/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110634	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
335432	Ordering, Referring, Prescribing	N/A	1497300115	0	0	RIDENOUR, KRYSTYNA P LMFT	9/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131340	N/A	N/A	N/A	N/A	N/A	29775 HAUN RD	None	MENIFEE	CA	92586	6540	00	06000	33.68839122	-117.1750902	Riverside County
335441	Ordering, Referring, Prescribing	N/A	1497319446	0	0	ROSE, NATELY LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116574	N/A	N/A	N/A	N/A	N/A	2130 STOCKTON BLVD	100	SACRAMENTO	CA	95817	1337	00	06000	38.557593	-121.4616735	Sacramento County
335461	Ordering, Referring, Prescribing	N/A	1497374755	0	0	RAMOS, PAIGE LMFT	4/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146485	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ RD	230	MISSION VIEJO	CA	92691	5319	00	06000	33.60038172	-117.6735855	Orange County
335479	Ordering, Referring, Prescribing	N/A	1497402184	0	0	RONCAROLO DE VRIES, ROXANE	2/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020083	N/A	N/A	N/A	N/A	N/A	8480 ENTERPRISE WAY	None	OAKLAND	CA	94621	0000	00	06000	37.74207882	-122.1925503	Alameda County
335502	Ordering, Referring, Prescribing	N/A	1497455810	0	0	RIOS, NELSON O CNP	3/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024493	N/A	N/A	N/A	N/A	N/A	1180 N INDIAN CANYON DR	420	PALM SPRINGS	CA	92262	4800	00	06000	33.839505	-116.5455735	Riverside County
335509	Ordering, Referring, Prescribing	N/A	1497474399	0	0	RAMOS, CLESTHER DDS	8/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107777	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
335553	Ordering, Referring, Prescribing	N/A	1497834402	0	0	RAMIREZ, JOSE PA	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	16167	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
335560	Ordering, Referring, Prescribing	N/A	1497851174	0	0	RUSSELL, JUANITA LMFT	9/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29702	N/A	N/A	N/A	N/A	N/A	621 CHERRY ST.	None	SANTA ROSA	CA	95404	4202	00	06000	38.444877	-122.7163005	Sonoma County
335577	Ordering, Referring, Prescribing	N/A	1497887046	0	0	RAFISOLYMAN, KARMELL DDS	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS47997	N/A	N/A	N/A	N/A	N/A	500 E ALMOND AVE	3	MADERA	CA	93637	5600	00	06000	36.94548547	-120.0518941	Madera County
335623	Ordering, Referring, Prescribing	N/A	1497989347	0	0	RELIA, SACHIN MD	2/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119785	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92340	0000	00	06000	34.48058899	-117.2907353	San Bernardino County
335637	Ordering, Referring, Prescribing	N/A	1508007238	0	0	RICHARDSON, WENDY M PA-C	8/31/2019	Taxonomy not applicable	NA	n/a	000	Unknown	20225	N/A	N/A	N/A	N/A	N/A	670 CO RD 83	None	CANBY	CA	96015	0000	00	06000	41.44344745	-120.8718025	Modoc County
335679	Ordering, Referring, Prescribing	N/A	1508131509	0	0	REMY, DAVID C MD	3/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167477	N/A	N/A	N/A	N/A	N/A	6221 WILSHIRE BLVD	509	LOS ANGELES	CA	90048	0001	00	06000	34.06329534	-118.3640031	Los Angeles County
335687	Ordering, Referring, Prescribing	N/A	1508143058	0	0	RIVOR, JENNIFER PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63750	N/A	N/A	N/A	N/A	N/A	1430 EASTLAKE PKWY	None	CHULA VISTA	CA	91915	1926	00	06000	32.62994867	-116.9650465	San Diego County
335712	Ordering, Referring, Prescribing	N/A	1508171372	0	0	RISEDEN, DEREK L NP	9/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15117	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
335740	Ordering, Referring, Prescribing	N/A	1508218678	0	0	ROE, DEBORAH LMFT	3/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117096	N/A	N/A	N/A	N/A	N/A	12912 BROOKHURST ST	480	GARDEN GROVE	CA	92840	4835	00	06000	33.77487003	-117.9552276	Orange County
335766	Ordering, Referring, Prescribing	N/A	1508265497	0	0	RAMIREZ, ANDREW F	6/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	D63903	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
335819	Ordering, Referring, Prescribing	N/A	1508347543	0	0	RODRIGUEZ, KAYLA M LCSW	5/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122478	N/A	N/A	N/A	N/A	N/A	1600 E BELLE TER	None	BAKERSFIELD	CA	93307	3871	00	06000	35.34672702	-118.9837495	Kern County
335847	Ordering, Referring, Prescribing	N/A	1508390816	0	0	RAMAKRISHNAN, RAVICHANDRAN MD	10/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159857	N/A	N/A	N/A	N/A	N/A	9460 N NAME UNO	None	GILROY	CA	95020	3537	00	06000	37.037781	-121.570965	Santa Clara County
335850	Ordering, Referring, Prescribing	N/A	1508403478	0	0	RUIZ, MONICA A LCSW	7/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116787	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
335868	Ordering, Referring, Prescribing	N/A	1508437930	0	0	RAWAL, BHAKTIDEVI M PSYD	7/26/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35214	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	MS 144	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
335876	Ordering, Referring, Prescribing	N/A	1508451501	0	0	ROJAS, CRYSTAL LCSW	8/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125292	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
335897	Ordering, Referring, Prescribing	N/A	1508516022	0	0	RAJAN, SAHANA MD	12/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189415	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
335915	Ordering, Referring, Prescribing	N/A	1508572710	0	0	ROCHA, BRYAN NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022575	N/A	N/A	N/A	N/A	N/A	16127 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10650281	-117.4531156	San Bernardino County
336020	Ordering, Referring, Prescribing	N/A	1518009646	0	0	ROJAS, BESSIE D MSW LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91135	N/A	N/A	N/A	N/A	N/A	162 E CARSON ST	None	COLUSA	CA	95932	2880	00	06000	39.20587882	-122.0061518	Colusa County
336062	Ordering, Referring, Prescribing	N/A	1518092204	0	0	REED, ANNMARIE LMFT	5/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44918	N/A	N/A	N/A	N/A	N/A	1625 W. OLYMPIC BL.	600	LOS ANGELES	CA	90015	3809	00	06000	34.04957404	-118.2750068	Los Angeles County
336067	Ordering, Referring, Prescribing	N/A	1518097880	0	0	RITH, SOTHY T LMFT	4/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106672	N/A	N/A	N/A	N/A	N/A	4910 E ASHLAN AVE	118	FRESNO	CA	93726	3020	00	06000	36.79411387	-119.7309194	Fresno County
336070	Ordering, Referring, Prescribing	N/A	1518097898	0	0	RODRIGUEZ, J FELIX D LMFT	4/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106370	N/A	N/A	N/A	N/A	N/A	4205 W FIGARDEN DR	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
336177	Ordering, Referring, Prescribing	N/A	1518319318	0	0	RANDALL, TYLER MD	1/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	R9535	N/A	N/A	N/A	N/A	N/A	8811 VILLAGE DR	None	SAN ANTONIO	TX	78217	5415	00	06000	29.52050008	-98.42777396	Bexar County
336188	Ordering, Referring, Prescribing	N/A	1518337849	0	0	RIVAS, AIDA S LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118810	N/A	N/A	N/A	N/A	N/A	3208 ROSEMEAD BLVD	100	EL MONTE	CA	91731	2830	00	06000	34.06580258	-118.0676162	Los Angeles County
336216	Ordering, Referring, Prescribing	N/A	1518369339	0	0	RODRIGUEZ, SARA M LMFT	7/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105107	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
336243	Ordering, Referring, Prescribing	N/A	1518409820	0	0	RIVERA, ADRIANA LMFT	3/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131937	N/A	N/A	N/A	N/A	N/A	201 N. COURT ST	None	VISALIA	CA	93291	4918	00	06000	36.331218	-119.292561	Tulare County
336271	Ordering, Referring, Prescribing	N/A	1518459007	0	0	RONDINI, KEENAN LMFT	3/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145563	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD	D	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
336274	Ordering, Referring, Prescribing	N/A	1518459197	0	0	ROBERTSON, KRISTI L LMFT	12/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130237	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	201	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
336300	Ordering, Referring, Prescribing	N/A	1518504299	0	0	ROMERO, SHIRLEY L NP	7/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012260	N/A	N/A	N/A	N/A	N/A	731 S HIGHLAND AVE	None	FULLERTON	CA	92832	2753	00	06000	33.863598	-117.928718	Orange County
336315	Ordering, Referring, Prescribing	N/A	1518548452	0	0	ROSTAMIZADEH, SARA MD	2/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	8168	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
336329	Ordering, Referring, Prescribing	N/A	1518607282	0	0	RAYAS ALMERAZ, MA DE LOURDES MD	7/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197839	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
336346	Ordering, Referring, Prescribing	N/A	1518671981	0	0	RAHIM, STEPHANIE PA-C	2/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA61751	N/A	N/A	N/A	N/A	N/A	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	00	06000	33.70481104	-117.9882948	Orange County
336353	Ordering, Referring, Prescribing	N/A	1518687268	0	0	ROJAS FLORES, KIMBERLY LCSW	3/10/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW129103	N/A	N/A	N/A	N/A	N/A	4137 VERDUGO RD	None	LOS ANGELES	CA	90065	3820	00	06000	34.1261475	-118.2319835	Los Angeles County
336361	Ordering, Referring, Prescribing	N/A	1518738871	0	0	ROSE, MARILYN NP	8/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026964	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
336412	Ordering, Referring, Prescribing	N/A	1528136462	0	0	ROJAS, RICHARD D	2/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D28801	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
336461	Ordering, Referring, Prescribing	N/A	1528248796	0	0	RUSSON, DEANN P LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60515	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	None	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
336495	Ordering, Referring, Prescribing	N/A	1528311669	0	0	RATHBUN, TERRI T LMFT	5/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46212	N/A	N/A	N/A	N/A	N/A	776 S STATE ST	107	UKIAH	CA	95482	5847	00	06000	39.13987386	-123.2059844	Mendocino County
336543	Ordering, Referring, Prescribing	N/A	1528406121	0	0	RAMIREZ, RUTH PSYD	7/10/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30908	N/A	N/A	N/A	N/A	N/A	5731 W SLAUSON AVE	220	CULVER CITY	CA	90230	6537	00	06000	33.98898953	-118.3818077	Los Angeles County
336582	Ordering, Referring, Prescribing	N/A	1528449972	0	0	RAIRDON, CHRIS LCSW	5/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81498	N/A	N/A	N/A	N/A	N/A	14045 MILL ST.	None	GUERNEVILLE	CA	95446	8303	00	06000	38.50242677	-123.0003077	Sonoma County
336587	Ordering, Referring, Prescribing	N/A	1528456050	0	0	REYES, TONI M NP	9/25/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	734301	N/A	N/A	N/A	N/A	N/A	15403 PARK AVE EAST	None	VICTORVILLE	CA	92391	3482	00	06000	34.50640129	-117.3250645	San Bernardino County
336590	Ordering, Referring, Prescribing	N/A	1528463544	0	0	ROMO, ALEJANDRA V LCSW	5/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101593	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
336599	Ordering, Referring, Prescribing	N/A	1528479300	0	0	ROBERTSON, MONIQUE N LMFT	8/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121097	N/A	N/A	N/A	N/A	N/A	790 E COLORADO BLVD	9	PASADENA	CA	91101	2193	00	06000	34.14586347	-118.1342295	Los Angeles County
336604	Ordering, Referring, Prescribing	N/A	1528492477	0	0	RATTY, CAITLIN LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101442	N/A	N/A	N/A	N/A	N/A	55 WESTCHESTER SQ	None	BRONX	NY	10461	3525	00	06000	40.841685	-73.8432675	Bronx County
336606	Ordering, Referring, Prescribing	N/A	1528497872	0	0	RODARTE, LAUREN LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99570	N/A	N/A	N/A	N/A	N/A	897 GRANITE DR.	None	PASADENA	CA	91101	3501	00	06000	34.13703447	-118.1317905	Los Angeles County
336625	Ordering, Referring, Prescribing	N/A	1528528197	0	0	RILEY, ASHLEY MD	6/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A187268	N/A	N/A	N/A	N/A	N/A	509 S I ST	STE C	MADERA	CA	93637	4660	00	06000	36.95460782	-120.0589258	Madera County
336652	Ordering, Referring, Prescribing	N/A	1528580792	0	0	REMBOLT, KELLY PA-C	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58595	N/A	N/A	N/A	N/A	N/A	1250 6TH AVE	100	SAN DIEGO	CA	92101	4300	00	06000	32.71854144	-117.1593008	San Diego County
336654	Ordering, Referring, Prescribing	N/A	1528580438	0	0	RODRIGUEZ, PERLA M NP	11/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014765	N/A	N/A	N/A	N/A	N/A	335 EAST AVENUE I	None	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
336660	Ordering, Referring, Prescribing	N/A	1528586062	0	0	ROBERTS, KATHRYN LCSW	4/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101042	N/A	N/A	N/A	N/A	N/A	762 W CYPRESS STREET	None	SAN DIMAS	CA	91773	0000	00	06000	34.09577399	-117.8223776	Los Angeles County
336699	Ordering, Referring, Prescribing	N/A	1528650165	0	0	RAMIREZ, RUPERT M NP	1/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016550	N/A	N/A	N/A	N/A	N/A	1402 BAILEY AVE	None	NEEDLES	CA	92363	3104	00	06000	34.832781	-114.618349	San Bernardino County
336752	Ordering, Referring, Prescribing	N/A	1528794302	0	0	RICKARDS, RYAN DDS	6/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108908	N/A	N/A	N/A	N/A	N/A	1400 MARKET ST	STE 8103	REDDING	CA	96001	1052	00	06000	40.58499451	-122.3911682	Shasta County
336786	Ordering, Referring, Prescribing	N/A	1538202031	0	0	RODRIGUEZ, CARLOS L MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89335	N/A	N/A	N/A	N/A	N/A	4025 W 226TH ST	None	TORRANCE	CA	90505	2340	00	06000	33.82360754	-118.3560922	Los Angeles County
336798	Ordering, Referring, Prescribing	N/A	1538230438	0	0	RAMOS, RICARDO A MD	11/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63720	N/A	N/A	N/A	N/A	N/A	1530 E MANNING AVE	None	REEDLEY	CA	93654	2346	00	06000	36.60413846	-119.4316515	Fresno County
336802	Ordering, Referring, Prescribing	N/A	1538238993	0	0	RAFF, STACEY PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49902	N/A	N/A	N/A	N/A	N/A	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48941956	-122.2227204	San Mateo County
336825	Ordering, Referring, Prescribing	N/A	1538286505	0	0	RUBENSTEIN, ADAM S MD	1/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A75969	N/A	N/A	N/A	N/A	N/A	375 89TH ST	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
336828	Ordering, Referring, Prescribing	N/A	1538293618	0	0	RAMIREZ, RAFAEL LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49317	N/A	N/A	N/A	N/A	N/A	1000 GOODRICH BLVD	None	COMMERCE	CA	90022	5103	00	06000	34.01730604	-118.1549572	Los Angeles County
336841	Ordering, Referring, Prescribing	N/A	1538318811	0	0	ROJAS, RICHARD J DC	2/1/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC31024	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
336859	Ordering, Referring, Prescribing	N/A	1538322763	0	0	RUBIO, MARTHA P DDS PC	6/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS53728	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
336888	Ordering, Referring, Prescribing	N/A	1538410550	0	0	RANDALLS, JESSICA L PA	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54982	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
336916	Ordering, Referring, Prescribing	N/A	1538446521	0	0	RIZOR, NANCY A	10/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	37007	N/A	N/A	N/A	N/A	N/A	1135 LINDERO CANYON RD	None	THOUSAND OAKS	CA	91362	1111	00	06000	34.184133	-118.788336	Ventura County
336918	Ordering, Referring, Prescribing	N/A	1538449327	0	0	RUDKIN, AMY M LCSW	2/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71703	N/A	N/A	N/A	N/A	N/A	900 E MAIN ST	SUITE 201	GRASS VALLEY	CA	95945	5853	00	06000	39.22827201	-121.0517684	Nevada County
336925	Ordering, Referring, Prescribing	N/A	1538463260	0	0	RYAN, MEGHAN M NP	5/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007642	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
336934	Ordering, Referring, Prescribing	N/A	1538484175	0	0	RUFFINO, LYNN LCSW	11/25/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14787	N/A	N/A	N/A	N/A	N/A	975 FLYNN RD	None	CAMARILLO	CA	93012	8704	00	06000	34.22667906	-119.0196947	Ventura County
336992	Ordering, Referring, Prescribing	N/A	1538568134	0	0	RULE, KELLI A PSYD	4/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30541	N/A	N/A	N/A	N/A	N/A	176 HOLSTON DR	None	LANCASTER	CA	93535	4531	00	06000	34.6649465	-118.1286477	Los Angeles County
337003	Ordering, Referring, Prescribing	N/A	1538578562	0	0	ROJAS, BIANCA LCSW	1/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113342	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
337010	Ordering, Referring, Prescribing	N/A	1538595590	0	0	ROBERTSON, SARAH LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93166	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	100	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
337015	Ordering, Referring, Prescribing	N/A	1538600564	0	0	ROSENTHAL, KRISTEN B	6/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	687110	N/A	N/A	N/A	N/A	N/A	7100 VAN NUYS BLVD	108	VAN NUYS	CA	91405	0000	00	06000	34.19957761	-118.4487663	Los Angeles County
337054	Ordering, Referring, Prescribing	N/A	1538674437	0	0	RASI, POUYAN LCSW	10/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98075	N/A	N/A	N/A	N/A	N/A	940 AVENUE 64	None	PASADENA	CA	91105	2711	00	06000	34.124895	-118.174671	Los Angeles County
337062	Ordering, Referring, Prescribing	N/A	1538688023	0	0	REYES, JASON PA-C	7/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55044	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
337067	Ordering, Referring, Prescribing	N/A	1538694534	0	0	ROSALES, MARLENNE LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79189	N/A	N/A	N/A	N/A	N/A	349-A EAST AVE K-6	None	LANCASTER	CA	93535	4548	00	06000	34.6750509	-118.1246552	Los Angeles County
337108	Ordering, Referring, Prescribing	N/A	1538807870	0	0	ROBERSON, JENNIFER L LCSW	2/10/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128612	N/A	N/A	N/A	N/A	N/A	7818 BAR DU LN	None	SACRAMENTO	CA	95829	9469	00	06000	38.473209	-121.34421	Sacramento County
337110	Ordering, Referring, Prescribing	N/A	1538814645	0	0	REED, EMILY T	5/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021718	N/A	N/A	N/A	N/A	N/A	5100 SIERRA COLLEGE BLVD	None	ROCKLIN	CA	95677	3397	00	06000	38.790306	-121.214862	Placer County
337114	Ordering, Referring, Prescribing	N/A	1538833199	0	0	ROSS, JILLIAN K NP	1/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015869	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1902	00	06000	34.57915154	-117.414216	San Bernardino County
337126	Ordering, Referring, Prescribing	N/A	1538836499	0	0	RIVERA, ILIANA NP	6/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025494	N/A	N/A	N/A	N/A	N/A	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
337167	Ordering, Referring, Prescribing	N/A	1548095292	0	0	ROMERO, ABIGAIL	7/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031214	N/A	N/A	N/A	N/A	N/A	4434 MISSION ST	None	SAN FRANCISCO	CA	94112	1927	00	06000	37.72675413	-122.4332747	San Francisco County
337168	Ordering, Referring, Prescribing	N/A	1548203904	0	0	ROWEN, SHERI L MD	5/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C131504	N/A	N/A	N/A	N/A	N/A	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	00	06000	33.89326085	-117.9300987	Orange County
337246	Ordering, Referring, Prescribing	N/A	1548426604	0	0	REDDINGTON, MARK E DO	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2258	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
337258	Ordering, Referring, Prescribing	N/A	1548450471	0	0	REAL, MARIA F NP	6/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17328	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
337265	Ordering, Referring, Prescribing	N/A	1548460132	0	0	ROMANS, AURORA LMFT	11/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47430	N/A	N/A	N/A	N/A	N/A	619 CROUCH ST	STE 100	OCEANSIDE	CA	92054	4460	00	06000	33.19572979	-117.3536776	San Diego County
337266	Ordering, Referring, Prescribing	N/A	1548455405	0	0	REVELES, DIANA M PA-C	12/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA19306	N/A	N/A	N/A	N/A	N/A	352 L ST	None	CHULA VISTA	CA	91911	1208	00	06000	32.61997526	-117.0739163	San Diego County
337269	Ordering, Referring, Prescribing	N/A	1548463235	0	0	RAMOS, SANDRA B NP	4/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001055	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
337312	Ordering, Referring, Prescribing	N/A	1548561640	0	0	RODGERS, JOSEPH W PHARMD	4/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	57809	N/A	N/A	N/A	N/A	N/A	1260 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3411	00	06000	33.89200144	-118.2982685	Los Angeles County
337402	Ordering, Referring, Prescribing	N/A	1548730807	0	0	RUBIO, NORMA A LCSW	5/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108289	N/A	N/A	N/A	N/A	N/A	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	00	06000	34.15365596	-118.1370318	Los Angeles County
337411	Ordering, Referring, Prescribing	N/A	1548744774	0	0	REYNOLDS, TESSA M LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122095	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
337415	Ordering, Referring, Prescribing	N/A	1548746423	0	0	RUIZ, REBECCA LCSW	9/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118203	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	SUITE 400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
337460	Ordering, Referring, Prescribing	N/A	1548831787	0	0	REYES, ISABEL PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82947	N/A	N/A	N/A	N/A	N/A	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	00	06000	37.76850146	-122.3949365	San Francisco County
337478	Ordering, Referring, Prescribing	N/A	1548876337	0	0	RICHARDSON, JENAE A PSYD	2/23/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32403	N/A	N/A	N/A	N/A	N/A	1108 S EL CAMINO REAL	None	SAN MATEO	CA	94402	2804	00	06000	37.55635875	-122.3187345	San Mateo County
337549	Ordering, Referring, Prescribing	N/A	1558311134	0	0	RAJ, SATISH P MD	1/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51736	N/A	N/A	N/A	N/A	N/A	77 CASA ST	SUITE 201	SAN LUIS OBISPO	CA	93405	5803	00	06000	35.29306786	-120.6650709	San Luis Obispo County
337587	Ordering, Referring, Prescribing	N/A	1558457671	0	0	ROJAS, DIEGO A	10/8/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D50817	N/A	N/A	N/A	N/A	N/A	542 UNION ST	None	RED BLUFF	CA	96080	2743	00	06000	40.17965437	-122.2407213	Tehama County
337610	Ordering, Referring, Prescribing	N/A	1558506865	0	0	ROUGEAU, SEAN E	5/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003703	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
337629	Ordering, Referring, Prescribing	N/A	1558546424	0	0	REGALADO, MOINA E LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48944	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
337655	Ordering, Referring, Prescribing	N/A	1558625053	0	0	RIVAS GUATEMALA, OSCAR LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105446	N/A	N/A	N/A	N/A	N/A	349 E. AVE. K6	A	LANCASTER	CA	93535	4508	00	06000	34.66949452	-118.1244465	Los Angeles County
337670	Ordering, Referring, Prescribing	N/A	1558640243	0	0	RANKER, GIGI J PHARMD	11/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54424	N/A	N/A	N/A	N/A	N/A	2940 EAST ST	None	ANDERSON	CA	96007	3411	00	06000	40.45107638	-122.2980834	Shasta County
337691	Ordering, Referring, Prescribing	N/A	1558687475	0	0	REAMS, JACQUELINE J NP	6/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006168	N/A	N/A	N/A	N/A	N/A	1 SAINT VINCENTS DR	None	SAN RAFAEL	CA	94903	1504	00	06000	38.034216	-122.525199	Marin County
337695	Ordering, Referring, Prescribing	N/A	1558697060	0	0	ROSALES, FRANCEEN M LCSW	6/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70798	N/A	N/A	N/A	N/A	N/A	182 E WALNUT AVE	None	RIALTO	CA	92376	3530	00	06000	34.12866149	-117.3689595	San Bernardino County
337704	Ordering, Referring, Prescribing	N/A	1558710038	0	0	ROGERS, TANYA L CNP	1/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004443	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
337705	Ordering, Referring, Prescribing	N/A	1558708578	0	0	RATHORE, AWTAR K	12/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14836	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
337713	Ordering, Referring, Prescribing	N/A	1558712810	0	0	ROSEN, JACOB D LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107103	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
337714	Ordering, Referring, Prescribing	N/A	1558718072	0	0	RODGERS, MICHAEL J LCSW	11/14/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71140	N/A	N/A	N/A	N/A	N/A	5855 CAPISTRANO AVE	STE D	ATASCADERO	CA	93422	7201	00	06000	35.48988121	-120.6645004	San Luis Obispo County
337722	Ordering, Referring, Prescribing	N/A	1558731802	0	0	RODRIGUES, ALICIA LMFT	4/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124962	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
337726	Ordering, Referring, Prescribing	N/A	1558741777	0	0	ROBIE, MEREDITH LMFT	10/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122327	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 301	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
337728	Ordering, Referring, Prescribing	N/A	1558748335	0	0	RUEZGA, ROSALINDA CNP	4/15/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029792	N/A	N/A	N/A	N/A	N/A	5101 MARKET ST	2000	SAN DIEGO	CA	92114	2219	00	06000	32.71040444	-117.0849667	San Diego County
337755	Ordering, Referring, Prescribing	N/A	1558791277	0	0	RICHTER, MEGAN LCSW	2/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89979	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
337768	Ordering, Referring, Prescribing	N/A	1558815142	0	0	REED, CHELSEA NP	11/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019068	N/A	N/A	N/A	N/A	N/A	3100 UMATILLA ST	None	DENVER	CO	80211	3837	00	06000	39.76102118	-105.0118073	Denver County
337775	Ordering, Referring, Prescribing	N/A	1558829341	0	0	REYNOSO, GENILL NP	1/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95021583	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
337804	Ordering, Referring, Prescribing	N/A	1558873513	0	0	ROYBAL, ELIKA NP	12/22/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007402	N/A	N/A	N/A	N/A	N/A	11110 ALONDRA BLVD	None	NORWALK	CA	90650	6203	00	06000	33.885675	-118.097631	Los Angeles County
337819	Ordering, Referring, Prescribing	N/A	1558894048	0	0	RODRIGUEZ, KRISTINA A MD	8/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158311	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
337824	Ordering, Referring, Prescribing	N/A	1558900084	0	0	RIVERA, BYRON PSYD	6/27/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31537	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
337839	Ordering, Referring, Prescribing	N/A	1558942193	0	0	RAJARATNAM, AKASH MD	1/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192535	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
337863	Ordering, Referring, Prescribing	N/A	1558992230	0	0	ROBLES VARGAS, RICHARD LCSW	12/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103483	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
337865	Ordering, Referring, Prescribing	N/A	1558947903	0	0	RIDDER, AARON	9/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21053	N/A	N/A	N/A	N/A	N/A	1360 E ANAHEIM ST.	101	LONG BEACH	CA	90813	5514	00	06000	33.78258054	-118.1744415	Los Angeles County
337898	Ordering, Referring, Prescribing	N/A	1568043305	0	0	ROSALES, ANDREW MD	8/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A198600	N/A	N/A	N/A	N/A	N/A	1200 N STATE ST	None	LOS ANGELES	CA	90089	1001	00	06000	34.05855992	-118.209755	Los Angeles County
337914	Ordering, Referring, Prescribing	N/A	1568090132	0	0	RAMIREZ, JEFFREY A	9/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191155	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
337943	Ordering, Referring, Prescribing	N/A	1568203628	0	0	RANAUTA, NAVRATTAN NP	5/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030004	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
337981	Ordering, Referring, Prescribing	N/A	1568510352	0	0	RIEWERTS, ROBERT J	5/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63701	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
337993	Ordering, Referring, Prescribing	N/A	1568541803	0	0	RUTERBUSCH, VICTOR MD	6/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C134507	N/A	N/A	N/A	N/A	N/A	9400 RUFFIN CT	None	SAN DIEGO	CA	92123	5300	00	06000	32.830713	-117.1230525	San Diego County
337997	Ordering, Referring, Prescribing	N/A	1568545457	0	0	RIVERA, IDA E PHD	7/26/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20306	N/A	N/A	N/A	N/A	N/A	2325 CRENSHAW BLVD	None	TORRANCE	CA	90501	3325	00	06000	33.82457516	-118.3285598	Los Angeles County
337999	Ordering, Referring, Prescribing	N/A	1568548063	0	0	ROSENGARTEN, ARTHUR E PHD	8/15/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	11016	N/A	N/A	N/A	N/A	N/A	12835 POINTE DEL MAR WAY	1	DEL MAR	CA	92014	3846	00	06000	32.93216216	-117.2433492	San Diego County
338020	Ordering, Referring, Prescribing	N/A	1568591386	0	0	RA-SMITH, EUNA T LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27497	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
338045	Ordering, Referring, Prescribing	N/A	1568658789	0	0	RENDON, HERMILA	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82971	N/A	N/A	N/A	N/A	N/A	430 F ST	None	CHULA VISTA	CA	91910	3711	00	06000	32.63977028	-117.0851206	San Diego County
338062	Ordering, Referring, Prescribing	N/A	1568705226	0	0	RIESTENBERG, CARRIE K MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134807	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
338075	Ordering, Referring, Prescribing	N/A	1568718930	0	0	REEL, MATTHEW MSW LCSW	10/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109796	N/A	N/A	N/A	N/A	N/A	480 TESCONI CIR STE B	STE B	SANTA ROSA	CA	95401	4691	00	06000	38.449557	-122.7357315	Sonoma County
338098	Ordering, Referring, Prescribing	N/A	1568752772	0	0	ROCKOFF, BRADLEY I MD	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	S4674	N/A	N/A	N/A	N/A	N/A	111 DALLAS ST	None	SAN ANTONIO	TX	78205	1201	00	06000	29.43317376	-98.49236007	Bexar County
338102	Ordering, Referring, Prescribing	N/A	1568755247	0	0	REYNOSO, VIVIANA LMFT	10/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113411	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92018	4711	00	06000	32.77025942	-117.2017196	San Diego County
338112	Ordering, Referring, Prescribing	N/A	1568769628	0	0	ROMERO, LAURA I LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96325	N/A	N/A	N/A	N/A	N/A	499 LOMA ALTA AVE	None	LOS GATOS	CA	95030	6227	00	06000	37.21747493	-121.9662128	Santa Clara County
338122	Ordering, Referring, Prescribing	N/A	1568792398	0	0	ROBLES, MARINA LCSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61489	N/A	N/A	N/A	N/A	N/A	2213 BUCHANAN RD	103	ANTIOCH	CA	94509	4265	00	06000	37.99879828	-121.8360576	Contra Costa County
338135	Ordering, Referring, Prescribing	N/A	1568807816	0	0	RICE, JUSTIN MD	3/27/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132397	N/A	N/A	N/A	N/A	N/A	1200 N. STATE ST.	None	LOS ANGELES	CA	90033	1083	00	06000	34.05855992	-118.209755	Los Angeles County
338144	Ordering, Referring, Prescribing	N/A	1568815595	0	0	RODOLFA, EUGENE PA-C	4/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	53587	N/A	N/A	N/A	N/A	N/A	6095 N 1ST STREET	None	FRESNO	CA	93710	5444	00	06000	36.82524765	-119.7723922	Fresno County
338200	Ordering, Referring, Prescribing	N/A	1568892685	0	0	RENTFROW, SANDRA D LPCC	12/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	9014	N/A	N/A	N/A	N/A	N/A	3333 E AMERICAN AVE	None	FRESNO	CA	93725	9247	00	06000	36.66341855	-119.7304116	Fresno County
338207	Ordering, Referring, Prescribing	N/A	1568896926	0	0	RABIZADEH, REBECCA M	11/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80422	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
338226	Ordering, Referring, Prescribing	N/A	1568924678	0	0	ROSES, STEPHANIE MD	7/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187790	N/A	N/A	N/A	N/A	N/A	213 QUARRY RD	None	PALO ALTO	CA	94304	1416	00	06000	37.44187674	-122.169544	Santa Clara County
338235	Ordering, Referring, Prescribing	N/A	1568946218	0	0	RAMOS, MELISSA N PHARMD	3/24/2019	Taxonomy not applicable	NA	n/a	000	Unknown	79001	N/A	N/A	N/A	N/A	N/A	1988 HACIENDA DRIVE	None	VISTA	CA	92081	6026	00	06000	33.18501367	-117.2846232	San Diego County
338238	Ordering, Referring, Prescribing	N/A	1568947885	0	0	RIVERO, AMANDA S LMFT	6/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126330	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST	375	PASADENA	CA	91124	3697	00	06000	34.14963648	-118.1522925	Los Angeles County
338243	Ordering, Referring, Prescribing	N/A	1568952976	0	0	REDOUTEY, SHEILA A LCSW	4/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101049	N/A	N/A	N/A	N/A	N/A	2937 VENEMAN AVE	B125	MODESTO	CA	95356	0638	00	06000	37.68940892	-121.0483835	Stanislaus County
338248	Ordering, Referring, Prescribing	N/A	1568965069	0	0	RAMOS, KARA A NP	10/30/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95146198	N/A	N/A	N/A	N/A	N/A	645 WOOL CREEK DR	None	SAN JOSE	CA	95112	2617	00	06000	37.31593216	-121.8501245	Santa Clara County
338267	Ordering, Referring, Prescribing	N/A	1568995157	0	0	ROJAS DE LA PAZ, PATRICIA NP	1/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005887	N/A	N/A	N/A	N/A	N/A	1311 NORTH SAN FERNANDO	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
338306	Ordering, Referring, Prescribing	N/A	1578058327	0	0	RAJIC, JOVANKA NP	9/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	827873	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	101	LOS ANGELES	CA	90015	3048	00	06000	34.03692236	-118.2655238	Los Angeles County
338323	Ordering, Referring, Prescribing	N/A	1578084547	0	0	RAUCHUT, KEVIN W NP	7/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95047173	N/A	N/A	N/A	N/A	N/A	5901 W OLYMPIC BLVD	STE. 310	LOS ANGELES	CA	90036	4667	00	06000	34.05764121	-118.3603115	Los Angeles County
338324	Ordering, Referring, Prescribing	N/A	1578084455	0	0	ROMERO GARCIA, ULMA I LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101295	N/A	N/A	N/A	N/A	N/A	11303 W. WASHINGTON BLVD	200	LOS ANGELES	CA	90066	6003	00	06000	34.00408212	-118.4147433	Los Angeles County
338351	Ordering, Referring, Prescribing	N/A	1578128716	0	0	REID, DOUGLAS A	10/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108318	N/A	N/A	N/A	N/A	N/A	1111 N NAGLE ST	None	ALTURAS	CA	96101	3840	00	06000	41.48746641	-120.5528507	Modoc County
338356	Ordering, Referring, Prescribing	N/A	1578144994	0	0	RODRIGUEZ, VANESSA N PA	12/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59902	N/A	N/A	N/A	N/A	N/A	916 W BURBANK BLVD	None	BURBANK	CA	91506	1400	00	06000	34.18397121	-118.3225966	Los Angeles County
338370	Ordering, Referring, Prescribing	N/A	1578190674	0	0	REDDY, KALYN L MD MPH	8/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181149	N/A	N/A	N/A	N/A	N/A	3800 W. CHAPMAN AVE	STE 500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
338432	Ordering, Referring, Prescribing	N/A	1578547576	0	0	REINER, STEVEN C	7/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G27015	N/A	N/A	N/A	N/A	N/A	15201 ELEVENTH ST	300	VICTORVILLE	CA	92395	3735	00	06000	34.52725895	-117.2925031	San Bernardino County
338442	Ordering, Referring, Prescribing	N/A	1578603973	0	0	ROZELL, KATHY L LCSW	5/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25068	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
338444	Ordering, Referring, Prescribing	N/A	1578610028	0	0	RIVERA, ANGEL L MD	6/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87828	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
338464	Ordering, Referring, Prescribing	N/A	1578648598	0	0	RUSS, SUSANA LCSW	11/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19115	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES ROAD	None	DAVIS	CA	95617	9701	00	06000	38.56371578	-121.7691963	Yolo County
338519	Ordering, Referring, Prescribing	N/A	1578750691	0	0	RATLIFF, JILL S LCSW	9/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23795	N/A	N/A	N/A	N/A	N/A	370 9TH STREET	None	CRESCENT CITY	CA	95531	3432	00	06000	41.7541885	-124.2055122	Del Norte County
338526	Ordering, Referring, Prescribing	N/A	1578753562	0	0	RAINS, CORINA LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT92788	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
338540	Ordering, Referring, Prescribing	N/A	1578782272	0	0	ROBINSON, CYNTHIA A LMFT	5/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40779	N/A	N/A	N/A	N/A	N/A	6244 EL CAJON BLVD.	SUITE 3	SAN DIEGO	CA	92115	3918	00	06000	32.76342577	-117.0636924	San Diego County
338552	Ordering, Referring, Prescribing	N/A	1578802138	0	0	ROSENTHAL, JENNIFER L PHD	6/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22522	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
338556	Ordering, Referring, Prescribing	N/A	1578813408	0	0	RINGWOOD, BRENT LMFT	12/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136244	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE	SUITE 260	PLEASANT HILL	CA	94523	4344	00	06000	37.93963113	-122.0591644	Contra Costa County
338563	Ordering, Referring, Prescribing	N/A	1578829024	0	0	ROBERTS FINFROCK, MINDY M MD	11/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159455	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
338590	Ordering, Referring, Prescribing	N/A	1578862108	0	0	RICKS, DEIDRE LMFT	10/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40522	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92108	4711	00	06000	32.77025942	-117.2017196	San Diego County
338615	Ordering, Referring, Prescribing	N/A	1578900767	0	0	RASHID, MOIRA MD	12/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133103	N/A	N/A	N/A	N/A	N/A	1520 NUTMEG PL	UNIT 101	COSTA MESA	CA	92626	2501	00	06000	33.68196448	-117.920322	Orange County
338636	Ordering, Referring, Prescribing	N/A	1578915807	0	0	RAMOS, ELIZABETH LCSW	12/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98408	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
338655	Ordering, Referring, Prescribing	N/A	1578942207	0	0	RAMIREZ, CLAUDIA LMFT	5/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132984	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
338656	Ordering, Referring, Prescribing	N/A	1578930590	0	0	RAMOS, FAYE DEAN S LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119074	N/A	N/A	N/A	N/A	N/A	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
338703	Ordering, Referring, Prescribing	N/A	1588006357	0	0	REEDOM, ZERUAH LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106913	N/A	N/A	N/A	N/A	N/A	1400 W. MINTHORN STREET	None	LAKE ELSINORE	CA	92530	0000	00	06000	33.68269545	-117.3326588	Riverside County
338724	Ordering, Referring, Prescribing	N/A	1588026033	0	0	RUIZ, JORGE L MD MPH	6/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152784	N/A	N/A	N/A	N/A	N/A	7240 W MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1906	00	06000	34.202016	-118.6294315	Los Angeles County
338745	Ordering, Referring, Prescribing	N/A	1588057061	0	0	RIVERA, JACQUELINE LMFT	7/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112862	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	None	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
338746	Ordering, Referring, Prescribing	N/A	1588057459	0	0	REILLEY HOGUE, ALYSSA K LMFT	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113806	N/A	N/A	N/A	N/A	N/A	1360 E LASSEN AVE	None	CHICO	CA	95973	7823	00	06000	39.77359746	-121.8420053	Butte County
338821	Ordering, Referring, Prescribing	N/A	1588166656	0	0	RUBIN, SUSANNAH LPCC	3/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6638	N/A	N/A	N/A	N/A	N/A	1000 GOODRICH BLVD	None	COMMERCE	CA	90022	5103	00	06000	34.01730604	-118.1549572	Los Angeles County
338843	Ordering, Referring, Prescribing	N/A	1588198352	0	0	RODRIGUEZ, RICHARD MD	11/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161390	N/A	N/A	N/A	N/A	N/A	15 MACARTHUR PLACE	1408	SANTA ANA	CA	92707	0000	00	06000	33.69862364	-117.8655552	Orange County
338850	Ordering, Referring, Prescribing	N/A	1588212328	0	0	RODRIGUEZ, EVELYN B LMFT	1/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137404	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
338862	Ordering, Referring, Prescribing	N/A	1588226294	0	0	RIES, JENNIFER M NP	3/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011933	N/A	N/A	N/A	N/A	N/A	3972 NORTH WATERMAN AVE.	None	SAN BERNARDINO	CA	92404	1767	00	06000	34.164153	-117.2787275	San Bernardino County
338869	Ordering, Referring, Prescribing	N/A	1588252209	0	0	RIVERA-SANTOS, VERONICA NP	9/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95015384	N/A	N/A	N/A	N/A	N/A	1040 STERLING WAY	None	BALDWIN PARK	CA	91706	4223	00	06000	34.08477146	-117.9635802	Los Angeles County
338891	Ordering, Referring, Prescribing	N/A	1588323133	0	0	ROSEN, ROXANNA PSYD	6/20/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33095	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
338895	Ordering, Referring, Prescribing	N/A	1588331318	0	0	ROGERS, SUSANNAH L CNP	7/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026173	N/A	N/A	N/A	N/A	N/A	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
338922	Ordering, Referring, Prescribing	N/A	1588471353	0	0	RODRIGUEZ, ILIANA N CNP	7/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030999	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
338972	Ordering, Referring, Prescribing	N/A	1588773451	0	0	RAMIREZ, LISANNE LMFT	12/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52462	N/A	N/A	N/A	N/A	N/A	1855 W. KATELLA AVE	SUITE 150	ORANGE	CA	92867	3432	00	06000	33.8061655	-117.872442	Orange County
339075	Ordering, Referring, Prescribing	N/A	1588963839	0	0	REZAI, SANA MD	7/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131410	N/A	N/A	N/A	N/A	N/A	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	00	06000	36.72031784	-120.060276	Fresno County
339083	Ordering, Referring, Prescribing	N/A	1588971733	0	0	REYNA, MARY C PSYD	6/4/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32657	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
339093	Ordering, Referring, Prescribing	N/A	1588985485	0	0	RIAHI, CYRUS	6/7/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	16858	N/A	N/A	N/A	N/A	N/A	6309 VAN NUYS BLVD.	None	VAN NUYS	CA	91401	6629	00	06000	34.18496271	-118.4487785	Los Angeles County
339104	Ordering, Referring, Prescribing	N/A	1588997860	0	0	RAMIREZ, ERICA PA-C	9/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20462	N/A	N/A	N/A	N/A	N/A	155 15TH ST	None	WEST SACRAMENTO	CA	95691	3737	00	06000	38.57104661	-121.5260133	Yolo County
339147	Ordering, Referring, Prescribing	N/A	1598060345	0	0	REYES, ESTER E LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103067	N/A	N/A	N/A	N/A	N/A	7555 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	00	06000	34.207911	-118.4487955	Los Angeles County
339151	Ordering, Referring, Prescribing	N/A	1598067688	0	0	ROBINSON, ANGEL C MD MPH	1/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174567	N/A	N/A	N/A	N/A	N/A	1505 WILSON TER	SUITE 130	GLENDALE	CA	91206	4071	00	06000	34.14960934	-118.2313491	Los Angeles County
339156	Ordering, Referring, Prescribing	N/A	1598074338	0	0	RUVALCABA, ALBERTO	5/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112939	N/A	N/A	N/A	N/A	N/A	40657 RD. 128	None	CUTLER	CA	93615	2003	00	06000	36.52783577	-119.286894	Tulare County
339167	Ordering, Referring, Prescribing	N/A	1598095028	0	0	REBOLLEDO, SANDRA LCSW	11/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81892	N/A	N/A	N/A	N/A	N/A	9040 TELSTAR AVE	None	EL MONTE	CA	91731	2831	00	06000	34.06878294	-118.06946	Los Angeles County
339189	Ordering, Referring, Prescribing	N/A	1598130023	0	0	RILEY, TANYA LCSW	7/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116511	N/A	N/A	N/A	N/A	N/A	301 E 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29248035	-120.4730619	Merced County
339299	Ordering, Referring, Prescribing	N/A	1598312498	0	0	ROJAS, JONATHAN M NP	8/21/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012535	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
339336	Ordering, Referring, Prescribing	N/A	1598379380	0	0	REDMAN, CHARITY J LCSW	4/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107748	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
339337	Ordering, Referring, Prescribing	N/A	1598378895	0	0	ROMERO, CARINA LCSW	11/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127369	N/A	N/A	N/A	N/A	N/A	1870 N MAIN ST	None	SALINAS	CA	93906	2042	00	06000	36.71784314	-121.6554107	Monterey County
339345	Ordering, Referring, Prescribing	N/A	1598394371	0	0	RUBIO, HALEY M PA	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59701	N/A	N/A	N/A	N/A	N/A	1595 GRAND AVE	SUITE 106	SAN MARCOS	CA	92078	2450	00	06000	33.14530488	-117.1982671	San Diego County
339361	Ordering, Referring, Prescribing	N/A	1598430555	0	0	RODRIGUEZ, YESENIA NP	8/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017982	N/A	N/A	N/A	N/A	N/A	801 W L ST	None	LOS BANOS	CA	93635	0001	00	06000	37.05962558	-120.8625896	Merced County
339378	Ordering, Referring, Prescribing	N/A	1598524118	0	0	RUIZ, HEIDY N PHARMD	6/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	81622	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
339379	Ordering, Referring, Prescribing	N/A	1598522849	0	0	ROMERO, RICHARD A PA-C	6/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64581	N/A	N/A	N/A	N/A	N/A	1206 E 17TH STREET SUITE	None	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
339396	Ordering, Referring, Prescribing	N/A	1598772469	0	0	RICE, REBECCA LCSW	10/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24930	N/A	N/A	N/A	N/A	N/A	747 52ND ST.	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
339412	Ordering, Referring, Prescribing	N/A	1598822322	0	0	RAMIREZ, GUILLERMO LCSW	4/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20303	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
339443	Ordering, Referring, Prescribing	N/A	1598915134	0	0	REAGAN, DENISE LMFT	9/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134567	N/A	N/A	N/A	N/A	N/A	401 E. OCEAN AVE	None	LOMPOC	CA	93436	6828	00	06000	34.6389765	-120.4537095	Santa Barbara County
339454	Ordering, Referring, Prescribing	N/A	1598927519	0	0	RIEMER, CHRISTINA M LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52420	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
339461	Ordering, Referring, Prescribing	N/A	1598942153	0	0	ROCHA, MARIANA LCSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29021	N/A	N/A	N/A	N/A	N/A	222 PAUL SCANNELL DR	None	SAN MATEO	CA	94402	4061	00	06000	37.51168342	-122.3375282	San Mateo County
339466	Ordering, Referring, Prescribing	N/A	1598950859	0	0	RAPP, BEAU C LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97260	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	SUITE 100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
339470	Ordering, Referring, Prescribing	N/A	1598955890	0	0	RETANA, HUMBERTO LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49372	N/A	N/A	N/A	N/A	N/A	747 52ND STREET	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
339472	Ordering, Referring, Prescribing	N/A	1598960742	0	0	RAMIREZ, DEBORA D LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76568	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	SUITE 125-D	OAKLAND	CA	94541	2424	00	06000	37.768221	-122.17608	Alameda County
339501	Ordering, Referring, Prescribing	N/A	1609030360	0	0	RIVERA, ARIANA LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90201	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
339516	Ordering, Referring, Prescribing	N/A	1609078153	0	0	REZA, SALVADOR LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52394	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
339565	Ordering, Referring, Prescribing	N/A	1609161983	0	0	RAMESHNI, NAGHMEH PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56390	N/A	N/A	N/A	N/A	N/A	8810 TAMPA AVE	None	NORTHRIDGE	CA	91324	3519	00	06000	34.230771	-118.5510825	Los Angeles County
339584	Ordering, Referring, Prescribing	N/A	1609186584	0	0	ROBILLARD, CAYLA C L	1/9/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14872	N/A	N/A	N/A	N/A	N/A	857 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.2882813	-120.497688	Merced County
339587	Ordering, Referring, Prescribing	N/A	1609183672	0	0	RICHMAN, TERESA D LCSW	9/18/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85841	N/A	N/A	N/A	N/A	N/A	341 BROADWAY ST STE 223	STE 223	CHICO	CA	95928	5355	00	06000	39.72853436	-121.8398597	Butte County
339605	Ordering, Referring, Prescribing	N/A	1609225622	0	0	RODRIGO, ANDREA N LCSW	7/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83277	N/A	N/A	N/A	N/A	N/A	3104 PONTE MORINO DR	SUITE 110	CAMERON PARK	CA	95682	8282	00	06000	38.66304719	-120.9667044	El Dorado County
339633	Ordering, Referring, Prescribing	N/A	1609288422	0	0	RIZO, MARIA B LCSW	8/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91460	N/A	N/A	N/A	N/A	N/A	1327 E EL MONTE WAY	None	DINUBA	CA	93618	1825	00	06000	36.54556162	-119.3810375	Tulare County
339640	Ordering, Referring, Prescribing	N/A	1609295401	0	0	RODRIGUEZ, ESTEFANIA MSW LCSW	10/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126869	N/A	N/A	N/A	N/A	N/A	108 WEST VICTORIA STREET	None	CARSON	CA	90248	0000	00	06000	33.86509452	-118.2762279	Los Angeles County
339654	Ordering, Referring, Prescribing	N/A	1609303825	0	0	RAMIREZ, JESSICA LMFT	6/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126338	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	None	PICO RIVERA	CA	90660	4909	00	06000	33.96454327	-118.1134473	Los Angeles County
339673	Ordering, Referring, Prescribing	N/A	1609324763	0	0	REYES, BERNADETTE	1/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93733	N/A	N/A	N/A	N/A	N/A	5350 MACHADO RD	None	CULVER CITY	CA	90230	8800	00	06000	33.99781622	-118.3966503	Los Angeles County
339685	Ordering, Referring, Prescribing	N/A	1609351535	0	0	RIOJAS, MARISSA D LAC	10/28/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17909	N/A	N/A	N/A	N/A	N/A	150 15TH ST.	None	PACIFIC GROVE ACU	CA	93950	0011	00	06000	36.62105452	-121.9158054	Monterey County
339701	Ordering, Referring, Prescribing	N/A	1609381698	0	0	RAHIMI, NEEMA PHARMD	9/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78079	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
339705	Ordering, Referring, Prescribing	N/A	1609389030	0	0	RAINEY, AMANDA E	9/12/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007521	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
339744	Ordering, Referring, Prescribing	N/A	1609455831	0	0	RODRIGUEZ, MIGUEL A MD	3/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194973	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
339747	Ordering, Referring, Prescribing	N/A	1609477090	0	0	RIZO, CARLA P LMFT	5/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146883	N/A	N/A	N/A	N/A	N/A	15830 CALLE MONTANA	None	SANTA CLARITA	CA	91390	1017	00	06000	34.62431151	-118.4078685	Los Angeles County
339756	Ordering, Referring, Prescribing	N/A	1609496298	0	0	RISBRUDT, CAROLYN LMFT	10/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135058	N/A	N/A	N/A	N/A	N/A	5855 CAPISTRANO AVE	SUITE G	ATASCADERO	CA	93422	7201	00	06000	35.48988121	-120.6645004	San Luis Obispo County
339846	Ordering, Referring, Prescribing	N/A	1609947449	0	0	RUSSELL, MARIE MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168165	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
339861	Ordering, Referring, Prescribing	N/A	1609988229	0	0	ROSS, TIFFANY V LCSW	7/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22846	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
339872	Ordering, Referring, Prescribing	N/A	1619006004	0	0	RONDINA, JOSEPH - MD	9/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55804	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
339876	Ordering, Referring, Prescribing	N/A	1619008091	0	0	RUSH, BRUCE A PSYD	10/5/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17799	N/A	N/A	N/A	N/A	N/A	7862 FIRESTONE BOULEVARD	None	DOWNEY	CA	90241	4004	00	06000	33.94382457	-118.1402202	Los Angeles County
339883	Ordering, Referring, Prescribing	N/A	1619022266	0	0	ROSSO, STEPHANIE PHD	7/2/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19711	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
339906	Ordering, Referring, Prescribing	N/A	1619055183	0	0	ROBLES, SARAH A LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51739	N/A	N/A	N/A	N/A	N/A	2615 S. MILLER STREET	106	SANTA MARIA	CA	93455	1775	00	06000	34.91141828	-120.4320168	Santa Barbara County
339907	Ordering, Referring, Prescribing	N/A	1619071883	0	0	RIVERA, OSCAR R	4/2/2007	Taxonomy not applicable	NA	n/a	099	DENTIST	D39326	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
339933	Ordering, Referring, Prescribing	N/A	1619126018	0	0	ROJAS, GLORIA L LCSW	12/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29191	N/A	N/A	N/A	N/A	N/A	2620 INDUSTRY WAY	C	LYNWOOD	CA	90262	4024	00	06000	33.92360701	-118.2254995	Los Angeles County
339942	Ordering, Referring, Prescribing	N/A	1619140498	0	0	ROMERO, CLAUDIA LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38704	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	SUITE 200	SAN MATEO	CA	94403	1269	00	06000	37.54524373	-122.3205511	San Mateo County
339965	Ordering, Referring, Prescribing	N/A	1619190501	0	0	RIZVI, SABA F MD	4/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A95786	N/A	N/A	N/A	N/A	N/A	1209 W TOKAY ST	#5	LODI	CA	95240	3845	00	06000	38.12635934	-121.2874011	San Joaquin County
339972	Ordering, Referring, Prescribing	N/A	1619201431	0	0	RODRIGUEZ, FERNANDO LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79403	N/A	N/A	N/A	N/A	N/A	12715 PIONEER BLVD	None	NORWALK	CA	90650	2873	00	06000	33.91524469	-118.081899	Los Angeles County
339982	Ordering, Referring, Prescribing	N/A	1619223799	0	0	RUBIO COSS Y LEON, LUCIA PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67144	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
339999	Ordering, Referring, Prescribing	N/A	1619252038	0	0	ROMERO, ENRIQUE A PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62383	N/A	N/A	N/A	N/A	N/A	1065 S FORTUNA BLVD	None	FORTUNA	CA	95540	3010	00	06000	40.579398	-124.1466635	Humboldt County
340027	Ordering, Referring, Prescribing	N/A	1619294113	0	0	REMLEY, VIRGINIA NP	10/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023041	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	9	CANOGA PARK	CA	91303	1760	00	06000	34.20113553	-118.5912126	Los Angeles County
340046	Ordering, Referring, Prescribing	N/A	1619338936	0	0	RODRIGUEZ-WINTER, JAVIER R LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80445	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
340070	Ordering, Referring, Prescribing	N/A	1619366598	0	0	RON, NAKARI M LCSW	9/17/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80914	N/A	N/A	N/A	N/A	N/A	50 IVY STREET	None	SAN FRANCISCO	CA	94102	4506	00	06000	37.77797898	-122.4185591	San Francisco County
340072	Ordering, Referring, Prescribing	N/A	1619367117	0	0	RIBEIRO, TATIANA X LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107244	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
340075	Ordering, Referring, Prescribing	N/A	1619369642	0	0	RIOS-DAMACIO, ANA K LPCC	4/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC10911	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
340098	Ordering, Referring, Prescribing	N/A	1619397338	0	0	RATNAYAKE, RUWAN P MD	8/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141625	N/A	N/A	N/A	N/A	N/A	2801 K ST	STE 410	SACRAMENTO	CA	95816	5119	00	06000	38.572947	-121.46904	Sacramento County
340128	Ordering, Referring, Prescribing	N/A	1619441086	0	0	RICHARDSON, TANISHA S NP	2/26/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011270	N/A	N/A	N/A	N/A	N/A	1200 W HILLCREST	None	THOUSAND OAKS	CA	91320	0000	00	06000	34.18505362	-118.9068862	Ventura County
340135	Ordering, Referring, Prescribing	N/A	1619454253	0	0	RUIZ, BYRON DDS PC	9/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	102885	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
340172	Ordering, Referring, Prescribing	N/A	1619524626	0	0	ROMINE, HOLLY E CNP	5/21/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011842	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	SUITE B3	SANTA BARBARA	CA	93110	1810	00	06000	34.4404695	-119.7612045	Santa Barbara County
340197	Ordering, Referring, Prescribing	N/A	1619590742	0	0	RAGHEB, MONIKA M LMFT	8/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149115	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	130	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
340219	Ordering, Referring, Prescribing	N/A	1619674371	0	0	RICHMOND-MOORE, KELLY LCSW	2/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27779	N/A	N/A	N/A	N/A	N/A	1750 CIRBY WAY	None	ROSEVILLE	CA	95661	5520	00	06000	38.72953047	-121.258368	Placer County
340239	Ordering, Referring, Prescribing	N/A	1619948502	0	0	RENTERIA, ADALBERTO L MD	4/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G65072	N/A	N/A	N/A	N/A	N/A	1142 ROSE AVE	STE C	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
340268	Ordering, Referring, Prescribing	N/A	1629101217	0	0	ROSS, ROBIN L MD	12/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	C171173	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE STE 100	STE 100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
340279	Ordering, Referring, Prescribing	N/A	1629105820	0	0	ROSAS, YOLANDA Q LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45741	N/A	N/A	N/A	N/A	N/A	2001 28TH ST	None	BAKERSFIELD	CA	93301	1924	00	06000	35.38486605	-119.0251102	Kern County
340283	Ordering, Referring, Prescribing	N/A	1629119557	0	0	RUSSELL, PATRICIA L LCSW	8/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28080	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
340291	Ordering, Referring, Prescribing	N/A	1629129176	0	0	ROBINSON, WESLEY A PHD	4/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	15066	N/A	N/A	N/A	N/A	N/A	509 W. 10TH ST.	None	ANTIOCH	CA	94509	1653	00	06000	38.01116769	-121.8130914	Contra Costa County
340306	Ordering, Referring, Prescribing	N/A	1629152541	0	0	RAVI, HIMABINDU MD	1/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C160213	N/A	N/A	N/A	N/A	N/A	2235 N, LAKE AVENUE	SUITE 212	ALTADENA	CA	91001	1400	00	06000	34.18412319	-118.1316642	Los Angeles County
340315	Ordering, Referring, Prescribing	N/A	1629182050	0	0	ROSS, COLLIN A	12/12/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA16058	N/A	N/A	N/A	N/A	N/A	4004 BEYER BOULEVARD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
340392	Ordering, Referring, Prescribing	N/A	1629343330	0	0	RAMOS VU, ALANA M LMFT	7/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94582	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
340407	Ordering, Referring, Prescribing	N/A	1629363445	0	0	ROWE, RICHARD A LCSW	10/20/2016	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	9929	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
340433	Ordering, Referring, Prescribing	N/A	1629411897	0	0	RAMIREZ, JESUS LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93465	N/A	N/A	N/A	N/A	N/A	5740 RALSTON ST	STE 201	VENTURA	CA	93003	6571	00	06000	34.26070802	-119.213699	Ventura County
340436	Ordering, Referring, Prescribing	N/A	1629419916	0	0	ROMERO, MARICELA LCSW	12/8/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87105	N/A	N/A	N/A	N/A	N/A	225 ALTAIR AVE	None	LOMPOC	CA	93436	1423	00	06000	34.70594022	-120.4670096	Santa Barbara County
340460	Ordering, Referring, Prescribing	N/A	1629468988	0	0	ROSA, KITRICE LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100186	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8828	00	06000	39.15563037	-121.620091	Sutter County
340462	Ordering, Referring, Prescribing	N/A	1629468749	0	0	ROONEY, JULIANNE E NP	12/10/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	788757	N/A	N/A	N/A	N/A	N/A	1125 10TH ST	None	SACRAMENTO	CA	95814	3503	00	06000	38.57890563	-121.4939739	Sacramento County
340478	Ordering, Referring, Prescribing	N/A	1629493150	0	0	REYNOLDS, MEGAN A CNP	8/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	778456	N/A	N/A	N/A	N/A	N/A	12677 HESPERIA ROAD	SUITE 160	VICTORVILLE	CA	92395	7735	00	06000	34.48148078	-117.2906175	San Bernardino County
340495	Ordering, Referring, Prescribing	N/A	1629521430	0	0	RASCO, ROBERT Z	12/12/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100332	N/A	N/A	N/A	N/A	N/A	765 MORNING STAR DR	None	SONORA	CA	95370	5193	00	06000	37.98482091	-120.3717019	Tuolumne County
340507	Ordering, Referring, Prescribing	N/A	1629548169	0	0	ROACH, KRISTINA L NP	1/25/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010985	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
340517	Ordering, Referring, Prescribing	N/A	1629563713	0	0	RIVAS, EDUARDO A LMFT	10/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135127	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
340537	Ordering, Referring, Prescribing	N/A	1629582465	0	0	RAMOS, MICHELLE G NP	2/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008052	N/A	N/A	N/A	N/A	N/A	69175 RAMON RD	BLDG A	CATHEDRAL CTY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
340560	Ordering, Referring, Prescribing	N/A	1629616305	0	0	RODRIGUEZ, LIBBY NP	3/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012738	N/A	N/A	N/A	N/A	N/A	130 W RT 66	100	GLENDORA	CA	91740	6249	00	06000	34.12865951	-117.8651745	Los Angeles County
340568	Ordering, Referring, Prescribing	N/A	1629630496	0	0	RODRIGUEZ, ADAM P	8/20/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103904	N/A	N/A	N/A	N/A	N/A	31 MAIN ST	None	WINTERS	CA	95694	1722	00	06000	38.52157996	-121.9697277	Yolo County
340574	Ordering, Referring, Prescribing	N/A	1629634738	0	0	RIVERA, ARIANA LMFT	4/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138987	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
340595	Ordering, Referring, Prescribing	N/A	1629671722	0	0	ROSALES, ARIANNA PHARMD	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82950	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
340596	Ordering, Referring, Prescribing	N/A	1629683347	0	0	REYES, CELINA R LCSW	7/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124102	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	STE A	BALDWIN PARK	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
340602	Ordering, Referring, Prescribing	N/A	1629670500	0	0	RICHARDS, ELISA LMFT	8/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141282	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95127	1439	00	06000	37.34293689	-121.9270392	Santa Clara County
340610	Ordering, Referring, Prescribing	N/A	1629713789	0	0	ROGERS, DANA E LMFT	10/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132448	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT.	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
340613	Ordering, Referring, Prescribing	N/A	1629711726	0	0	ROBINSON, KYLE E MD	10/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199690	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
340630	Ordering, Referring, Prescribing	N/A	1629785332	0	0	RAM, YANCY G PHARMD	10/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87022	N/A	N/A	N/A	N/A	N/A	14780 S HARLAN RD	None	LATHROP	CA	95330	9719	00	06000	37.82739316	-121.2866038	San Joaquin County
340631	Ordering, Referring, Prescribing	N/A	1629803580	0	0	RATLEY, LIA	8/30/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031990	N/A	N/A	N/A	N/A	N/A	6095 N. 1ST STREET	None	FRESNO	CA	93710	5444	00	06000	36.82524765	-119.7723922	Fresno County
340640	Ordering, Referring, Prescribing	N/A	1629883558	0	0	RUIZ, CARLOS DDS	3/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	109928	N/A	N/A	N/A	N/A	N/A	661 W 1ST STREET	SUITE G	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
340649	Ordering, Referring, Prescribing	N/A	1639172190	0	0	ROMER, BLAIR L MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79022	N/A	N/A	N/A	N/A	N/A	500 CROWN POINT CIRCLE	STE 120	GRASS VALLEY	CA	95945	9561	00	06000	39.22028885	-121.0316663	Nevada County
340658	Ordering, Referring, Prescribing	N/A	1639202195	0	0	RIOS, SANDRA L	6/11/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D50978	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
340675	Ordering, Referring, Prescribing	N/A	1639237886	0	0	RUIZ, GUSTAVO E MD	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68519	N/A	N/A	N/A	N/A	N/A	1328 SECOND STREET	None	SANTA MONICA	CA	90401	0000	00	06000	34.01557114	-118.497924	Los Angeles County
340680	Ordering, Referring, Prescribing	N/A	1639250475	0	0	RILEY, KIMBERLY A PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43692	N/A	N/A	N/A	N/A	N/A	4647 ZION AVE	4TH FLOOR ROOM 4825	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
340706	Ordering, Referring, Prescribing	N/A	1639327273	0	0	RAMIREZ, AMY M PA-C	2/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	53122	N/A	N/A	N/A	N/A	N/A	630 BERCUT DR	C	SACRAMENTO	CA	95811	0110	00	06000	38.600856	-121.497543	Sacramento County
340707	Ordering, Referring, Prescribing	N/A	1639328958	0	0	RAY, MEGAN E LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75758	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
340710	Ordering, Referring, Prescribing	N/A	1639334840	0	0	RICHMOND, ANDREA S	5/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29634	N/A	N/A	N/A	N/A	N/A	24065 BIGGAR LN	None	COVELO	CA	95428	0000	00	06000	39.80972354	-123.2469688	Mendocino County
340711	Ordering, Referring, Prescribing	N/A	1639335268	0	0	RAI, AANMOL I MD	5/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113881	N/A	N/A	N/A	N/A	N/A	78140 CALLE TAMPICO	None	LA QUINTA	CA	92253	2900	00	06000	33.67817342	-116.3001151	Riverside County
340723	Ordering, Referring, Prescribing	N/A	1639366446	0	0	ROSS, KATHRYN E LMFT	8/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105881	N/A	N/A	N/A	N/A	N/A	590 ANTELOPE BLVD	A40	RED BLUFF	CA	96080	2474	00	06000	40.18602075	-122.2057399	Tehama County
340749	Ordering, Referring, Prescribing	N/A	1639410681	0	0	RODRIGUEZ, ALVINA A LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105645	N/A	N/A	N/A	N/A	N/A	3133 NORTH MILBROOK AVE.	None	FRESNO	CA	93703	0001	00	06000	36.77841	-119.7635455	Fresno County
340753	Ordering, Referring, Prescribing	N/A	1639423627	0	0	RAMIREZ MAGANA, BERTHA A LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91456	N/A	N/A	N/A	N/A	N/A	1624 SANTA CLARA DR	None	ROSEVILLE	CA	95661	3554	00	06000	38.74308965	-121.2620987	Placer County
340766	Ordering, Referring, Prescribing	N/A	1639447717	0	0	REYES, TRINA M PHARMD	10/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66615	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	None	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
340768	Ordering, Referring, Prescribing	N/A	1639450398	0	0	RALSTON, SCOTT M LCSW	4/27/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75965	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2412	00	06000	37.86680859	-122.2969443	Alameda County
340770	Ordering, Referring, Prescribing	N/A	1639451040	0	0	RUSSELL, JARI L LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87242	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
340771	Ordering, Referring, Prescribing	N/A	1639451578	0	0	REDDY, VEMURU SUNIL K MD FACS	4/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133552	N/A	N/A	N/A	N/A	N/A	16311 VENTURA BLVD	505	ENCINO	CA	91436	2124	00	06000	34.15706864	-118.4885978	Los Angeles County
340774	Ordering, Referring, Prescribing	N/A	1639453624	0	0	REIMER, SRISUDA C	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60403	N/A	N/A	N/A	N/A	N/A	8766 NAVAJO RD	None	SAN DIEGO	CA	92119	2722	00	06000	32.8030677	-117.0089304	San Diego County
340784	Ordering, Referring, Prescribing	N/A	1639471493	0	0	REDALIA, SARITA R LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44670	N/A	N/A	N/A	N/A	N/A	1865 UNION ST	None	SAN FRANCISCO	CA	94123	4307	00	06000	37.79776031	-122.4299642	San Francisco County
340791	Ordering, Referring, Prescribing	N/A	1639485758	0	0	ROSALES, LOUIS MD	7/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197686	N/A	N/A	N/A	N/A	N/A	1245 E HERNDON AVE	None	FRESNO	CA	93720	0000	00	06000	36.83626267	-119.7674845	Fresno County
340838	Ordering, Referring, Prescribing	N/A	1639549736	0	0	RUBIN, DAVID N LMFT	11/29/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88029	N/A	N/A	N/A	N/A	N/A	7810 ARROYO CIR	None	GILROY	CA	95020	7313	00	06000	37.01553707	-121.5621428	Santa Clara County
340876	Ordering, Referring, Prescribing	N/A	1639597578	0	0	RAHMAN, MUNIRA M DO	2/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15490	N/A	N/A	N/A	N/A	N/A	22675 ALESANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
340886	Ordering, Referring, Prescribing	N/A	1639603442	0	0	RIVERA PEREZ, DANIA K LCSW	7/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116378	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	None	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
340893	Ordering, Referring, Prescribing	N/A	1639626328	0	0	ROBINSON, MEAGAN M LCSW	6/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101908	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE.	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
340918	Ordering, Referring, Prescribing	N/A	1639650294	0	0	RATTANACOMMON, LYNDA	1/17/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	300837	N/A	N/A	N/A	N/A	N/A	909 S. FAIR OAKS AVE.	None	PASADENA	CA	91105	2625	00	06000	34.13056002	-118.1503751	Los Angeles County
340919	Ordering, Referring, Prescribing	N/A	1639653710	0	0	REIJER, MANNY LMFT	7/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133948	N/A	N/A	N/A	N/A	N/A	13356 ELDRIDGE AVE	None	SYLMAR	CA	91342	3200	00	06000	34.31405061	-118.4197394	Los Angeles County
341025	Ordering, Referring, Prescribing	N/A	1639941362	0	0	RODRIGUEZ, YVONNE NP	8/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026483	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
341028	Ordering, Referring, Prescribing	N/A	1649013301	0	0	RODRIGUEZ, ARLENE NP	10/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95027786	N/A	N/A	N/A	N/A	N/A	17500 FOOTHILL BLVD	#A-2	FONTANA	CA	92335	3736	00	06000	34.1067065	-117.4218885	San Bernardino County
341056	Ordering, Referring, Prescribing	N/A	1649287426	0	0	ROBSON, JANET C NP	4/10/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	487229	N/A	N/A	N/A	N/A	N/A	1820 W LINCOLN AVE	None	ANAHEIM	CA	92801	6730	00	06000	33.83242148	-117.946809	Orange County
341068	Ordering, Referring, Prescribing	N/A	1649300088	0	0	RAMIREZ, TERESA MSW LCSW	10/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110465	N/A	N/A	N/A	N/A	N/A	SOUTH VERMONT	3787	LOS ANGELES	CA	90007	4203	00	06000	34.03275787	-118.2915584	Los Angeles County
341076	Ordering, Referring, Prescribing	N/A	1649320649	0	0	REDDY, NARENDRA MD	11/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C166662	N/A	N/A	N/A	N/A	N/A	514 N. PROSPECT AVE.	300	REDONDO BEACH	CA	90277	3036	00	06000	33.85253987	-118.3796668	Los Angeles County
341103	Ordering, Referring, Prescribing	N/A	1649364258	0	0	REMINGTON, SUZANNE M LCSW	6/18/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	3642	N/A	N/A	N/A	N/A	N/A	770 10TH ST	None	ARCATA	CA	95521	6210	00	06000	40.86976947	-124.0859772	Humboldt County
341123	Ordering, Referring, Prescribing	N/A	1649416892	0	0	RACINE, JENNIFER A LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52845	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
341149	Ordering, Referring, Prescribing	N/A	1649479908	0	0	ROMERO, FRANKLIN E LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80858	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
341162	Ordering, Referring, Prescribing	N/A	1649494493	0	0	RUSH-SANDBERG, LEEANN M LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41835	N/A	N/A	N/A	N/A	N/A	1000 S MAIN ST STE 210B	STE 210B	SALINAS	CA	93901	2354	00	06000	36.66226091	-121.6578913	Monterey County
341234	Ordering, Referring, Prescribing	N/A	1649626748	0	0	RODRIGUEZ, DANIEL LMFT	9/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121947	N/A	N/A	N/A	N/A	N/A	14021 AMARGOSA RD	SUITE 100	VICTORVILLE	CA	92392	6404	00	06000	34.50419053	-117.3300794	San Bernardino County
341240	Ordering, Referring, Prescribing	N/A	1649635277	0	0	RAFIQ, SAIRA	12/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	66660	N/A	N/A	N/A	N/A	N/A	6633 COYLE AVE STE 1	1	CARMICHAEL	CA	95608	6346	00	06000	38.668275	-121.3097265	Sacramento County
341270	Ordering, Referring, Prescribing	N/A	1649679390	0	0	ROGERS, AMY L NP	5/28/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001186	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
341271	Ordering, Referring, Prescribing	N/A	1649678087	0	0	RUIZ, ANA L LMFT	7/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133788	N/A	N/A	N/A	N/A	N/A	2121 W. TEMPLE ST	None	LOS ANGELES	CA	90026	4195	00	06000	34.07053729	-118.268744	Los Angeles County
341287	Ordering, Referring, Prescribing	N/A	1649709908	0	0	RAMSEY, LATOYA J LCSW	12/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99334	N/A	N/A	N/A	N/A	N/A	3900 ALDER ST	None	SACRAMENTO	CA	95838	3605	00	06000	38.63853	-121.4370045	Sacramento County
341288	Ordering, Referring, Prescribing	N/A	1649706425	0	0	RODRIGUEZ, EDGAR DC	8/27/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33517	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	100	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
341302	Ordering, Referring, Prescribing	N/A	1649731894	0	0	RAJA, SHELLA K MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1947	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
341313	Ordering, Referring, Prescribing	N/A	1649756974	0	0	ROSENSTEIN, IRVING PA-C	6/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	56410	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
341319	Ordering, Referring, Prescribing	N/A	1649773466	0	0	RAMADAN, SAMY S MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164950	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
341329	Ordering, Referring, Prescribing	N/A	1649787490	0	0	RATKOVICH, AMY C LMFT	2/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124308	N/A	N/A	N/A	N/A	N/A	1970 BROADWAY	SUITE 835	OAKLAND	CA	94612	2299	00	06000	37.80880176	-122.2683539	Alameda County
341352	Ordering, Referring, Prescribing	N/A	1649830654	0	0	RAND, KATHERINE MD	5/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178426	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
341355	Ordering, Referring, Prescribing	N/A	1649830852	0	0	ROJAS MARTINEZ, VALERIA LCSW	10/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126781	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
341365	Ordering, Referring, Prescribing	N/A	1649848268	0	0	RAMIREZ, ANNIE NP	5/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017272	N/A	N/A	N/A	N/A	N/A	1125 17TH STREET	N152	SANTA ANA	CA	92701	2265	00	06000	33.76004145	-117.854838	Orange County
341375	Ordering, Referring, Prescribing	N/A	1649862434	0	0	RODRIGUEZ, DAISY CNP	2/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016585	N/A	N/A	N/A	N/A	N/A	565 N. THOMPSON RD.,	None	TIPTON	CA	93272	1234	00	06000	36.06373491	-119.3121874	Tulare County
341381	Ordering, Referring, Prescribing	N/A	1649868688	0	0	ROBMAN, HILARY LMFT	11/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113002	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
341385	Ordering, Referring, Prescribing	N/A	1649888421	0	0	RAMIREZ, AIRY I LCSW	10/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126729	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1709	00	06000	34.57915154	-117.414216	San Bernardino County
341406	Ordering, Referring, Prescribing	N/A	1649950874	0	0	RANDHAWA, GAGANDEEP K	5/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025393	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	FRESNO	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
341431	Ordering, Referring, Prescribing	N/A	1659027803	0	0	RICHARDS, CHRISTINA M NP	2/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95020136	N/A	N/A	N/A	N/A	N/A	16465 SIERRA LAKES PKWY	300	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
341448	Ordering, Referring, Prescribing	N/A	1659102390	0	0	RAMOS, STEPHANIE GRACE PA	11/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65385	N/A	N/A	N/A	N/A	N/A	4402 E COMPTON BLVD	None	COMPTON	CA	90221	3667	00	06000	33.8960937	-118.1944727	Los Angeles County
341472	Ordering, Referring, Prescribing	N/A	1659326858	0	0	ROMERO, MARIA L	11/20/2017	Taxonomy not applicable	NA	n/a	000	Unknown	16934	N/A	N/A	N/A	N/A	N/A	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
341481	Ordering, Referring, Prescribing	N/A	1659402584	0	0	RODRIGUEZ, IVAN LCSW	12/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27284	N/A	N/A	N/A	N/A	N/A	5000 W CYPRESS AVE	None	VISALIA	CA	93277	8300	00	06000	36.324207	-119.3463225	Tulare County
341500	Ordering, Referring, Prescribing	N/A	1659428555	0	0	RHOAT, TOMOKO LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42972	N/A	N/A	N/A	N/A	N/A	5575 HOSPITAL DRIVE	None	ATASCADERO	CA	93422	4264	00	06000	35.49162766	-120.6627516	San Luis Obispo County
341502	Ordering, Referring, Prescribing	N/A	1659447902	0	0	ROBERTS, CAROLINE MD	12/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C146670	N/A	N/A	N/A	N/A	N/A	201 CALIFORNIA STREET	SUITE 1300	SAN FRANCISCO	CA	94111	5015	00	06000	37.7933184	-122.3990768	San Francisco County
341555	Ordering, Referring, Prescribing	N/A	1659554087	0	0	ROSS, JESSICA MD	6/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A86375	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
341558	Ordering, Referring, Prescribing	N/A	1659561702	0	0	ROSINTOSKI, ANJU A LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43867	N/A	N/A	N/A	N/A	N/A	6203 SAN IGNACIO AVE	150	SAN JOSE	CA	95119	1374	00	06000	37.23598537	-121.7783065	Santa Clara County
341567	Ordering, Referring, Prescribing	N/A	1659580207	0	0	RAKE, LINDA A PA	2/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	13290	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
341575	Ordering, Referring, Prescribing	N/A	1659593663	0	0	RIOS, MARY A LMFT	7/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120267	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	GOLETA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
341590	Ordering, Referring, Prescribing	N/A	1659625465	0	0	RAMIREZ, JESSICA C LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80691	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
341609	Ordering, Referring, Prescribing	N/A	1659654614	0	0	RICAFORT, MARIA LIZA J	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56775	N/A	N/A	N/A	N/A	N/A	6819 WATT AVE	None	NORTH HIGHLANDS	CA	95660	3203	00	06000	38.690892	-121.383558	Sacramento County
341611	Ordering, Referring, Prescribing	N/A	1659654713	0	0	RODRIGUEZ, ALLISON C LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93744	N/A	N/A	N/A	N/A	N/A	455 1ST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
341649	Ordering, Referring, Prescribing	N/A	1659718443	0	0	RAMOS, ALPHONSE-LEA N	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D62355	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
341698	Ordering, Referring, Prescribing	N/A	1659777381	0	0	RAMOS, ESTHER G PSYD	11/17/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30254	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
341706	Ordering, Referring, Prescribing	N/A	1659799278	0	0	ROSS, JAMES MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142020	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
341733	Ordering, Referring, Prescribing	N/A	1659830545	0	0	ROSTAMI, BENJAMIN MD	2/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176597	N/A	N/A	N/A	N/A	N/A	1080 N. WESTERN AVE.	None	LOS ANGELES	CA	90029	2310	00	06000	34.090281	-118.3091425	Los Angeles County
341762	Ordering, Referring, Prescribing	N/A	1659876779	0	0	REHAK-LEPORE, TAYLOR A LMFT	10/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135403	N/A	N/A	N/A	N/A	N/A	3100 BRISTOL ST	150	COSTA MESA	CA	92626	3099	00	06000	33.6865398	-117.885491	Orange County
341792	Ordering, Referring, Prescribing	N/A	1659945749	0	0	RILEY, KAITLYN PA-C	8/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61466	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
341801	Ordering, Referring, Prescribing	N/A	1659952422	0	0	RINCON, PAULA	9/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199056	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
341852	Ordering, Referring, Prescribing	N/A	1669110326	0	0	RANGEL, LORIE NP	7/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021548	N/A	N/A	N/A	N/A	N/A	311 W. NOBLE AVENUE	None	VISALIA	CA	93277	2669	00	06000	36.326304	-119.295477	Tulare County
341868	Ordering, Referring, Prescribing	N/A	1669150637	0	0	RYAN, REBECCA PA	3/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62464	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVE	301	SAN DIEGO	CA	92101	0000	00	06000	32.72646147	-117.1638767	San Diego County
341873	Ordering, Referring, Prescribing	N/A	1669142840	0	0	ROSS, ALEXANDRA N	5/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61140	N/A	N/A	N/A	N/A	N/A	398 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	3099	00	06000	36.93055964	-121.7769628	Santa Cruz County
341908	Ordering, Referring, Prescribing	N/A	1669495107	0	0	REID, BETH E NP	1/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16015	N/A	N/A	N/A	N/A	N/A	590 RIO LINDO	None	CHICO	CA	95926	1817	00	06000	39.75427022	-121.8482553	Butte County
341920	Ordering, Referring, Prescribing	N/A	1669512729	0	0	ROSS, CYNTHIA B LCSW	4/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100983	N/A	N/A	N/A	N/A	N/A	242 N VILLA AVE	None	WILLOWS	CA	95988	2641	00	06000	39.52243848	-122.208844	Glenn County
341936	Ordering, Referring, Prescribing	N/A	1669539524	0	0	ROBLES, ROBERTO LCSW	12/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20832	N/A	N/A	N/A	N/A	N/A	419 MASON STREET	201	VACAVILLE	CA	95688	4546	00	06000	38.35495952	-121.988385	Solano County
341940	Ordering, Referring, Prescribing	N/A	1669551891	0	0	REY, MA MILDRED MD	6/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39331	N/A	N/A	N/A	N/A	N/A	16415 S COLORADO AVE	308	PARAMOUNT	CA	90723	5053	00	06000	33.8853075	-118.1614695	Los Angeles County
341949	Ordering, Referring, Prescribing	N/A	1669591475	0	0	RUBALCAVA, LAURA E LCSW	9/6/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28161	N/A	N/A	N/A	N/A	N/A	9209 COLIMA RD	4600	WHITTIER	CA	90605	1800	00	06000	33.9505367	-118.0054552	Los Angeles County
341951	Ordering, Referring, Prescribing	N/A	1669593828	0	0	RIOS, ANNA C LMFT	3/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97545	N/A	N/A	N/A	N/A	N/A	22445 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8358	00	06000	33.91687854	-117.270999	Riverside County
341988	Ordering, Referring, Prescribing	N/A	1669685228	0	0	ROLDAN, ROSE E	9/3/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D48541	N/A	N/A	N/A	N/A	N/A	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPO	CA	92675	1304	00	06000	33.5230101	-117.6683028	Orange County
342020	Ordering, Referring, Prescribing	N/A	1669767521	0	0	RAMIREZ, ESPERANZA DO	1/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11198	N/A	N/A	N/A	N/A	N/A	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
342062	Ordering, Referring, Prescribing	N/A	1669845301	0	0	REINISCH, FRANCESCA D PA	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61531	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	SUITE A	LOS ANGELES	CA	90021	3082	00	06000	34.02578238	-118.2530622	Los Angeles County
342073	Ordering, Referring, Prescribing	N/A	1669856712	0	0	RUIZ, LETICIA LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115747	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	SUITE 107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
342094	Ordering, Referring, Prescribing	N/A	1669900817	0	0	RAMIREZ, AYELET L LMFT	4/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132486	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
342099	Ordering, Referring, Prescribing	N/A	1669906772	0	0	ROWE, CALLUM J MD	8/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4721	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
342117	Ordering, Referring, Prescribing	N/A	1669939211	0	0	ROBINSON, JORDAN LMFT	10/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141812	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	None	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
342193	Ordering, Referring, Prescribing	N/A	1679067920	0	0	RAD, NASEEM S	7/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188125	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
342244	Ordering, Referring, Prescribing	N/A	1679135560	0	0	ROSE, ASHLEY N LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103917	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
342307	Ordering, Referring, Prescribing	N/A	1679541528	0	0	REMINGTON, BENJAMIN J MD	5/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76179	N/A	N/A	N/A	N/A	N/A	4016 DALE ROAD	None	MODESTO	CA	95356	9268	00	06000	37.69723812	-121.049967	Stanislaus County
342317	Ordering, Referring, Prescribing	N/A	1679602700	0	0	RAHIMI SAYLOR, JEFFREY J LMFT	1/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50859	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
342326	Ordering, Referring, Prescribing	N/A	1679614820	0	0	RAGHAVAN, MURLI MD	3/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55677	N/A	N/A	N/A	N/A	N/A	1818 N ORANGE GROVE AVE	SUITE 205	POMONA	CA	91767	3028	00	06000	34.07694934	-117.7489598	Los Angeles County
342393	Ordering, Referring, Prescribing	N/A	1679744254	0	0	RODRIGUEZ, LUISA LCSW	2/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99955	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	None	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
342396	Ordering, Referring, Prescribing	N/A	1679766075	0	0	ROGERS, LAURA MSW LCSW	12/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27262	N/A	N/A	N/A	N/A	N/A	4244 CHEROKEE AVENUE	7	SAN DIEGO	CA	92104	6602	00	06000	32.75415531	-117.114759	San Diego County
342425	Ordering, Referring, Prescribing	N/A	1679813810	0	0	ROSAS, JOSETTE M LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81331	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
342460	Ordering, Referring, Prescribing	N/A	1679892608	0	0	ROBERTS, KARA LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113001	N/A	N/A	N/A	N/A	N/A	212 CARMEN LN	None	SANTA MARIA	CA	93458	7769	00	06000	34.92481416	-120.4383025	Santa Barbara County
342461	Ordering, Referring, Prescribing	N/A	1679881965	0	0	RUIZ, TASBA X LCSW	5/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75504	N/A	N/A	N/A	N/A	N/A	762 W CYPRESS ST	None	SAN DIMAS	CA	91773	3505	00	06000	34.09577399	-117.8223776	Los Angeles County
342464	Ordering, Referring, Prescribing	N/A	1679897136	0	0	ROHRER, AARON P LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81490	N/A	N/A	N/A	N/A	N/A	1035 MARKET ST STE 400	None	SAN FRANCISCO	CA	94103	1600	00	06000	37.78152549	-122.4111668	San Francisco County
342499	Ordering, Referring, Prescribing	N/A	1679956783	0	0	RAMIREZ, ERIKA LCSW	12/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95141	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
342517	Ordering, Referring, Prescribing	N/A	1679985253	0	0	RICE, AMY LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100794	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
342519	Ordering, Referring, Prescribing	N/A	1679988182	0	0	RODRIGUEZ VALENCIA, ROCIO L MD	4/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146225	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
342572	Ordering, Referring, Prescribing	N/A	1689077752	0	0	RODRIGUEZ, MIGUEL LCSW	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80602	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY,	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
342584	Ordering, Referring, Prescribing	N/A	1689108771	0	0	ROLLINS, XOCHITL E LMFT	4/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139071	N/A	N/A	N/A	N/A	N/A	202 GLACIER DR	None	MARTINEZ	CA	94553	4826	00	06000	37.988865	-122.087427	Contra Costa County
342590	Ordering, Referring, Prescribing	N/A	1689115446	0	0	RUESCHENBERG, ALLYSA NP	6/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006199	N/A	N/A	N/A	N/A	N/A	850 FAIR OAKS AVE	STE 220	ARROYO GRANDE	CA	93420	0011	00	06000	35.11274104	-120.588873	San Luis Obispo County
342593	Ordering, Referring, Prescribing	N/A	1689116725	0	0	RODRIGUEZ, LETICIA	4/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122121	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA RD.	D	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
342635	Ordering, Referring, Prescribing	N/A	1689171795	0	0	RODRIGUES, MEDORA D MD MPH	10/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183708	N/A	N/A	N/A	N/A	N/A	2813S MAIN STREET	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
342660	Ordering, Referring, Prescribing	N/A	1689209900	0	0	REECHER, SOPHIE PA	9/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63294	N/A	N/A	N/A	N/A	N/A	283 SPRECKELS AVE	None	MANTECA	CA	95336	6005	00	06000	37.79494991	-121.1980509	San Joaquin County
342662	Ordering, Referring, Prescribing	N/A	1689210221	0	0	RUSLIE, ERNI	8/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023653	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	STE 500	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
342671	Ordering, Referring, Prescribing	N/A	1689234783	0	0	RANGEL VENTURA, FRANCIS MD	2/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182083	N/A	N/A	N/A	N/A	N/A	850 5TH ST	None	GONZALES	CA	93926	9491	00	06000	36.51464322	-121.4354965	Monterey County
342679	Ordering, Referring, Prescribing	N/A	1689248171	0	0	RODRIGUEZ, RANDALL MD	5/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196505	N/A	N/A	N/A	N/A	N/A	2035 CAMFIELD AVE	None	LOS ANGELES	CA	90040	1501	00	06000	34.00869305	-118.1558956	Los Angeles County
342686	Ordering, Referring, Prescribing	N/A	1689261026	0	0	RIVERA, ANGELICA LCSW	5/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115043	N/A	N/A	N/A	N/A	N/A	2655 CAMINO DEL RIO N	450	SAN DIEGO	CA	92108	1633	00	06000	32.77261373	-117.1347389	San Diego County
342698	Ordering, Referring, Prescribing	N/A	1689292484	0	0	RAMSEY, MICHELLE	10/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142020	N/A	N/A	N/A	N/A	N/A	2020 HIGH ST	None	SELMA	CA	93662	3518	00	06000	36.56926799	-119.612517	Fresno County
342699	Ordering, Referring, Prescribing	N/A	1689280562	0	0	RHODES, SARAH	9/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015465	N/A	N/A	N/A	N/A	N/A	2810 CAMINO DEL RIO S	STE 102	SAN DIEGO	CA	92108	3818	00	06000	32.77081335	-117.1316557	San Diego County
342717	Ordering, Referring, Prescribing	N/A	1689343121	0	0	REILLY, BRIAN J LCSW	9/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126320	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
342718	Ordering, Referring, Prescribing	N/A	1689339558	0	0	ROCHA MILLAN, JORGE MD	11/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P3	N/A	N/A	N/A	N/A	N/A	1186 E LELAND AVE	None	TULARE	CA	93274	7811	00	06000	36.23014473	-119.3277192	Tulare County
342736	Ordering, Referring, Prescribing	N/A	1689455255	0	0	ROCHESTER, WALENA	10/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027636	N/A	N/A	N/A	N/A	N/A	201 29TH ST	B	SACRAMENTO	CA	95816	3482	00	06000	38.581875	-121.463802	Sacramento County
342772	Ordering, Referring, Prescribing	N/A	1689729097	0	0	ROJAS, AIMIE L LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24064	N/A	N/A	N/A	N/A	N/A	2719 N AIR FRESNO DR	None	FRESNO	CA	93727	1547	00	06000	36.77448139	-119.7281325	Fresno County
342795	Ordering, Referring, Prescribing	N/A	1689790768	0	0	RANDALL, AMANDA M LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28232	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
342797	Ordering, Referring, Prescribing	N/A	1689797961	0	0	ROJAS, RUBEN H MSW LCSW	6/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW12822	N/A	N/A	N/A	N/A	N/A	1230 ANDERSON ROAD	None	EXETER	CA	93221	1438	00	06000	36.30558929	-119.1714445	Tulare County
342809	Ordering, Referring, Prescribing	N/A	1689834772	0	0	ROLDA, MARIA FRANCIA OT	6/24/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT19260	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
342813	Ordering, Referring, Prescribing	N/A	1689837262	0	0	RICKARDS, KRISTINA L LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50815	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
342815	Ordering, Referring, Prescribing	N/A	1689839219	0	0	RICHARD, ANYA M LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53071	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET	E500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
342822	Ordering, Referring, Prescribing	N/A	1689855595	0	0	RAHMAN, NABEELA M MD MPH	12/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104967	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
342843	Ordering, Referring, Prescribing	N/A	1689898389	0	0	ROEMER, BEVERLY	10/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	36196	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
342849	Ordering, Referring, Prescribing	N/A	1689917213	0	0	REEVES, CAROL S	1/26/2018	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	180331	N/A	N/A	N/A	N/A	N/A	250 WEST 5TH STREET	None	HANFORD	CA	93230	8823	00	06000	36.32439821	-119.6472235	Kings County
342878	Ordering, Referring, Prescribing	N/A	1689956492	0	0	RYU, JENNIFER M PHARMD	8/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54950	N/A	N/A	N/A	N/A	N/A	2376 E COLORADO BLVD	None	PASADENA	CA	91107	4249	00	06000	34.1460495	-118.1013165	Los Angeles County
342885	Ordering, Referring, Prescribing	N/A	1689961518	0	0	ROSSI, CHRISTINA E LCSW	5/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82469	N/A	N/A	N/A	N/A	N/A	230 N MORRISON AVE	None	SAN JOSE	CA	95126	2741	00	06000	37.33307626	-121.9084647	Santa Clara County
342986	Ordering, Referring, Prescribing	N/A	1699134155	0	0	RODRIGUEZ, JESSICA PHARMD	11/24/2019	Taxonomy not applicable	NA	n/a	000	Unknown	70491	N/A	N/A	N/A	N/A	N/A	1560 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	00	06000	32.779782	-115.569736	Imperial County
343032	Ordering, Referring, Prescribing	N/A	1699211821	0	0	RICHARDSON, HEATHER LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97723	N/A	N/A	N/A	N/A	N/A	30 PROFESSIONAL CENTER P	None	SAN RAFAEL	CA	94901	0000	00	06000	38.00989519	-122.5391142	Marin County
343053	Ordering, Referring, Prescribing	N/A	1699258814	0	0	ROSICA, CARRIE A RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	660121	N/A	N/A	N/A	N/A	N/A	1530 E 19TH ST	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
343072	Ordering, Referring, Prescribing	N/A	1699263053	0	0	RODRIGUEZ MELGOZA, GABRIELA MD	3/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165081	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD	None	LOS ANGELES	CA	90028	5411	00	06000	34.07607952	-118.373418	Los Angeles County
343077	Ordering, Referring, Prescribing	N/A	1699316802	0	0	REEVES, MICHELLE L LMFT	12/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129647	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
343079	Ordering, Referring, Prescribing	N/A	1699324434	0	0	RODRIGUEZ MCCUTCHEN, DAISY LCSW	11/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127165	N/A	N/A	N/A	N/A	N/A	162 E CARSON ST	SUITE A	COLUSA	CA	95932	2880	00	06000	39.20587882	-122.0061518	Colusa County
343134	Ordering, Referring, Prescribing	N/A	1699409821	0	0	REYES, CHRISTINA PA-C	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61624	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST	STE 101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
343153	Ordering, Referring, Prescribing	N/A	1699470211	0	0	RAMSAY, JACQUELINE MD	9/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G179727	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
343165	Ordering, Referring, Prescribing	N/A	1699552505	0	0	RIVERA, LILIANA NP	6/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030712	N/A	N/A	N/A	N/A	N/A	3860 CRENSHAW BLVD	#201	LOS ANGELES	CA	90008	5142	00	06000	34.01580888	-118.3348505	Los Angeles County
343182	Ordering, Referring, Prescribing	N/A	1699758219	0	0	ROMNEY, RICHARD L	11/16/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D35542	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
343198	Ordering, Referring, Prescribing	N/A	1699806794	0	0	ROMERO, CHRISTIAN L LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53592	N/A	N/A	N/A	N/A	N/A	658 E. BRIER DR.	STE. 200	SAN BERNARDINO	CA	92408	2487	00	06000	34.07137738	-117.2702805	San Bernardino County
343209	Ordering, Referring, Prescribing	N/A	1699809657	0	0	RIAHI KASHANI, SEDIGHEH LMFT	4/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48455	N/A	N/A	N/A	N/A	N/A	2202 N 1ST ST	None	SAN JOSE	CA	95131	2007	00	06000	37.37749791	-121.921213	Santa Clara County
343243	Ordering, Referring, Prescribing	N/A	1699894832	0	0	RIBEIRO, MARTIN Z LMFT	12/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	23148	N/A	N/A	N/A	N/A	N/A	314 E. AVE. K-4	#104	LANCASTER	CA	93535	4689	00	06000	34.67493892	-118.1243687	Los Angeles County
343269	Ordering, Referring, Prescribing	N/A	1699956763	0	0	RODRIGUEZ, PATRICIA D	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50008	N/A	N/A	N/A	N/A	N/A	7676 FIRESTONE BLVD	None	DOWNEY	CA	90241	4206	00	06000	33.94594877	-118.1441458	Los Angeles County
343297	Ordering, Referring, Prescribing	N/A	1700030608	0	0	RAMOS, JACQUELINE V LCSW	6/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115716	N/A	N/A	N/A	N/A	N/A	560 S ST LOUIS ST	None	LOS ANGELES	CA	90033	4320	00	06000	34.03924138	-118.2172475	Los Angeles County
343298	Ordering, Referring, Prescribing	N/A	1700045424	0	0	REDDY, SHEELA G MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106025	N/A	N/A	N/A	N/A	N/A	3870 ROSIN COURT	130	SACRAMENTO	CA	95834	1647	00	06000	38.638881	-121.4740395	Sacramento County
343340	Ordering, Referring, Prescribing	N/A	1700123247	0	0	RINCON, MARISOL V LMFT	8/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134520	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	250	VENTURA	CA	93004	1378	00	06000	34.29321532	-119.1597424	Ventura County
343349	Ordering, Referring, Prescribing	N/A	1700140159	0	0	ROBITZ, RACHEL A MD	8/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127641	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
343354	Ordering, Referring, Prescribing	N/A	1700152378	0	0	RALLY, SANJEEV K MD	6/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C179346	N/A	N/A	N/A	N/A	N/A	4650 PALM AVENUE	None	SAN DIEGO	CA	92154	8404	00	06000	32.5839467	-117.0337851	San Diego County
343382	Ordering, Referring, Prescribing	N/A	1700175197	0	0	RODRIGUEZ, RENEE L LCSW	5/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101576	N/A	N/A	N/A	N/A	N/A	485 N FIRST ST	None	SAN JOSE	CA	95112	4031	00	06000	37.34444033	-121.8968517	Santa Clara County
343389	Ordering, Referring, Prescribing	N/A	1700188943	0	0	ROSENBLATT, JUDITH S LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65073	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD.	None	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
343444	Ordering, Referring, Prescribing	N/A	1700267499	0	0	RINCON-SCHLUTZ, JESSIE E PSYD	2/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31476	N/A	N/A	N/A	N/A	N/A	11721 E. TELEGRAPH ROAD	SUITE A	SANTA FE SPRINGS	CA	90670	6835	00	06000	33.94629336	-118.0832752	Los Angeles County
343449	Ordering, Referring, Prescribing	N/A	1700283751	0	0	ROUTHIER, KAREL MD	6/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154672	N/A	N/A	N/A	N/A	N/A	299 12TH ST	None	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
343450	Ordering, Referring, Prescribing	N/A	1700281987	0	0	RANDALL, LINDSAY M PT	9/12/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	41847	N/A	N/A	N/A	N/A	N/A	162 S MAIN ST	None	BISHOP	CA	93514	3415	00	06000	37.3608019	-118.3951979	Inyo County
343464	Ordering, Referring, Prescribing	N/A	1700303799	0	0	ROMAN, ERIKA LCSW	5/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101492	N/A	N/A	N/A	N/A	N/A	150 W 7TH ST	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
343470	Ordering, Referring, Prescribing	N/A	1700317237	0	0	RADPARVAR, MELINA R MD	6/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163164	N/A	N/A	N/A	N/A	N/A	7138 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3005	00	06000	34.200464	-118.4487407	Los Angeles County
343490	Ordering, Referring, Prescribing	N/A	1700351574	0	0	RO, EDWARD PHARMD	1/30/2024	Taxonomy not applicable	NA	n/a	000	Unknown	79108	N/A	N/A	N/A	N/A	N/A	8510 BALBOA BLVD	150	NORTHRIDGE	CA	91325	3583	00	06000	34.224507	-118.5026015	Los Angeles County
343499	Ordering, Referring, Prescribing	N/A	1700360385	0	0	ROMAN, STEPHANIE PHARMD	8/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	78837	N/A	N/A	N/A	N/A	N/A	2424 MISSION ST	None	SAN FRANCISCO	CA	94110	2415	00	06000	37.75816928	-122.4190376	San Francisco County
343506	Ordering, Referring, Prescribing	N/A	1700360633	0	0	RHOADES, KAYLEE R LMFT	10/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142148	N/A	N/A	N/A	N/A	N/A	222 S. HILL ST	None	LOS ANGELES	CA	90012	2715	00	06000	34.0525918	-118.2482081	Los Angeles County
343512	Ordering, Referring, Prescribing	N/A	1700372067	0	0	RODRIGUEZ, MAYRA A LMFT	9/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134884	N/A	N/A	N/A	N/A	N/A	115 S LA CUMBRE LN	SUITE 200	SANTA BARBARA	CA	93105	5102	00	06000	34.43809964	-119.7511604	Santa Barbara County
343543	Ordering, Referring, Prescribing	N/A	1700435211	0	0	REDDY, PRIYA	2/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95020387	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
343546	Ordering, Referring, Prescribing	N/A	1700435880	0	0	RENNO, LAVONNE M LPCC	11/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC8744	N/A	N/A	N/A	N/A	N/A	41945 BIG BEAR BLVD	None	BIG BEAR LAKE	CA	92315	2030	00	06000	34.24334115	-116.8869688	San Bernardino County
343570	Ordering, Referring, Prescribing	N/A	1700478401	0	0	REISER, BRITTNEY A LMFT	3/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124918	N/A	N/A	N/A	N/A	N/A	1710 SCOTT ST	None	SAN FRANCISCO	CA	94115	3004	00	06000	37.78570982	-122.4382098	San Francisco County
343578	Ordering, Referring, Prescribing	N/A	1700502838	0	0	RAMIREZ, JOCELYN PA	10/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61894	N/A	N/A	N/A	N/A	N/A	1030 W GARDENA BLVD	None	GARDENA	CA	90247	4956	00	06000	33.88154027	-118.2925662	Los Angeles County
343598	Ordering, Referring, Prescribing	N/A	1700555802	0	0	RENTON, RACHAEL M NP	9/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018362	N/A	N/A	N/A	N/A	N/A	3075 ADELINE ST	280	BERKELEY	CA	94703	2576	00	06000	37.85258905	-122.2697614	Alameda County
343615	Ordering, Referring, Prescribing	N/A	1700662491	0	0	RODRIGO, JAEMELENE T PHARMD	6/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH88001	N/A	N/A	N/A	N/A	N/A	7117 BROCKTON AVE.	None	RIVERSIDE	CA	92506	3912	00	06000	33.94354395	-117.394926	Riverside County
343624	Ordering, Referring, Prescribing	N/A	1700835675	0	0	RIGOR, RONALD O MD	7/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92405	N/A	N/A	N/A	N/A	N/A	675 S ARROYO PKWY	100B	PASADENA	CA	91105	3235	00	06000	34.13385453	-118.1474229	Los Angeles County
343655	Ordering, Referring, Prescribing	N/A	1700926474	0	0	ROSBERG, MICHAEL D PHD	4/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15355	N/A	N/A	N/A	N/A	N/A	2457 ENDICOTT ST	None	LOS ANGELES	CA	90032	3047	00	06000	34.0756087	-118.1731005	Los Angeles County
343744	Ordering, Referring, Prescribing	N/A	1710139258	0	0	ROTH, MAYA	10/7/2016	Taxonomy not applicable	NA	n/a	000	Unknown	329	N/A	N/A	N/A	N/A	N/A	4110 SORRENTO VALLEY BLV	None	SAN DIEGO	CA	92121	1429	00	06000	32.90375674	-117.2170258	San Diego County
343761	Ordering, Referring, Prescribing	N/A	1710182993	0	0	RICHERT, JILL	1/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14595	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
343774	Ordering, Referring, Prescribing	N/A	1710210232	0	0	RAJA, FURQAN A	6/17/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA20489	N/A	N/A	N/A	N/A	N/A	1100 FOURTH ST	BLDG A	TAFT	CA	93268	2415	00	06000	35.14905085	-119.4534352	Kern County
343800	Ordering, Referring, Prescribing	N/A	1710256102	0	0	RICE, KATIE	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0796339	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
343808	Ordering, Referring, Prescribing	N/A	1710261177	0	0	REGER, JULIA C	2/6/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0621676	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	2620	00	06000	34.0900257	-118.2916693	Los Angeles County
343813	Ordering, Referring, Prescribing	N/A	1710268206	0	0	ROSS, JONATHON M OD	1/12/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15382	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
343834	Ordering, Referring, Prescribing	N/A	1710300710	0	0	RUACHO, BENITO LCSW	7/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW124574	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE, 3RD FL	None	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
343841	Ordering, Referring, Prescribing	N/A	1710310230	0	0	ROWSEY, LAUREN MSW LCSW	1/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93035	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
343845	Ordering, Referring, Prescribing	N/A	1710316450	0	0	RODRIGUEZ JEREZ, ROBERTO D MD	12/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154298	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVENUE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
343896	Ordering, Referring, Prescribing	N/A	1710392030	0	0	RUBIO, ALEJANDRA A LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85377	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
343905	Ordering, Referring, Prescribing	N/A	1710408430	0	0	REA, MARTHA PA	11/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54603	N/A	N/A	N/A	N/A	N/A	220 EUCLID AVE	30	SAN DIEGO	CA	92114	3644	00	06000	32.706387	-117.085098	San Diego County
343937	Ordering, Referring, Prescribing	N/A	1710458054	0	0	REED, SAMANTHA L LCSW	6/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101897	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
343977	Ordering, Referring, Prescribing	N/A	1710529219	0	0	RICHARDS, KATHRYN	12/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012296	N/A	N/A	N/A	N/A	N/A	5440 THORNWOOD DRIVE	SUITE G	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
343996	Ordering, Referring, Prescribing	N/A	1710591615	0	0	REYES, MEGAN LPCC	5/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13966	N/A	N/A	N/A	N/A	N/A	22445 ALESSANDRO BLVD	113-114	MORENO VALLEY	CA	92553	8358	00	06000	33.91687854	-117.270999	Riverside County
344001	Ordering, Referring, Prescribing	N/A	1710626445	0	0	RYKER, DAVID DDS	7/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	D00001	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
344040	Ordering, Referring, Prescribing	N/A	1710939418	0	0	REAGEN, DORIS L NP	2/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5837	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	0000	00	06000	34.25974984	-119.2179337	Ventura County
344062	Ordering, Referring, Prescribing	N/A	1720044860	0	0	RUSH, STEPHEN MD	5/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	H3604	N/A	N/A	N/A	N/A	N/A	555 CREEKSIDE XING	None	NEW BRAUNFELS	TX	78130	2594	00	06000	29.721942	-98.0702055	Comal County
344098	Ordering, Referring, Prescribing	N/A	1720152374	0	0	ROYLANCE, LEAH J LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52267	N/A	N/A	N/A	N/A	N/A	4258 TELEGRAPH RD.	None	VENTURA	CA	93003	0200	00	06000	34.27458778	-119.2375085	Ventura County
344131	Ordering, Referring, Prescribing	N/A	1720217607	0	0	ROHE, MADELINE C CCC-SLP	12/21/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP34544	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AVE	None	UKIAH	CA	95482	5022	00	06000	39.14729048	-123.1987868	Mendocino County
344133	Ordering, Referring, Prescribing	N/A	1720222136	0	0	REDDY, SONIA LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70214	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	None	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
344159	Ordering, Referring, Prescribing	N/A	1720273196	0	0	RODRIGUEZ-WATKINS, ROSANGELA M MSW LCSW	3/1/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69688	N/A	N/A	N/A	N/A	N/A	501 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	2621	00	06000	34.0270205	-118.155308	Los Angeles County
344184	Ordering, Referring, Prescribing	N/A	1720328719	0	0	RUIZ-CHONG, VANESSA G LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100475	N/A	N/A	N/A	N/A	N/A	7120 FRANKLIN AVE	None	LOS ANGELES	CA	90046	3002	00	06000	34.10383456	-118.3455459	Los Angeles County
344186	Ordering, Referring, Prescribing	N/A	1720334188	0	0	RODRIGUEZ, CAMILLE L LCSW	8/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76635	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVE	155	TORRANCE	CA	90502	1314	00	06000	33.84828383	-118.2860386	Los Angeles County
344232	Ordering, Referring, Prescribing	N/A	1720384704	0	0	ROTH, CHELSEA L LCSW	1/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28525	N/A	N/A	N/A	N/A	N/A	10956 DONNER PASS RD	2ND FLOOR	TRUCKEE	CA	96161	4861	00	06000	39.32625521	-120.2012059	Nevada County
344266	Ordering, Referring, Prescribing	N/A	1720427958	0	0	ROSALES, KARINA LMFT	9/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121978	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
344267	Ordering, Referring, Prescribing	N/A	1720429400	0	0	REYES, AMARILYS LMFT	10/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97788	N/A	N/A	N/A	N/A	N/A	10200 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	2649	00	06000	34.25572562	-118.4673156	Los Angeles County
344292	Ordering, Referring, Prescribing	N/A	1720453830	0	0	RAFILA, ERENI LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113147	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	100	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
344324	Ordering, Referring, Prescribing	N/A	1720507437	0	0	RIOS, SUSANA O NP	2/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007375	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
344337	Ordering, Referring, Prescribing	N/A	1720518889	0	0	ROMAN GONZALEZ, JENNIFER LMFT	6/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126304	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD	FIRST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
344341	Ordering, Referring, Prescribing	N/A	1720531585	0	0	ROMERO, SUENIA LCSW	1/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71155	N/A	N/A	N/A	N/A	N/A	30 AZUL CT	None	HOLLISTER	CA	95023	3202	00	06000	36.85354873	-121.4280324	San Benito County
344364	Ordering, Referring, Prescribing	N/A	1720554306	0	0	RAMIREZ, STEPHANIE LCSW	10/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104749	N/A	N/A	N/A	N/A	N/A	14677 MERRILL AVE	None	FONTANA	CA	92335	4219	00	06000	34.09195549	-117.484956	San Bernardino County
344371	Ordering, Referring, Prescribing	N/A	1720558083	0	0	ROYAL, REVA J RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	307054	N/A	N/A	N/A	N/A	N/A	1530 E 19TH ST	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
344408	Ordering, Referring, Prescribing	N/A	1720618010	0	0	ROBINSON, JONATHAN A NP	7/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017602	N/A	N/A	N/A	N/A	N/A	501 S BROOKHURST RD	None	FULLERTON	CA	92833	3207	00	06000	33.865002	-117.959396	Orange County
344426	Ordering, Referring, Prescribing	N/A	1720646623	0	0	RODRIGUEZ, JANETTE LCSW	2/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121031	N/A	N/A	N/A	N/A	N/A	18350 MOUNT LANGLEY ST	None	FOUNTAIN VALLEY	CA	92708	6900	00	06000	33.69633523	-117.9420534	Orange County
344429	Ordering, Referring, Prescribing	N/A	1720677958	0	0	ROWLAND, LESLIE A NP	1/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016346	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
344457	Ordering, Referring, Prescribing	N/A	1720744162	0	0	RUIZ, MONA LISA NP	1/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018466	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8517	00	06000	32.773176	-115.5270465	Imperial County
344471	Ordering, Referring, Prescribing	N/A	1720790157	0	0	RIES, BROOKE M NP	9/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022708	N/A	N/A	N/A	N/A	N/A	5068 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3128	00	06000	34.02101146	-118.1603463	Los Angeles County
344483	Ordering, Referring, Prescribing	N/A	1720872906	0	0	RAHBAR, IRAN RN PHN	4/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95099045	N/A	N/A	N/A	N/A	N/A	500 DYER ST	None	SANTA MARIA	CA	93455	5300	00	06000	34.86135214	-120.4422303	Santa Barbara County
344484	Ordering, Referring, Prescribing	N/A	1730110784	0	0	RAMASWAMY, VYJAYANTI MD	8/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C56139	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
344488	Ordering, Referring, Prescribing	N/A	1730132457	0	0	REDDY, ARJUN N	2/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61204	N/A	N/A	N/A	N/A	N/A	5442 SYCUAN RD	None	EL CAJON	CA	92019	1816	00	06000	32.78885903	-116.8320996	San Diego County
344511	Ordering, Referring, Prescribing	N/A	1730207242	0	0	RIOS, GUADALUPE V LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99785	N/A	N/A	N/A	N/A	N/A	500 AIRPORT WAY	None	CAMARILLO	CA	93010	8500	00	06000	34.2075752	-119.0762641	Ventura County
344515	Ordering, Referring, Prescribing	N/A	1730210915	0	0	RAYMOND-RIVERA, TIFFANY A LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40632	N/A	N/A	N/A	N/A	N/A	1700 MCHENRY VILLAGE WAY	None	MODESTO	CA	95350	4308	00	06000	37.668096	-120.9900045	Stanislaus County
344537	Ordering, Referring, Prescribing	N/A	1730243676	0	0	RAPHAEL, JENNY MD	1/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76422	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAHON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
344539	Ordering, Referring, Prescribing	N/A	1730243981	0	0	RODRIGUEZ-DELGADO, IRIS E. MD	12/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C158512	N/A	N/A	N/A	N/A	N/A	209 E 7TH STREET	None	MADERA	CA	93638	0000	00	06000	36.96069768	-120.0559841	Madera County
344551	Ordering, Referring, Prescribing	N/A	1730263716	0	0	RICH, STEPHEN M MD	7/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G40922	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
344586	Ordering, Referring, Prescribing	N/A	1730381385	0	0	RAMERS, CHRISTIAN B MD	5/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119631	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
344681	Ordering, Referring, Prescribing	N/A	1730538570	0	0	RUPPERT, ANGELA PA	3/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	53492	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVE	350	SAN DIEGO	CA	92105	1645	00	06000	32.74957853	-117.101439	San Diego County
344716	Ordering, Referring, Prescribing	N/A	1730600388	0	0	RALPH, MARK W MD	1/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169633	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
344735	Ordering, Referring, Prescribing	N/A	1730637653	0	0	ROMERO, CARLA M LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98925	N/A	N/A	N/A	N/A	N/A	200 BROADWAY ST	SUITE 70	KING CITY	CA	93930	2865	00	06000	36.2133658	-121.1256124	Monterey County
344743	Ordering, Referring, Prescribing	N/A	1730654559	0	0	REDMOND, STACIE LMFT	2/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130917	N/A	N/A	N/A	N/A	N/A	1161 BAY BLVD	STE B	CHULA VISTA	CA	91911	2670	00	06000	32.6050811	-117.0922508	San Diego County
344754	Ordering, Referring, Prescribing	N/A	1730664343	0	0	ROTHENBERGER, LISA M LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93518	N/A	N/A	N/A	N/A	N/A	2531 W WOODLAND DR	SUITE 200	ANAHEIM	CA	92801	2637	00	06000	33.8492705	-117.973044	Orange County
344772	Ordering, Referring, Prescribing	N/A	1730694035	0	0	RIVERS, ALINA LAC	3/24/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17852	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
344774	Ordering, Referring, Prescribing	N/A	1730698887	0	0	RAFIQI, MARIAM PHARMD	5/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73943	N/A	N/A	N/A	N/A	N/A	2110 TRUXTUN AVE	400	BAKERSFIELD	CA	93301	3703	00	06000	35.37344851	-119.0261655	Kern County
344780	Ordering, Referring, Prescribing	N/A	1730701863	0	0	ROLAND, KAREN NP	4/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014408	N/A	N/A	N/A	N/A	N/A	80495 HIGHWAY 111	None	INDIO	CA	92201	6534	00	06000	33.70724448	-116.260686	Riverside County
344790	Ordering, Referring, Prescribing	N/A	1730728486	0	0	RICHERT, MEGAN LCSW	9/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68063	N/A	N/A	N/A	N/A	N/A	310 JAMES WAY	SUITE 150	PISMO BEACH	CA	93449	2877	00	06000	35.1377942	-120.6260995	San Luis Obispo County
344802	Ordering, Referring, Prescribing	N/A	1730744871	0	0	RAMIREZ, LAUREN LCSW	5/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23068	N/A	N/A	N/A	N/A	N/A	1400 E JANSS RD	None	THOUSAND OAKS	CA	91362	2133	00	06000	34.19964827	-118.8541386	Ventura County
344803	Ordering, Referring, Prescribing	N/A	1730745035	0	0	RUIZ, GABRIEL LCSW	1/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120752	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
344807	Ordering, Referring, Prescribing	N/A	1730763376	0	0	RABANAL, FRANCES CAMILLE R NP	9/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95018473	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS BLVD	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
344833	Ordering, Referring, Prescribing	N/A	1730832742	0	0	RAMOS, MELSOMAR R NP	5/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018273	N/A	N/A	N/A	N/A	N/A	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90089	1001	00	06000	34.05855992	-118.209755	Los Angeles County
344841	Ordering, Referring, Prescribing	N/A	1730846114	0	0	RAUCH, DANIELLE M PA-C	12/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA62053	N/A	N/A	N/A	N/A	N/A	1303 W 6TH ST	SUITE 105	CORONA	CA	92882	3196	00	06000	33.87785815	-117.5891694	Riverside County
344854	Ordering, Referring, Prescribing	N/A	1730897174	0	0	ROSENTHAL, GABRIELLA R NP	10/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95023003	N/A	N/A	N/A	N/A	N/A	4725 MARKET STREET	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
344892	Ordering, Referring, Prescribing	N/A	1740254713	0	0	ROUEL, WADI R	1/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55979	N/A	N/A	N/A	N/A	N/A	165 S FIRST ST	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
344895	Ordering, Referring, Prescribing	N/A	1740301787	0	0	RODENBUSH, KACEY LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47476	N/A	N/A	N/A	N/A	N/A	299 12TH STREET	None	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
344899	Ordering, Referring, Prescribing	N/A	1740303700	0	0	ROBISON, HEIDI L PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52612	N/A	N/A	N/A	N/A	N/A	1011 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	00	06000	38.72827776	-121.2904066	Placer County
344911	Ordering, Referring, Prescribing	N/A	1740311869	0	0	RAMOS, RAYMOND D	7/5/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D42215	N/A	N/A	N/A	N/A	N/A	725 W I ST	None	LOS BANOS	CA	93635	3478	00	06000	37.06257631	-120.8618873	Merced County
344913	Ordering, Referring, Prescribing	N/A	1740317072	0	0	ROBLES, ANITA M LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109280	N/A	N/A	N/A	N/A	N/A	1691 GRAMERCY AVE	None	TORRANCE	CA	90501	3236	00	06000	33.83161459	-118.3165672	Los Angeles County
344916	Ordering, Referring, Prescribing	N/A	1740319565	0	0	RIPHAGEN, RACHEL C PSYD	1/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30013	N/A	N/A	N/A	N/A	N/A	572 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1251	00	06000	34.109667	-117.289669	San Bernardino County
344921	Ordering, Referring, Prescribing	N/A	1740328806	0	0	RANDALL, JACQUIE Z LMFT	3/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT29219	N/A	N/A	N/A	N/A	N/A	25 W. ROLLING OAKS DR,	STE 204	THOUSAND OAKS	CA	91361	1004	00	06000	34.1751748	-118.8764458	Ventura County
344926	Ordering, Referring, Prescribing	N/A	1740336783	0	0	ROMERO, MARISOL PSYD	6/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27105	N/A	N/A	N/A	N/A	N/A	770 53RD ST	None	OAKLAND	CA	94609	1814	00	06000	37.8380933	-122.2688598	Alameda County
344962	Ordering, Referring, Prescribing	N/A	1740443860	0	0	RIDDOCH, GAGE N PSY	9/11/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PY00003860	N/A	N/A	N/A	N/A	N/A	104 BIG BEND RANCH ROAD	None	WADSWORTH	NV	89434	0000	00	06000	39.63129365	-119.2959314	Washoe County
344968	Ordering, Referring, Prescribing	N/A	1740472828	0	0	REZA-SOLTANI, SHIRIN D	12/19/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D56107	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	STE 235	SAN DIEGO	CA	92126	2375	00	06000	32.91416051	-117.1437943	San Diego County
344973	Ordering, Referring, Prescribing	N/A	1740478973	0	0	RODRIGUES, DIEGO LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52347	N/A	N/A	N/A	N/A	N/A	900 CORPORATE CENTER DRI	350	MONTEREY PARK	CA	91754	7685	00	06000	34.05166169	-118.1621338	Los Angeles County
344995	Ordering, Referring, Prescribing	N/A	1740543016	0	0	ROBINSON, DANYEL K LCSW	5/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122338	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
345022	Ordering, Referring, Prescribing	N/A	1740586338	0	0	ROBERSON, SHONA LMFT	12/22/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84932	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
345029	Ordering, Referring, Prescribing	N/A	1740603877	0	0	ROLDAN-ALDANA, KARLA LMFT	4/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100836	N/A	N/A	N/A	N/A	N/A	20501 VENTURA BLVD	SUITE 170	WOODLAND HILLS	CA	91364	2337	00	06000	34.16800818	-118.5797688	Los Angeles County
345031	Ordering, Referring, Prescribing	N/A	1740607019	0	0	ROBERTS, KATHERINE	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154272	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
345041	Ordering, Referring, Prescribing	N/A	1740615954	0	0	RUIZ, BORIS A LCSW	1/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93684	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
345066	Ordering, Referring, Prescribing	N/A	1740656842	0	0	ROLLINS, CHELSEA LCSW	3/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100512	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY COURT	SUITE 300	RIVERSIDE	CA	92507	2156	00	06000	34.00024862	-117.32403	Riverside County
345073	Ordering, Referring, Prescribing	N/A	1740667047	0	0	REDDY, ARCHANA K MD	7/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	A146005	N/A	N/A	N/A	N/A	N/A	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
345101	Ordering, Referring, Prescribing	N/A	1740702794	0	0	RINEAR, ERIK LPCC	5/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC3927	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
345103	Ordering, Referring, Prescribing	N/A	1740707215	0	0	RUIZ, YESENIA LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92018	N/A	N/A	N/A	N/A	N/A	2750 E WASHINGTON BLVD.	230	PASADENA	CA	91107	1448	00	06000	34.1680038	-118.0943955	Los Angeles County
345111	Ordering, Referring, Prescribing	N/A	1740718733	0	0	REGLOS, JOHNNIE D PHARMD	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61894	N/A	N/A	N/A	N/A	N/A	1801 N ROSE AVE	None	OXNARD	CA	93030	2600	00	06000	34.21761901	-119.1584531	Ventura County
345114	Ordering, Referring, Prescribing	N/A	1740719236	0	0	REQUEJO, JESSICA M LCSW	11/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105453	N/A	N/A	N/A	N/A	N/A	9445 FAIRWAY VIEW PL	SUITE 100	RANCHO CUCAMONGA	CA	91730	0929	00	06000	34.08193054	-117.5597308	San Bernardino County
345178	Ordering, Referring, Prescribing	N/A	1740824390	0	0	ROSS, SHARON M LPCC	6/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11690	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
345183	Ordering, Referring, Prescribing	N/A	1740825090	0	0	REJALI, NASIM PHARMD	11/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75731	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
345241	Ordering, Referring, Prescribing	N/A	1750009650	0	0	RIVERA, KRISTINE NP	7/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95021748	N/A	N/A	N/A	N/A	N/A	916 W BURBANK BLVD	M	BURBANK	CA	91506	1400	00	06000	34.18397121	-118.3225966	Los Angeles County
345266	Ordering, Referring, Prescribing	N/A	1750059424	0	0	RIVERA, LILIAN C MSW LCSW	1/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102359	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA STREE	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
345273	Ordering, Referring, Prescribing	N/A	1750152393	0	0	RODRIGUEZ, CASSANDRA PA-C	1/15/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65702	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL RD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
345301	Ordering, Referring, Prescribing	N/A	1750405858	0	0	REED, MARY L LCSW	8/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66332	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
345313	Ordering, Referring, Prescribing	N/A	1750415212	0	0	RENTERIA, MARTHA LMFT	5/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123289	N/A	N/A	N/A	N/A	N/A	1168 LELAND AVE	None	TULARE	CA	93274	7811	00	06000	36.22979548	-119.3282914	Tulare County
345369	Ordering, Referring, Prescribing	N/A	1750539755	0	0	ROWE, CHARLA N LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50834	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
345399	Ordering, Referring, Prescribing	N/A	1750576054	0	0	RON, VANESSA L PHD	2/12/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32387	N/A	N/A	N/A	N/A	N/A	5110 W GOLDLEAF CIR	None	LOS ANGELES	CA	90056	1282	00	06000	33.98790164	-118.367233	Los Angeles County
345431	Ordering, Referring, Prescribing	N/A	1750693545	0	0	RAHMAN, AMBREEN DO	5/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13695	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE # A	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
345457	Ordering, Referring, Prescribing	N/A	1750724100	0	0	RODRIGUEZ MELENDEZ, DAVIS LCSW	11/3/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111804	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
345467	Ordering, Referring, Prescribing	N/A	1750743860	0	0	RODRIGUEZ, JOSE LCSW	8/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117472	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
345489	Ordering, Referring, Prescribing	N/A	1750759155	0	0	RAMIREZ, JULIANNA N PA-C	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59829	N/A	N/A	N/A	N/A	N/A	27725 SANTA MARGARITA PK	SUITE 101	MISSION VIEJO	CA	92691	6704	00	06000	33.65386492	-117.6476716	Orange County
345497	Ordering, Referring, Prescribing	N/A	1750782140	0	0	RODRIGUEZ, EVELYN A LMFT	12/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136183	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
345503	Ordering, Referring, Prescribing	N/A	1750781357	0	0	ROMERO, ALEXA LCSW	8/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LSCW96298	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
345508	Ordering, Referring, Prescribing	N/A	1750797510	0	0	RUPP, KRISTIN LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111631	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
345519	Ordering, Referring, Prescribing	N/A	1750813887	0	0	RIOS, ROSAURA	8/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140929	N/A	N/A	N/A	N/A	N/A	1425 W FOOTHILL BLVD	201	UPLAND	CA	91786	8007	00	06000	34.10713879	-117.676213	San Bernardino County
345582	Ordering, Referring, Prescribing	N/A	1750927265	0	0	ROGERS, ANGELICA	6/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RN425766	N/A	N/A	N/A	N/A	N/A	571 E. CITRUS DR.	None	FARMERSVILLE	CA	93223	1274	00	06000	36.3079474	-119.2019511	Tulare County
345587	Ordering, Referring, Prescribing	N/A	1750934014	0	0	ROGERS, DESTINY LCSW	9/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126171	N/A	N/A	N/A	N/A	N/A	3840 ROSIN COURT	SUITE 100	SACRAMENTO	CA	95834	1639	00	06000	38.637567	-121.473306	Sacramento County
345595	Ordering, Referring, Prescribing	N/A	1750949624	0	0	ROTHMAN, JOSHUA M MD	2/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182348	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
345609	Ordering, Referring, Prescribing	N/A	1750997441	0	0	REDDICK, ADRIENNE CNP	2/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019901	N/A	N/A	N/A	N/A	N/A	1860 HOWE AVE	440	SACRAMENTO	CA	95825	1073	00	06000	38.59947	-121.4142525	Sacramento County
345614	Ordering, Referring, Prescribing	N/A	1760006258	0	0	RIVERA, KAREN A LMFT	5/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132983	N/A	N/A	N/A	N/A	N/A	1500 HUGHES WAY	STE C100	LONG BEACH	CA	90810	1808	00	06000	33.82860528	-118.2124528	Los Angeles County
345634	Ordering, Referring, Prescribing	N/A	1760035182	0	0	RODRIGUEZ, IRMA A NP	3/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014283	N/A	N/A	N/A	N/A	N/A	8112 MILLIKEN AVENUE	STE 100	RANCHO CUCAMONGA	CA	91730	0100	00	06000	34.10480366	-117.5570863	San Bernardino County
345635	Ordering, Referring, Prescribing	N/A	1760033781	0	0	RAMOS, SHARON J LCSW	8/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110248	N/A	N/A	N/A	N/A	N/A	3105 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217634	-119.037921	Kern County
345642	Ordering, Referring, Prescribing	N/A	1760047054	0	0	RODRIGUEZ PENA, EMILIO J MD	1/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179644	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
345673	Ordering, Referring, Prescribing	N/A	1760150403	0	0	REED, KATIE LMFT	9/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150161	N/A	N/A	N/A	N/A	N/A	902 MONTEREY SALINAS HWY	None	SALINAS	CA	93908	8820	00	06000	36.56808493	-121.7754309	Monterey County
345705	Ordering, Referring, Prescribing	N/A	1760466395	0	0	RUDA, JOSEPH F JR MD	4/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32463	N/A	N/A	N/A	N/A	N/A	1310 HANNA AVE	SUITE 1 & 3	CORCORAN	CA	93212	2314	00	06000	36.09975818	-119.5641426	Kings County
345711	Ordering, Referring, Prescribing	N/A	1760491948	0	0	RABBANI, RAMIN A OD	7/11/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11736	N/A	N/A	N/A	N/A	N/A	8527 SEPULVEDA BLVD	None	NORTH HILLS	CA	91343	5824	00	06000	34.225524	-118.4677265	Los Angeles County
345765	Ordering, Referring, Prescribing	N/A	1760596175	0	0	ROSSER, PAUL S NP	3/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	3021754405	N/A	N/A	N/A	N/A	N/A	6948 W DUSTY ROSE CIR	None	HERRIMAN	UT	84096	0000	00	06000	40.49471374	-112.0564584	Salt Lake County
345782	Ordering, Referring, Prescribing	N/A	1760670509	0	0	RAFANAN, FRANKLIN	9/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28204	N/A	N/A	N/A	N/A	N/A	9601 KIEFER BLVD	None	SACRAMENTO	CA	95827	3818	00	06000	38.54628	-121.3397415	Sacramento County
345793	Ordering, Referring, Prescribing	N/A	1760677934	0	0	RUIZ-MADERO, RITA P LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106350	N/A	N/A	N/A	N/A	N/A	2101 GEER RD	SUITE 120	TURLOCK	CA	95382	2454	00	06000	37.512324	-120.8489985	Stanislaus County
345803	Ordering, Referring, Prescribing	N/A	1760692685	0	0	RILEY, SHARON A LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40017	N/A	N/A	N/A	N/A	N/A	60 W. MARKET ST.	None	SALINAS	CA	93901	2655	00	06000	36.67846746	-121.6582192	Monterey County
345828	Ordering, Referring, Prescribing	N/A	1760740377	0	0	RODRIGUEZ, JOSHUA MD	10/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P8724	N/A	N/A	N/A	N/A	N/A	2101 PEASE ST	None	HARLINGEN	TX	78550	8307	00	06000	26.17434909	-97.67149907	Cameron County
345853	Ordering, Referring, Prescribing	N/A	1760780142	0	0	RANGEL, MICHELLE LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93281	N/A	N/A	N/A	N/A	N/A	840 N AVE 66	None	LOS ANGELES	CA	90042	1508	00	06000	34.12110842	-118.1725545	Los Angeles County
345858	Ordering, Referring, Prescribing	N/A	1760786651	0	0	RAMIREZ LOZA, SABRINA LMFT	12/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111249	N/A	N/A	N/A	N/A	N/A	1830 S. CENTRAL STREET	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
345863	Ordering, Referring, Prescribing	N/A	1760801518	0	0	ROGERS, DEATRE LCSW	9/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126294	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	SUITE 110	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
345873	Ordering, Referring, Prescribing	N/A	1760819494	0	0	ROSAS, NANCY L LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95996	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
345892	Ordering, Referring, Prescribing	N/A	1760844310	0	0	ROESSNER, JEDD LYN T	12/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159778	N/A	N/A	N/A	N/A	N/A	184 BIMINI PL	None	LOS ANGELES	CA	90004	5903	00	06000	34.07060546	-118.290517	Los Angeles County
345899	Ordering, Referring, Prescribing	N/A	1760848683	0	0	RUIZ, EDUARDO LCSW	3/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97836	N/A	N/A	N/A	N/A	N/A	892 27TH ST	None	SAN DIEGO	CA	92154	1444	00	06000	32.581098	-117.075478	San Diego County
345912	Ordering, Referring, Prescribing	N/A	1760854798	0	0	ROSSELL, ANNE CNP	11/25/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006692	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
345961	Ordering, Referring, Prescribing	N/A	1760932883	0	0	ROWE, TAKIYAH J	4/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004888	N/A	N/A	N/A	N/A	N/A	6120 SEVILLE AVENUE	None	LOS ANGELES	CA	90255	0001	00	06000	33.98438021	-118.2226279	Los Angeles
345977	Ordering, Referring, Prescribing	N/A	1760943476	0	0	RAMOS, ROBERTO N MD MPH	3/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177000	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	5411	00	06000	34.1016835	-118.321569	Los Angeles County
345984	Ordering, Referring, Prescribing	N/A	1760952014	0	0	ROCHA, NICOLE RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95060066	N/A	N/A	N/A	N/A	N/A	1530 E 19TH ST	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
345990	Ordering, Referring, Prescribing	N/A	1760976898	0	0	RENTERIA-SALDANA, ELISA G LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98942	N/A	N/A	N/A	N/A	N/A	205 W OLIVE AVE	None	MERCED	CA	95348	3100	00	06000	37.321074	-120.472371	Merced County
345996	Ordering, Referring, Prescribing	N/A	1760986715	0	0	RIVERA, KEVIN JOHN R MD	2/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193862	N/A	N/A	N/A	N/A	N/A	680 FLETCHER PKWY	None	EL CAJON	CA	92020	2516	00	06000	32.80780847	-116.970687	San Diego County
346002	Ordering, Referring, Prescribing	N/A	1770006207	0	0	RIVERS, ASHLEY N PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75510	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
346008	Ordering, Referring, Prescribing	N/A	1770009102	0	0	RUSU, ALEXANDRA R LMFT	5/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125886	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 E	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
346014	Ordering, Referring, Prescribing	N/A	1770012221	0	0	RAYNOR, ROSALIND S LMFT	12/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139677	N/A	N/A	N/A	N/A	N/A	2336 COUNTRY HILLS DRIVE	None	ANTIOCH	CA	94531	8585	00	06000	37.97048742	-121.7832224	Contra Costa County
346019	Ordering, Referring, Prescribing	N/A	1770037004	0	0	RODAS, NAOMI V PHD	1/29/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33729	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
346021	Ordering, Referring, Prescribing	N/A	1770025595	0	0	RODRIGUEZ, CASSANDRA PT	2/22/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT292823	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
346042	Ordering, Referring, Prescribing	N/A	1770077448	0	0	RODRIGUEZ, LETICIA LMFT	1/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124172	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
346059	Ordering, Referring, Prescribing	N/A	1770123663	0	0	RAVAS, MAGLENDA NP	10/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013651	N/A	N/A	N/A	N/A	N/A	12444 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	00	06000	33.96757592	-118.046351	Los Angeles County
346066	Ordering, Referring, Prescribing	N/A	1770138802	0	0	REHMAN, YASMIN LMFT	1/7/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152532	N/A	N/A	N/A	N/A	N/A	11600 ELDRIDGE AVE	None	SYLMAR	CA	91342	6506	00	06000	34.28038404	-118.3838708	Los Angeles County
346080	Ordering, Referring, Prescribing	N/A	1770146862	0	0	READER, JORDAN DO	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20095	N/A	N/A	N/A	N/A	N/A	697 W TEFFT ST	None	NIPOMO	CA	93444	9190	00	06000	35.03397948	-120.4897062	San Luis Obispo County
346135	Ordering, Referring, Prescribing	N/A	1770508616	0	0	ROCHAT, JOHN A MD	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54024	N/A	N/A	N/A	N/A	N/A	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	00	06000	39.43163763	-123.8007631	Mendocino County
346157	Ordering, Referring, Prescribing	N/A	1770610032	0	0	REA, AMY LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47837	N/A	N/A	N/A	N/A	N/A	760 MOUNTAIN VIEW ST	SUITE 100	ALTADENA	CA	91001	4925	00	06000	34.19178664	-118.1657029	Los Angeles County
346169	Ordering, Referring, Prescribing	N/A	1770638694	0	0	RYAN, ELIZABETH PSYD	1/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22769	N/A	N/A	N/A	N/A	N/A	10421 S. FIGUEROA ST.	None	LOS ANGELES	CA	90003	4423	00	06000	33.941736	-118.2826495	Los Angeles County
346171	Ordering, Referring, Prescribing	N/A	1770647158	0	0	RECTOR, BRIAN J LMFT	8/31/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104737	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	100	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
346187	Ordering, Referring, Prescribing	N/A	1770676470	0	0	RODRIGUES, OLIVIA M	10/27/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D30865	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
346190	Ordering, Referring, Prescribing	N/A	1770699324	0	0	RAY, JANA K PA	4/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56715	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
346266	Ordering, Referring, Prescribing	N/A	1770861155	0	0	REYES, ANTHONY LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103384	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
346276	Ordering, Referring, Prescribing	N/A	1770879884	0	0	RAMIREZ, RICARDO MD	11/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116453	N/A	N/A	N/A	N/A	N/A	9101 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2405	00	06000	34.00074139	-118.0822944	Los Angeles County
346336	Ordering, Referring, Prescribing	N/A	1770959587	0	0	ROBERTS, JANICE M NP	9/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002757	N/A	N/A	N/A	N/A	N/A	6 WOODLAND RD	STE 304	SAINT HELENA	CA	94574	9562	00	06000	38.54297115	-122.4754501	Napa County
346356	Ordering, Referring, Prescribing	N/A	1770991697	0	0	RIKHYE, SHRADDHA DDS	12/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	63696	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	SUITE 4100	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
346381	Ordering, Referring, Prescribing	N/A	1780036905	0	0	RICE, RUSSELL R LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35479	N/A	N/A	N/A	N/A	N/A	26967 BEAUMONT AVE.	None	REDLANDS	CA	92373	4360	00	06000	34.03741027	-117.2157872	San Bernardino County
346383	Ordering, Referring, Prescribing	N/A	1780036780	0	0	RATIANI, BRITTANY L LMFT	3/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131667	N/A	N/A	N/A	N/A	N/A	131B STONY CIR	1200	SANTA ROSA	CA	95401	9507	00	06000	38.43966826	-122.7451256	Sonoma County
346403	Ordering, Referring, Prescribing	N/A	1780078865	0	0	RANDOLPH, ARIELLE V MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148089	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
346430	Ordering, Referring, Prescribing	N/A	1780110023	0	0	RING, CHRISTINA M MD	8/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173506	N/A	N/A	N/A	N/A	N/A	28049 SMYTH DR	None	VALENCIA	CA	91355	4023	00	06000	34.44339219	-118.5719935	Los Angeles County
346448	Ordering, Referring, Prescribing	N/A	1780127803	0	0	RUIZ RUELAS, MARIA MAGDALENA NP	6/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005450	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
346471	Ordering, Referring, Prescribing	N/A	1780174052	0	0	ROSSI, MELISSA S LPCC	10/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17821	N/A	N/A	N/A	N/A	N/A	1120 DEERPARK RD	None	OAKLEY	CA	94561	3154	00	06000	37.99961187	-121.7144331	Contra Costa County
346473	Ordering, Referring, Prescribing	N/A	1780188755	0	0	RUIZ, CALVIN J MD	7/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174162	N/A	N/A	N/A	N/A	N/A	1035 PLACER STREET	None	REDDING	CA	96001	4245	00	06000	40.58349378	-122.3853903	Shasta County
346491	Ordering, Referring, Prescribing	N/A	1780232330	0	0	RAMIREZ, VICTOR LMFT	5/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147145	N/A	N/A	N/A	N/A	N/A	1515 S BON VIEW AVE	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
346493	Ordering, Referring, Prescribing	N/A	1780233841	0	0	RODRIGUEZ, REYNA J PHD	8/5/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33492	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	MS #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
346507	Ordering, Referring, Prescribing	N/A	1780279091	0	0	RAMOS, ALEXSANDRA LMFT	1/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144112	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	STE. K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
346525	Ordering, Referring, Prescribing	N/A	1780334342	0	0	RAMIREZ, ARIEL	6/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64642	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LN	None	STOCKTON	CA	95207	5743	00	06000	37.98919284	-121.3152121	San Joaquin County
346530	Ordering, Referring, Prescribing	N/A	1780338624	0	0	REDDY, GAUTHAM T MD	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A34059	N/A	N/A	N/A	N/A	N/A	40925 COUNTY CENTER DR	None	TEMECULA	CA	92591	6054	00	06000	33.52802214	-117.1605544	Riverside County
346554	Ordering, Referring, Prescribing	N/A	1780437202	0	0	RICHARDSON, TORREY NP	3/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029639	N/A	N/A	N/A	N/A	N/A	15791 BEAR VALLEY RD	None	HESPERIA	CA	92345	1746	00	06000	34.47063553	-117.3190095	San Bernardino County
346593	Ordering, Referring, Prescribing	N/A	1780709436	0	0	ROMERO, RAPHAEL PSYD	1/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24863	N/A	N/A	N/A	N/A	N/A	10421 S. FIGUEROA ST	None	LOS ANGELES	CA	90003	4423	00	06000	33.941736	-118.2826495	Los Angeles County
346594	Ordering, Referring, Prescribing	N/A	1780716506	0	0	ROTH, BONNIE J LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS18460	N/A	N/A	N/A	N/A	N/A	16360 ROSCOE BLVD	FLOOR 2	VAN NUYS	CA	91406	1219	00	06000	34.22126852	-118.490805	Los Angeles County
346614	Ordering, Referring, Prescribing	N/A	1780763474	0	0	ROGERS, JOHN P LPCC	5/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	6291	N/A	N/A	N/A	N/A	N/A	23550 LYONS AVE.	211	SANTA CLARITA	CA	91321	5745	00	06000	34.37938495	-118.5458635	Los Angeles County
346615	Ordering, Referring, Prescribing	N/A	1780764662	0	0	ROMANO, IRENE P PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50196	N/A	N/A	N/A	N/A	N/A	1033 THIRD STREET	None	SAN RAFAEL	CA	94901	3107	00	06000	37.97209412	-122.5280013	Marin County
346623	Ordering, Referring, Prescribing	N/A	1780776682	0	0	RAMS, ROBERTA U	1/17/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D40387	N/A	N/A	N/A	N/A	N/A	175 MAIN ST	#1100	GUALALA	CA	95445	1100	00	06000	0	0	None
346635	Ordering, Referring, Prescribing	N/A	1780813717	0	0	RODARTE, MARTIN LCSW	10/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66631	N/A	N/A	N/A	N/A	N/A	1224 VINE ST.	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
346645	Ordering, Referring, Prescribing	N/A	1780819441	0	0	RIVAS, KARENA LMFT	5/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113148	N/A	N/A	N/A	N/A	N/A	801 E. CHAPMAN AVE.	None	MORENO VALLEY	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
346661	Ordering, Referring, Prescribing	N/A	1780875021	0	0	ROSEN, MARLA R LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99866	N/A	N/A	N/A	N/A	N/A	2484 SHATTUCK AVE	210	BERKELEY	CA	94704	2076	00	06000	37.8641716	-122.2676092	Alameda County
346662	Ordering, Referring, Prescribing	N/A	1780877845	0	0	RESENDEZ, CYNTHIA	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84098	N/A	N/A	N/A	N/A	N/A	1212 CALIFORNIA ST.	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
346681	Ordering, Referring, Prescribing	N/A	1780921916	0	0	RODRIGUEZ, SARAI LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143855	N/A	N/A	N/A	N/A	N/A	81812 DR CARREON BLVD,	SUITE D	INDIO	CA	92201	5594	00	06000	33.70742848	-116.236728	Riverside County
346690	Ordering, Referring, Prescribing	N/A	1780928424	0	0	RODRIGUEZ CRUZ, JESSICA N LCSW	7/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114622	N/A	N/A	N/A	N/A	N/A	405 W 5TH ST	300	SANTA ANA	CA	92701	4599	00	06000	33.74893088	-117.8713859	Orange County
346691	Ordering, Referring, Prescribing	N/A	1780932988	0	0	RAMIREZ, KARLA J LCSW	4/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87423	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
346749	Ordering, Referring, Prescribing	N/A	1790037661	0	0	REYES, MELANIE S LCSW	4/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78660	N/A	N/A	N/A	N/A	N/A	1520 N. RAYMOND AVE.	BUILDINGS 2-7	PASADENA	CA	91103	2236	00	06000	34.171812	-118.1490725	Los Angeles County
346770	Ordering, Referring, Prescribing	N/A	1790064889	0	0	ROBLES, ROBERT	3/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74971	N/A	N/A	N/A	N/A	N/A	300 BRADFORD ST	None	REDWOOD CITY	CA	94063	1530	00	06000	37.48767403	-122.2323005	San Mateo County
346775	Ordering, Referring, Prescribing	N/A	1790068013	0	0	REGO, ANDREA J	3/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50998	N/A	N/A	N/A	N/A	N/A	4051 DOUGLAS BLVD	None	GRANITE BAY	CA	95746	5901	00	06000	38.74390645	-121.2244714	Placer County
346825	Ordering, Referring, Prescribing	N/A	1790137271	0	0	RODRIGUEZ, CHRISTIAN D LMFT	1/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136968	N/A	N/A	N/A	N/A	N/A	16580 HARBOR BLVD	UNIT M	FOUNTAIN VALLEY	CA	92708	1386	00	06000	33.72282	-117.9197845	Orange County
346836	Ordering, Referring, Prescribing	N/A	1790158517	0	0	REYNOLDS, NATHANIEL A LMFT	2/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124562	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
346850	Ordering, Referring, Prescribing	N/A	1790166627	0	0	ROSENOW, ASHLEY PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61629	N/A	N/A	N/A	N/A	N/A	72800 DINAH SHORE DR	None	PALM DESERT	CA	92211	0814	00	06000	33.80472802	-116.3902768	Riverside County
346866	Ordering, Referring, Prescribing	N/A	1790203289	0	0	REEDY, MEGHAN R LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102290	N/A	N/A	N/A	N/A	N/A	5007 KENNETH AVE	None	FAIR OAKS	CA	95628	5329	00	06000	38.657052	-121.244616	Sacramento County
346874	Ordering, Referring, Prescribing	N/A	1790207793	0	0	RHYMES-DANIELSON, SHAWNA A LMFT	7/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120459	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
346895	Ordering, Referring, Prescribing	N/A	1790238046	0	0	RUBALCAVA, LETICIA PA-C	5/12/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53641	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
346897	Ordering, Referring, Prescribing	N/A	1790242469	0	0	RIVADENEYRA, KELLY LCSW	6/1/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122911	N/A	N/A	N/A	N/A	N/A	1675 N PERRIS BLVD	STE G1	PERRIS	CA	92571	4726	00	06000	33.802137	-117.2260135	Riverside County
346907	Ordering, Referring, Prescribing	N/A	1790250280	0	0	ROE, STEPHANIE S NP	8/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	NP95009835	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
346950	Ordering, Referring, Prescribing	N/A	1790321891	0	0	ROHANI, SAM M	11/2/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	103860	N/A	N/A	N/A	N/A	N/A	116 W MINNESOTA AVE	1143	MCCLOUD	CA	96057	1143	00	06000	41.25214176	-122.1368284	Siskiyou County
346973	Ordering, Referring, Prescribing	N/A	1790364156	0	0	RAMSEY, CLAUDIA N MD	11/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191467	N/A	N/A	N/A	N/A	N/A	3514 30TH STREET	None	SAN DIEGO	CA	92104	4120	00	06000	32.74247286	-117.1301067	San Diego County
346993	Ordering, Referring, Prescribing	N/A	1790434512	0	0	REYES, NORELLA PA	8/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61574	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
347001	Ordering, Referring, Prescribing	N/A	1790449338	0	0	RHEIN, JENNA LMFT	3/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137739	N/A	N/A	N/A	N/A	N/A	1074 EAST AVE	STE A4	CHICO	CA	95926	1052	00	06000	39.76099443	-121.8353929	Butte County
347033	Ordering, Referring, Prescribing	N/A	1790728764	0	0	ROWHANI, SHIRIN A	10/2/1995	Taxonomy not applicable	NA	n/a	099	DENTIST	D43490	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
347051	Ordering, Referring, Prescribing	N/A	1790812782	0	0	ROBBINS, DIANE E	9/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11437	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
347061	Ordering, Referring, Prescribing	N/A	1790816767	0	0	ROBLES BURGOS, GUILLERMINA LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26331	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	5986	00	06000	34.54007429	-117.2744761	San Bernardino County
347069	Ordering, Referring, Prescribing	N/A	1790842417	0	0	ROGERS, TERRI L	9/15/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D37599	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
347084	Ordering, Referring, Prescribing	N/A	1790857977	0	0	RODRIGUEZ, ROCIO B LMFT	7/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49538	N/A	N/A	N/A	N/A	N/A	1601 OLD BAYSHORE HWY	SUITE 123	BURLINGAME	CA	94010	1523	00	06000	37.59954916	-122.367774	San Mateo County
347090	Ordering, Referring, Prescribing	N/A	1790871887	0	0	ROBBINS, KATHY LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34626	N/A	N/A	N/A	N/A	N/A	550 W VISTA WAY	407	VISTA	CA	92083	5732	00	06000	33.19564771	-117.2534095	San Diego County
347119	Ordering, Referring, Prescribing	N/A	1790961191	0	0	RASKIN, SANDRA H	11/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT25539	N/A	N/A	N/A	N/A	N/A	494 BLOSSOM WAY	None	HAYWARD	CA	94541	1881	00	06000	37.67843796	-122.1037905	Alameda County
347159	Ordering, Referring, Prescribing	N/A	1801028642	0	0	REYES, TRINH T LCSW	7/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64458	N/A	N/A	N/A	N/A	N/A	409 JACKSON ST.	None	HAYWARD	CA	94544	1530	00	06000	37.66243575	-122.0841894	Alameda County
347231	Ordering, Referring, Prescribing	N/A	1801161807	0	0	RAHMAN, NASREEN S NP	3/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20296	N/A	N/A	N/A	N/A	N/A	4126 N. MAINE AVENUE	None	BALDWIN PARK	CA	91706	5103	00	06000	34.08740223	-117.9603532	Los Angeles County
347251	Ordering, Referring, Prescribing	N/A	1801186531	0	0	RIVERA, JAIMEE	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120736	N/A	N/A	N/A	N/A	N/A	3075 MYERS STREET	None	RIVERSIDE	CA	92503	5527	00	06000	33.90872869	-117.4423238	Riverside County
347265	Ordering, Referring, Prescribing	N/A	1801199260	0	0	RAMIREZ, VERONICA D	8/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20265	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
347270	Ordering, Referring, Prescribing	N/A	1801210638	0	0	RIVERA, ANTHONY LMFT	10/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135584	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	2777	00	06000	33.61712389	-117.6780482	Orange County
347279	Ordering, Referring, Prescribing	N/A	1801234638	0	0	REYES, JENNA M LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117917	N/A	N/A	N/A	N/A	N/A	117 WEST TUNNELL STREET	None	SANTA MARIA	CA	93458	4096	00	06000	34.95752999	-120.4366316	Santa Barbara County
347342	Ordering, Referring, Prescribing	N/A	1801318027	0	0	RANDALL WALKER, CHRISTINE M LCSW	12/27/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68030	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
347370	Ordering, Referring, Prescribing	N/A	1801356829	0	0	ROJAS-PARRA, ABEL E MD	4/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177118	N/A	N/A	N/A	N/A	N/A	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
347378	Ordering, Referring, Prescribing	N/A	1801370606	0	0	ROSS, NADIA	11/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW111677	N/A	N/A	N/A	N/A	N/A	265 S ANITA DR	STE 103	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
347391	Ordering, Referring, Prescribing	N/A	1801404439	0	0	RAMIREZ, OLIVIA D MD	11/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88992	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
347475	Ordering, Referring, Prescribing	N/A	1801801279	0	0	RADPARVAR, MANSOOR MD	5/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50959	N/A	N/A	N/A	N/A	N/A	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	00	06000	33.71114199	-117.8853958	Orange County
347478	Ordering, Referring, Prescribing	N/A	1801821855	0	0	REDDY, VIMALA	9/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54465	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
347501	Ordering, Referring, Prescribing	N/A	1801924667	0	0	ROLDAN, MARCELA LCSW	8/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109160	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
347504	Ordering, Referring, Prescribing	N/A	1801918388	0	0	RISCHALL-GUTHRIE, JOANNE D	2/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0326876	N/A	N/A	N/A	N/A	N/A	11722 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
347516	Ordering, Referring, Prescribing	N/A	1801941802	0	0	RICH, LESLIE A LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101076	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
347521	Ordering, Referring, Prescribing	N/A	1801956784	0	0	RAPPAPORT, MARC LMFT	8/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44839	N/A	N/A	N/A	N/A	N/A	2600 S EL CAMINO REAL	SUITE 300	SAN MATEO	CA	94403	1809	00	06000	37.54393248	-122.3052118	San Mateo County
347550	Ordering, Referring, Prescribing	N/A	1811028434	0	0	RANDALL, MANDI M LMFT	12/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47136	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
347551	Ordering, Referring, Prescribing	N/A	1811016579	0	0	ROLAND, CATHERINE M	2/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007939	N/A	N/A	N/A	N/A	N/A	79440 CORPORATE CENTRE D	None	LAQUINTA	CA	92253	0000	00	06000	33.70937862	-116.2788139	Riverside County
347557	Ordering, Referring, Prescribing	N/A	1811044407	0	0	ROTHBERG, JILL E MD	5/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69666	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
347571	Ordering, Referring, Prescribing	N/A	1811064793	0	0	ROWE, SILVIA LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS19452	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	2ND FLOOR	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
347574	Ordering, Referring, Prescribing	N/A	1811066210	0	0	RESA, RAMON MD	10/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40400	N/A	N/A	N/A	N/A	N/A	569 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	00	06000	36.06957307	-119.0296992	Tulare County
347581	Ordering, Referring, Prescribing	N/A	1811078660	0	0	RICHARDSON, JANICE M LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17467	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
347590	Ordering, Referring, Prescribing	N/A	1811121650	0	0	ROBERTS, KISA LPCC	6/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6430	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	None	EL CAJON	CA	92021	7417	00	06000	32.80772549	-116.94771	San Diego County
347593	Ordering, Referring, Prescribing	N/A	1811109986	0	0	RUDOLPH, ANDREA C NP	4/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	528463	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	MIDTOWN	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
347607	Ordering, Referring, Prescribing	N/A	1811172067	0	0	ROJAS, PABLO G PA-C	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	19380	N/A	N/A	N/A	N/A	N/A	2030 VIBORG ROAD	SUITE 205	SOLVANG	CA	93463	3226	00	06000	34.60247248	-120.1271535	Santa Barbara County
347649	Ordering, Referring, Prescribing	N/A	1811246838	0	0	RUGG, CANDICE M NP	11/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007494	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
347656	Ordering, Referring, Prescribing	N/A	1811252968	0	0	REGHUNATHAN, SARANYA MD	4/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162142	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
347695	Ordering, Referring, Prescribing	N/A	1811316706	0	0	ROBINSON, COLLEEN M PA-C	9/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61677	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
347699	Ordering, Referring, Prescribing	N/A	1811324130	0	0	RICH, JEFFREY A LCSW	5/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101697	N/A	N/A	N/A	N/A	N/A	169 ANDERSON PL	UPPER FRONT UNIT	BUFFALO	NY	14222	1803	00	06000	42.912027	-78.8756175	Erie County
347714	Ordering, Referring, Prescribing	N/A	1811360571	0	0	RIVERO, KRISTA S CNM	10/11/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235749	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
347738	Ordering, Referring, Prescribing	N/A	1811382963	0	0	ROHLFING, GEOFFREY DO	5/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15259	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
347764	Ordering, Referring, Prescribing	N/A	1811415185	0	0	REICH, JENAE M LMFT	1/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124151	N/A	N/A	N/A	N/A	N/A	2218 N 1ST ST	None	SAN JOSE	CA	95131	2007	00	06000	37.37769052	-121.9213491	Santa Clara County
347792	Ordering, Referring, Prescribing	N/A	1811459043	0	0	REZAC, KARI DO	8/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21020	N/A	N/A	N/A	N/A	N/A	10710 DONNER PASS RD	None	TRUCKEE	CA	96161	4884	00	06000	39.32660448	-120.1966779	Nevada County
347795	Ordering, Referring, Prescribing	N/A	1811457625	0	0	RODRIGUEZ-AMENERO, KEVIN MD	5/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196008	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	0001	00	06000	34.95019447	-120.4147816	Santa Barbara County
347812	Ordering, Referring, Prescribing	N/A	1811486467	0	0	RIVERA, MARIA G LMFT	11/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143204	N/A	N/A	N/A	N/A	N/A	3336 BRADSHAW ROAD	SUITE 215	SACRAMENTO	CA	95827	2624	00	06000	38.562597	-121.33692	Sacramento County
347814	Ordering, Referring, Prescribing	N/A	1811486301	0	0	ROSALES, AURORA CNP	9/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009028	N/A	N/A	N/A	N/A	N/A	190 S OAK AVE	BLDG. 2/STE 1	OAKDALE	CA	95361	3528	00	06000	37.75958945	-120.8613916	Stanislaus County
347863	Ordering, Referring, Prescribing	N/A	1811605967	0	0	RYLAND, THANYA NP	11/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023279	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
347867	Ordering, Referring, Prescribing	N/A	1811616634	0	0	RIVERA, ROSA M MSW LCSW	3/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22346	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
347878	Ordering, Referring, Prescribing	N/A	1811658040	0	0	REYES, DITAS JOY NP	8/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016729	N/A	N/A	N/A	N/A	N/A	335 E AVENUE K6	None	LANCASTER	CA	93535	4645	00	06000	34.6694985	-118.125468	Los Angeles County
347914	Ordering, Referring, Prescribing	N/A	1811970437	0	0	ROBERTSON, SCOTT MD	10/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81709	N/A	N/A	N/A	N/A	N/A	1304 ELLA ST	STEA	SAN LUIS OBISPO	CA	93401	4100	00	06000	35.27704692	-120.6496857	San Luis Obispo County
347946	Ordering, Referring, Prescribing	N/A	1821113770	0	0	RAVEN, KRISTA H LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49705	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
348012	Ordering, Referring, Prescribing	N/A	1821244153	0	0	RODRIGUEZ, GUADALUPE C LMFT	1/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88927	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	F	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
348019	Ordering, Referring, Prescribing	N/A	1821250481	0	0	REED, EBONIE LMFT	1/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81228	N/A	N/A	N/A	N/A	N/A	4892 SAN PABLO DAM RD	None	EL SOBRANTE	CA	94803	3222	00	06000	37.96337568	-122.2929195	Contra Costa County
348035	Ordering, Referring, Prescribing	N/A	1821291030	0	0	ROMANDO, MARYJOE DO	5/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11309	N/A	N/A	N/A	N/A	N/A	771 W BLAINE ST	SUITE D	RIVERSIDE	CA	92507	3940	00	06000	33.98300646	-117.327555	Riverside County
348041	Ordering, Referring, Prescribing	N/A	1821300500	0	0	RANGEL, RENE PA-C	7/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA21016	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
348093	Ordering, Referring, Prescribing	N/A	1821398975	0	0	RODRIGUEZ, GREGORIO PHARMD	12/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59968	N/A	N/A	N/A	N/A	N/A	1758 WEST GRAND AVE.	None	GROVER BEACH	CA	93433	0000	00	06000	35.12097722	-120.6101914	San Luis Obispo County
348100	Ordering, Referring, Prescribing	N/A	1821407248	0	0	RATELLE, KIMBERLY J	1/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013661	N/A	N/A	N/A	N/A	N/A	316 N. MAIN STREET	None	SALINAS	CA	93901	0000	00	06000	36.682749	-121.6533777	Monterey County
348107	Ordering, Referring, Prescribing	N/A	1821420530	0	0	ROTHBARD, ISABELLE L LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77229	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
348109	Ordering, Referring, Prescribing	N/A	1821421264	0	0	RUIZ, DEBRA	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104549	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE, STE	None	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
348153	Ordering, Referring, Prescribing	N/A	1821485947	0	0	RAMOS, ROSA Z LMFT	3/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124838	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
348184	Ordering, Referring, Prescribing	N/A	1821529793	0	0	ROSENTHAL, RACHEL L MD	8/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158634	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
348195	Ordering, Referring, Prescribing	N/A	1821544420	0	0	RIVERA, ANASTASIA LCSW	12/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100832	N/A	N/A	N/A	N/A	N/A	1701 STINE RD	None	BAKERSFIELD	CA	93309	4827	00	06000	35.33828383	-119.0513543	Kern County
348205	Ordering, Referring, Prescribing	N/A	1821545807	0	0	RUVALCABA, VANESSA LMFT	7/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120229	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
348210	Ordering, Referring, Prescribing	N/A	1821572249	0	0	RIVERA, JORDAN C MD MPH	2/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166171	N/A	N/A	N/A	N/A	N/A	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	00	06000	34.05373818	-118.3839685	Los Angeles County
348223	Ordering, Referring, Prescribing	N/A	1821591686	0	0	ROGOL, ALISSA M MD	8/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164131	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
348253	Ordering, Referring, Prescribing	N/A	1821659954	0	0	RONEY, ALAN L LPCC	1/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13136	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
348267	Ordering, Referring, Prescribing	N/A	1821676529	0	0	RIDAURA, TANYA LPCC	8/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14445	N/A	N/A	N/A	N/A	N/A	510 W MAIN ST	104	EL CENTRO	CA	92243	2900	00	06000	32.79286045	-115.555059	Imperial County
348287	Ordering, Referring, Prescribing	N/A	1821736141	0	0	ROBERTSON, BIANCA M MD	1/27/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200861	N/A	N/A	N/A	N/A	N/A	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
348344	Ordering, Referring, Prescribing	N/A	1831229624	0	0	ROSEN, ANDREA C PSYD	11/10/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28356	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DRIVE	None	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
348353	Ordering, Referring, Prescribing	N/A	1831249572	0	0	ROMAN, CARMEN MD	11/21/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35997	N/A	N/A	N/A	N/A	N/A	999 BAKER WAY	420	SAN MATEO	CA	94404	1582	00	06000	37.56022167	-122.286255	San Mateo County
348367	Ordering, Referring, Prescribing	N/A	1831286426	0	0	RAESE, JOACHIM MD	6/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33990	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
348375	Ordering, Referring, Prescribing	N/A	1831315498	0	0	RATHBURN, CARRIE K	12/5/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA18041	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	SUITE 201	CHULA VISTA	CA	91911	2976	00	06000	32.60364599	-117.0786521	San Diego County
348390	Ordering, Referring, Prescribing	N/A	1831349893	0	0	RUBIO, MARY SUZETTE LMFT	8/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52558	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
348400	Ordering, Referring, Prescribing	N/A	1831363035	0	0	RAMIREZ-PLAGEMAN, GINA LMFT	9/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125838	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
348405	Ordering, Referring, Prescribing	N/A	1831387679	0	0	RECHTSTEINER, SHERREE C	5/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	2099124405	N/A	N/A	N/A	N/A	N/A	410 N 100 E	None	KOOSHAREM	UT	84744	7700	00	06000	38.51295462	-111.8791899	Sevier County
348426	Ordering, Referring, Prescribing	N/A	1831435551	0	0	ROWLAND, SCOTT A LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102231	N/A	N/A	N/A	N/A	N/A	1505 EDGEMONT ST	None	LOS ANGELES	CA	90027	0027	00	06000	34.098408	-118.296167	Los Angeles County
348454	Ordering, Referring, Prescribing	N/A	1831487669	0	0	REYNA, YALITTZA LCSW	4/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105220	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
348459	Ordering, Referring, Prescribing	N/A	1831484674	0	0	RIVERA, TERESA LCSW	11/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77388	N/A	N/A	N/A	N/A	N/A	222 S. HILL ST.	600	LOS ANGELES	CA	90012	3523	00	06000	34.0525918	-118.2482081	Los Angeles County
348485	Ordering, Referring, Prescribing	N/A	1831530682	0	0	ROMESHA, ALISHA MSW LCSW	1/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74657	N/A	N/A	N/A	N/A	N/A	139 HENDERSON ST	None	ALTURAS	CA	96101	3921	00	06000	41.4808158	-120.5438775	Modoc County
348497	Ordering, Referring, Prescribing	N/A	1831553486	0	0	RODRIGUEZ, BIANCA LCSW	2/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113822	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
348498	Ordering, Referring, Prescribing	N/A	1831555721	0	0	ROWTHER, ARMAAN A MD	12/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL13513	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST BLDG N2	#498	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
348532	Ordering, Referring, Prescribing	N/A	1831594597	0	0	ROMERO, KRISTINA NP	11/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001329	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST.	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
348559	Ordering, Referring, Prescribing	N/A	1831639707	0	0	RAVANDOUST, KAVIAN M LMFT	9/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120969	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
348568	Ordering, Referring, Prescribing	N/A	1831646637	0	0	RAMIREZ, DANIEL Y	6/22/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	100777	N/A	N/A	N/A	N/A	N/A	3 SIXTH ST	910	POINT REYES STAT	CA	94956	0910	00	06000	38.06926923	-122.8086302	Marin County
348570	Ordering, Referring, Prescribing	N/A	1831657899	0	0	RAMIREZ, MARTIN LMFT	2/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137618	N/A	N/A	N/A	N/A	N/A	3840 ROSIN CT	100	SACRAMENTO	CA	95834	1639	00	06000	38.637567	-121.473306	Sacramento County
348586	Ordering, Referring, Prescribing	N/A	1831671676	0	0	RAMIREZ, ROCIO M LMFT	4/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124441	N/A	N/A	N/A	N/A	N/A	3117 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217251	-119.0385045	Kern County
348609	Ordering, Referring, Prescribing	N/A	1831702109	0	0	REVELO HERRERA, LUIS F LCSW	8/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125542	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
348623	Ordering, Referring, Prescribing	N/A	1831725332	0	0	ROBINSON, KATHERINE LMFT	9/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131291	N/A	N/A	N/A	N/A	N/A	3015 HUBBARD LN	SUITE 7	EUREKA	CA	95501	4802	00	06000	40.78115351	-124.1302893	Humboldt County
348671	Ordering, Referring, Prescribing	N/A	1831833193	0	0	RHAMES, ALLISON L LMFT	4/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132137	N/A	N/A	N/A	N/A	N/A	16255 VENTURA BLVD SUITE	None	ENCINO	CA	91436	2310	00	06000	34.15693902	-118.4876816	Los Angeles County
348678	Ordering, Referring, Prescribing	N/A	1831868546	0	0	RATHAUR, NEHA	5/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147102	N/A	N/A	N/A	N/A	N/A	740 FRONT ST	SUITE 370	SANTA CRUZ	CA	95060	4535	00	06000	36.97547419	-122.0254852	Santa Cruz County
348687	Ordering, Referring, Prescribing	N/A	1831905199	0	0	RAMIREZ-IBARRA, ALICIA PA-C	10/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65251	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
348688	Ordering, Referring, Prescribing	N/A	1831916857	0	0	ROBINSON, BRITTANY NP	12/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95033246	N/A	N/A	N/A	N/A	N/A	1120 WEST AVE M4	None	PALMDALE	CA	93551	1432	00	06000	34.64264888	-118.1509125	Los Angeles County
348694	Ordering, Referring, Prescribing	N/A	1831938596	0	0	ROODBAR, GRACE LCSW	7/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113403	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
348696	Ordering, Referring, Prescribing	N/A	1831939883	0	0	ROMO, ROXANNA M LMFT	4/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146627	N/A	N/A	N/A	N/A	N/A	1845 N FAIR OAKS AVE	STE. G-151	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
348707	Ordering, Referring, Prescribing	N/A	1841054400	0	0	ROOTS, EMMA R NP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029063	N/A	N/A	N/A	N/A	N/A	305 PRESTON AVE	None	IONE	CA	95640	9158	00	06000	38.35319813	-120.93512	Amador County
348730	Ordering, Referring, Prescribing	N/A	1841258886	0	0	ROMERO, JAIRO	11/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	G56983	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE.	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
348748	Ordering, Referring, Prescribing	N/A	1841312071	0	0	ROBBINS, TIFFANY L LMFT	2/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50768	N/A	N/A	N/A	N/A	N/A	2828 FORD ST.	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
348752	Ordering, Referring, Prescribing	N/A	1841327715	0	0	ROBINSON, JACQUELYN Y LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104762	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
348773	Ordering, Referring, Prescribing	N/A	1841374147	0	0	ROMERO, EDWARD T LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW14174	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
348794	Ordering, Referring, Prescribing	N/A	1841406840	0	0	REED, KRIS A PHD	6/6/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16355	N/A	N/A	N/A	N/A	N/A	8776 ARCHIBALD AVE	None	RANCHO CUCAMONGA	CA	91730	4634	00	06000	34.094223	-117.593508	San Bernardino County
348796	Ordering, Referring, Prescribing	N/A	1841407723	0	0	RAMANUJAM, ABHIJIT V MD	12/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110934	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
348800	Ordering, Referring, Prescribing	N/A	1841411931	0	0	ROBINSON, RICHARD J PA	7/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14075	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
348857	Ordering, Referring, Prescribing	N/A	1841532413	0	0	REEVES, VERA L NP	6/1/2015	Taxonomy not applicable	NA	n/a	000	Unknown	561031	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
348865	Ordering, Referring, Prescribing	N/A	1841527744	0	0	RHEINWALD-JONES, ALEXIS NP	9/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19339	N/A	N/A	N/A	N/A	N/A	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90260	3562	00	06000	33.833988	-118.0282915	Orange County
348868	Ordering, Referring, Prescribing	N/A	1841547197	0	0	RAMIREZ, GILBERT LMFT	9/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109804	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
348872	Ordering, Referring, Prescribing	N/A	1841544970	0	0	RAMIREZ, STEPHANNIE LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75194	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
348884	Ordering, Referring, Prescribing	N/A	1841556818	0	0	RAHIMI, KAVOSH MD	2/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135098	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	SUITE 100	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
348893	Ordering, Referring, Prescribing	N/A	1841572682	0	0	RADOMSKI, REBEKAH E LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103593	N/A	N/A	N/A	N/A	N/A	5 MAREBLU	None	ALISO VIEJO	CA	92656	3014	00	06000	33.57250566	-117.7027366	Orange County
348897	Ordering, Referring, Prescribing	N/A	1841571205	0	0	RODRIGUEZ GARCIA, GRACIELA MSW LCSW	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76462	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	A	NAPA	CA	94559	6216	00	06000	38.24829023	-122.2745626	Napa County
348913	Ordering, Referring, Prescribing	N/A	1841599487	0	0	ROCHA, MARICRUZ G LCSW	6/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70250	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
348927	Ordering, Referring, Prescribing	N/A	1841622305	0	0	RIVERA, MAIZAL NP	2/24/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028400	N/A	N/A	N/A	N/A	N/A	498 MAIN ST	None	TULELAKE	CA	96134	9411	00	06000	41.95501066	-121.4767132	Siskiyou County
348967	Ordering, Referring, Prescribing	N/A	1841687316	0	0	REED, SABRINA MD	12/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155405	N/A	N/A	N/A	N/A	N/A	905 E. 8TH ST.	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
348982	Ordering, Referring, Prescribing	N/A	1841712379	0	0	RABIEE, SOPHIA NP	12/31/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009970	N/A	N/A	N/A	N/A	N/A	200 PINE AVENUE	STE 400	LONG BEACH	CA	90802	3039	00	06000	33.76962	-118.1923435	Los Angeles County
348985	Ordering, Referring, Prescribing	N/A	1841714136	0	0	RASMUSSEN, SARAH B NP	2/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007053	N/A	N/A	N/A	N/A	N/A	518 GARDEN ST	None	SANTA BARBARA	CA	93101	0000	00	06000	34.42054634	-119.6928135	Santa Barbara County
349008	Ordering, Referring, Prescribing	N/A	1841748613	0	0	ROBINSON, LEANNA LMFT	6/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116975	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
349054	Ordering, Referring, Prescribing	N/A	1841823978	0	0	RUDA, AGA M LCSW	12/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88292	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO COVE	400	OAKLAND	CA	94606	4000	00	06000	37.78179304	-122.2428136	Alameda County
349075	Ordering, Referring, Prescribing	N/A	1841864972	0	0	READ, RILEY P PA	7/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62846	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
349084	Ordering, Referring, Prescribing	N/A	1841899770	0	0	RODRIGUEZ, MAYRA LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93132	N/A	N/A	N/A	N/A	N/A	1530 E MANNING AVE	None	REEDLEY	CA	93654	2346	00	06000	36.60413846	-119.4316515	Fresno County
349102	Ordering, Referring, Prescribing	N/A	1841957800	0	0	RUZIC, SOPHIE PSYD	11/18/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33815	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
349116	Ordering, Referring, Prescribing	N/A	1851006415	0	0	RIVERA, MARIA E CNP	10/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022987	N/A	N/A	N/A	N/A	N/A	400 W. PUEBLO	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
349158	Ordering, Referring, Prescribing	N/A	1851320675	0	0	RAJ, RASHPAL S PA-C	1/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	16409	N/A	N/A	N/A	N/A	N/A	284 SPRUCE ST.	None	GRIDLEY	CA	95948	2216	00	06000	39.36699345	-121.6910745	Butte County
349164	Ordering, Referring, Prescribing	N/A	1851347439	0	0	ROSLING, TINA NP	9/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6860	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
349200	Ordering, Referring, Prescribing	N/A	1851452155	0	0	RAMIREZ, OFELIA LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117252	N/A	N/A	N/A	N/A	N/A	1545 WEBSTER ST. SUITE A	None	FAIRFIELD	CA	94533	4917	00	06000	38.25753941	-122.0475412	Solano County
349226	Ordering, Referring, Prescribing	N/A	1851494975	0	0	REYES, MARCO A	10/31/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D51515	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
349260	Ordering, Referring, Prescribing	N/A	1851586499	0	0	ROGERS, JOHN R LCSW	8/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103348	N/A	N/A	N/A	N/A	N/A	19401 S. VERMONT AVE.	L102	TORRANCE	CA	90502	4459	00	06000	33.85486409	-118.2905603	Los Angeles County
349261	Ordering, Referring, Prescribing	N/A	1851588438	0	0	RODRIGUEZ, RUBICELA LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28739	N/A	N/A	N/A	N/A	N/A	15339 SATICOY ST	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
349277	Ordering, Referring, Prescribing	N/A	1851610356	0	0	ROSE, KIMBERLY J PA	9/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	1795	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
349342	Ordering, Referring, Prescribing	N/A	1851711204	0	0	RANGEL, HEATHER N LCSW	10/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28596	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
349360	Ordering, Referring, Prescribing	N/A	1851735401	0	0	ROMERO, ANGELA LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77056	N/A	N/A	N/A	N/A	N/A	524 W VISTA WAY	None	VISTA	CA	92083	5704	00	06000	33.19635191	-117.2517899	San Diego County
349389	Ordering, Referring, Prescribing	N/A	1851774749	0	0	RODRIGUEZ, WHITNEY L LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114737	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
349391	Ordering, Referring, Prescribing	N/A	1851775290	0	0	REEVES, KATHERINE W NP	6/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005035	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
349396	Ordering, Referring, Prescribing	N/A	1851780845	0	0	RODRIGUEZ, ADRIAN LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102813	N/A	N/A	N/A	N/A	N/A	39959 SIERRA HWY	150	PALMDALE	CA	93552	0000	00	06000	34.60850218	-118.1223966	Los Angeles County
349405	Ordering, Referring, Prescribing	N/A	1851797328	0	0	ROBINSON HERASME, MAYRA MD	6/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169015	N/A	N/A	N/A	N/A	N/A	900 MAIN ST	None	BRAWLEY	CA	92227	2737	00	06000	32.9785797	-115.5285802	Imperial County
349430	Ordering, Referring, Prescribing	N/A	1851833412	0	0	RAHIMI, NARWON	12/21/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT16852	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
349450	Ordering, Referring, Prescribing	N/A	1851868202	0	0	ROCKLAGE, MATTHEW W NP	8/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015165	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
349451	Ordering, Referring, Prescribing	N/A	1851867188	0	0	RECTOR, MICHAEL B LMFT	7/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126139	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
349480	Ordering, Referring, Prescribing	N/A	1851915250	0	0	REDDY, KEERTHI MD	12/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185994	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
349488	Ordering, Referring, Prescribing	N/A	1851935977	0	0	RODRIGUEZ, DENISSE NP	4/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012176	N/A	N/A	N/A	N/A	N/A	1873 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3303	00	06000	34.067781	-117.286122	San Bernardino County
349532	Ordering, Referring, Prescribing	N/A	1861038374	0	0	RAMIREZ, KARINA E LMFT	6/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147251	N/A	N/A	N/A	N/A	N/A	4900 SERRANIA AVE	None	WOODLAND HILLS	CA	91364	3301	00	06000	34.15843077	-118.5882436	Los Angeles County
349539	Ordering, Referring, Prescribing	N/A	1861045452	0	0	RING, JULIE A OD	7/22/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34277	N/A	N/A	N/A	N/A	N/A	1201 LARKSPUR LANDING CI	D	LARKSPUR	CA	94939	1807	00	06000	37.94780551	-122.5106436	Marin County
349549	Ordering, Referring, Prescribing	N/A	1861079295	0	0	RANA CUSTODIO, ALEJANDRO MD	6/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196911	N/A	N/A	N/A	N/A	N/A	8426 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3436	00	06000	34.22405394	-118.3655745	Los Angeles County
349572	Ordering, Referring, Prescribing	N/A	1861160640	0	0	RHEE, SEH JIN PHARMD	4/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74865	N/A	N/A	N/A	N/A	N/A	15932 DALMATIAN AVE	None	LA MIRADA	CA	90638	5718	00	06000	33.886962	-118.008711	Los Angeles County
349575	Ordering, Referring, Prescribing	N/A	1861168239	0	0	RUIZ, LIZETTE LMFT	7/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148346	N/A	N/A	N/A	N/A	N/A	1206 E 17TH STREET	SUITE 101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
349584	Ordering, Referring, Prescribing	N/A	1861234197	0	0	RUIZ, BRENDA D PA-C	12/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65560	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	None	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
349627	Ordering, Referring, Prescribing	N/A	1861544934	0	0	ROPER, BRIAN D CCC-SLP	11/30/2019	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP18963	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
349629	Ordering, Referring, Prescribing	N/A	1861545170	0	0	RAJABIAN, REZA DDS	10/10/2007	Taxonomy not applicable	NA	n/a	099	DENTIST	D56326	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DRIVE	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
349648	Ordering, Referring, Prescribing	N/A	1861577819	0	0	RODRIGUEZ, ADRIAN LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60626	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	600	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
349668	Ordering, Referring, Prescribing	N/A	1861641722	0	0	REYNA, ALONDRA LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27897	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
349695	Ordering, Referring, Prescribing	N/A	1861709768	0	0	ROBERTS, KATHERINE A LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83481	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
349713	Ordering, Referring, Prescribing	N/A	1861740102	0	0	RUSSELL, JAMES LMFT	9/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98174	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
349733	Ordering, Referring, Prescribing	N/A	1861774192	0	0	RASHID, LANITA B MD	3/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C154647	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
349758	Ordering, Referring, Prescribing	N/A	1861805848	0	0	ROBERTS-KELLY, JENNIFER DO	10/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14326	N/A	N/A	N/A	N/A	N/A	1102 E CLARK AVE	STE 120A	SANTA MARIA	CA	93455	5175	00	06000	34.86499805	-120.4185338	Santa Barbara County
349822	Ordering, Referring, Prescribing	N/A	1861911448	0	0	ROWLES, LAWANDA LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99284	N/A	N/A	N/A	N/A	N/A	10230 ARTESIA BLVD	310	BELLFLOWER	CA	90706	6763	00	06000	33.8728276	-118.1160403	Los Angeles County
349832	Ordering, Referring, Prescribing	N/A	1861921926	0	0	RIEGER, CHRISTINE NP	3/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004704	N/A	N/A	N/A	N/A	N/A	125 W MISSION AVE	None	ESCONDIDO	CA	92025	1720	00	06000	33.12998866	-117.0864074	San Diego County
349837	Ordering, Referring, Prescribing	N/A	1861926305	0	0	RONCO, ANTHONY	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159826	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2307	00	06000	38.555181	-121.4566785	Sacramento County
349838	Ordering, Referring, Prescribing	N/A	1861928921	0	0	REDDY, LAYA MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163652	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349840	Ordering, Referring, Prescribing	N/A	1861933095	0	0	ROBBINS, TERESA	10/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157792	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
349857	Ordering, Referring, Prescribing	N/A	1861951998	0	0	RAGHAVAN, GOVIND MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	319	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
349871	Ordering, Referring, Prescribing	N/A	1861975146	0	0	RUBIO, ANNE LMFT	5/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125924	N/A	N/A	N/A	N/A	N/A	1002 E GRAND AVE	None	ESCONDIDO	CA	92025	4605	00	06000	33.12639838	-117.0682191	San Diego County
349891	Ordering, Referring, Prescribing	N/A	1871010413	0	0	RICO, ERICA M LMFT	2/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124615	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37353416	-119.0392409	Kern County
349893	Ordering, Referring, Prescribing	N/A	1871016147	0	0	RUIZ LORA, ISRAEL E LCSW	10/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104664	N/A	N/A	N/A	N/A	N/A	101 JOSE FIGUERES AVE	50	SAN JOSE	CA	95116	2068	00	06000	37.35869865	-121.8481586	Santa Clara County
349934	Ordering, Referring, Prescribing	N/A	1871059964	0	0	RA, HANNAH PA-C	6/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57899	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
349965	Ordering, Referring, Prescribing	N/A	1871099523	0	0	REYNA, ELISSE LCSW	3/28/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82176	N/A	N/A	N/A	N/A	N/A	2680 S WHITE RD	SUITE 260	SAN JOSE	CA	95148	2074	00	06000	37.32946528	-121.7984732	Santa Clara County
349982	Ordering, Referring, Prescribing	N/A	1871148890	0	0	RODRIGUEZ, GABRIELLA A LMFT	9/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141633	N/A	N/A	N/A	N/A	N/A	49211 GRAPEFRUIT BLVD.	6	COACHELLA	CA	92263	1489	00	06000	33.69171437	-116.184351	Riverside County
350014	Ordering, Referring, Prescribing	N/A	1871218685	0	0	RANDHAWA, RAMANDEEP NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022599	N/A	N/A	N/A	N/A	N/A	1040 N MAIN ST	None	MANTECA	CA	95336	3745	00	06000	37.81164418	-121.216958	San Joaquin County
350036	Ordering, Referring, Prescribing	N/A	1871317883	0	0	RUIZ, HASON OSCAR DDS	11/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	111032	N/A	N/A	N/A	N/A	N/A	2379 N OXNARD BLVD	None	OXNARD	CA	93036	2000	00	06000	34.22731336	-119.1778098	Ventura County
350038	Ordering, Referring, Prescribing	N/A	1871331017	0	0	RUMINSON, JULIE M RDH	7/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	17290	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0391	00	06000	39.03521526	-120.9755343	Placer County
350042	Ordering, Referring, Prescribing	N/A	1871303438	0	0	RANGEL, AILEEN J PA-C	3/6/2025	Taxonomy not applicable	NA	n/a	000	Unknown	66105	N/A	N/A	N/A	N/A	N/A	1414 S GRAND AVE	STE 380	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
350064	Ordering, Referring, Prescribing	N/A	1871559898	0	0	RAHMAN, SURAIYA S MD	9/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54271	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
350083	Ordering, Referring, Prescribing	N/A	1871622878	0	0	RIGSBY, DIANE M LMFT	11/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	33611	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
350092	Ordering, Referring, Prescribing	N/A	1871630475	0	0	ROTH-FELTER, CYNTHIA S LCSW	5/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22962	N/A	N/A	N/A	N/A	N/A	1330 W RAMSEY ST	None	BANNING	CA	92220	4477	00	06000	33.92538854	-116.8912035	Riverside County
350094	Ordering, Referring, Prescribing	N/A	1871633370	0	0	RUDOLPH, HERBERT MD	11/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G191734	N/A	N/A	N/A	N/A	N/A	2800 RIVERSIDE AVE	None	PASO ROBLES	CA	93446	1311	00	06000	35.64351546	-120.6888699	San Luis Obispo County
350097	Ordering, Referring, Prescribing	N/A	1871634014	0	0	ROWE, FREDERIC L II MD	1/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G65546	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
350121	Ordering, Referring, Prescribing	N/A	1871688796	0	0	REABROI, MARIA L PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49813	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
350131	Ordering, Referring, Prescribing	N/A	1871720987	0	0	REZNIK, ALENA MD	8/26/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113775	N/A	N/A	N/A	N/A	N/A	1300 VERMONT AVE	SUITE 101	LOS ANGELES	CA	90027	0000	00	06000	34.0956033	-118.2916918	Los Angeles County
350138	Ordering, Referring, Prescribing	N/A	1871731513	0	0	REDOBLADO, SHERYL S LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75136	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
350140	Ordering, Referring, Prescribing	N/A	1871698357	0	0	RAO, SHEELA MD	3/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92501	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD MAIL	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
350187	Ordering, Referring, Prescribing	N/A	1871825042	0	0	REIS, LISA G	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47853	N/A	N/A	N/A	N/A	N/A	988 SIERRA ST	None	KINGSBURG	CA	93631	1554	00	06000	36.51781851	-119.5567515	Fresno County
350196	Ordering, Referring, Prescribing	N/A	1871837120	0	0	RENTERIA, HORACIO LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87788	N/A	N/A	N/A	N/A	N/A	740 G ST	STE G	REEDLEY	CA	93654	2634	00	06000	36.60007621	-119.4547214	Fresno County
350210	Ordering, Referring, Prescribing	N/A	1871856575	0	0	RESPICIO, FRANCES G LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14929	N/A	N/A	N/A	N/A	N/A	455 O'CONNOR DRIVE	SUITE 200	SAN JOSE	CA	95128	1632	00	06000	37.326654	-121.939897	Santa Clara County
350281	Ordering, Referring, Prescribing	N/A	1871948760	0	0	RECINOS, JEISON D MD	9/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156178	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
350284	Ordering, Referring, Prescribing	N/A	1871963090	0	0	RUMINSON, JONATHAN W	2/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D65113	N/A	N/A	N/A	N/A	N/A	20601 W PAOLI LANE	# 486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
350302	Ordering, Referring, Prescribing	N/A	1871981076	0	0	RIVERA, RUTH K CNP	12/15/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007165	N/A	N/A	N/A	N/A	N/A	1846 N. BROADWAY	SUITE A	SANTA MARIA	CA	93454	1447	00	06000	34.97363636	-120.4355462	Santa Barbara County
350318	Ordering, Referring, Prescribing	N/A	1881011575	0	0	ROMERO, JANET LMFT	8/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113184	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	None	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
350328	Ordering, Referring, Prescribing	N/A	1881018414	0	0	RAMIREZ, ROBERT L PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45478	N/A	N/A	N/A	N/A	N/A	305 N BREED ST	None	LOS ANGELES	CA	90033	1801	00	06000	34.04750163	-118.208751	Los Angeles County
350339	Ordering, Referring, Prescribing	N/A	1881044873	0	0	RAINWATER, MATTHEW MD	12/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153321	N/A	N/A	N/A	N/A	N/A	6113 N FRESNO ST	SUITE 101	FRESNO	CA	93710	8621	00	06000	36.82539	-119.7814385	Fresno County
350346	Ordering, Referring, Prescribing	N/A	1881054138	0	0	RENSINK, KATHERINE M NP	6/3/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	847858	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVE	SUITE 301	SAN DIEGO	CA	92101	2033	00	06000	32.72646147	-117.1638767	San Diego County
350352	Ordering, Referring, Prescribing	N/A	1881059608	0	0	RIOUX, KIM A LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36952	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
350357	Ordering, Referring, Prescribing	N/A	1881061422	0	0	RHYMAN, DEVIN CNP	6/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002968	N/A	N/A	N/A	N/A	N/A	1827 S. COURT ST.	A	VISALIA	CA	93277	5469	00	06000	36.314424	-119.2922235	Tulare County
350370	Ordering, Referring, Prescribing	N/A	1881076396	0	0	REED, RUSSELL LCSW	3/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100786	N/A	N/A	N/A	N/A	N/A	4250 FOWLER LN	None	DIAMOND SPRINGS	CA	95619	9781	00	06000	38.69331583	-120.8130299	El Dorado County
350396	Ordering, Referring, Prescribing	N/A	1881110567	0	0	ROBLES, LUCILA NP	11/7/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007669	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVE	STE A	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
350418	Ordering, Referring, Prescribing	N/A	1881146264	0	0	RYU, KEVIN LCSW	7/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99299	N/A	N/A	N/A	N/A	N/A	8300 S. VERMONT AVE	1ST FLOOR	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
350426	Ordering, Referring, Prescribing	N/A	1881146819	0	0	REIISIEH, SASHA LPCC	3/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7730	N/A	N/A	N/A	N/A	N/A	777 N FIRST ST.	220	SAN JOSE	CA	95122	6350	00	06000	37.35064564	-121.9015633	Santa Clara County
350442	Ordering, Referring, Prescribing	N/A	1881182699	0	0	RAHMAN, NARGES PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74596	N/A	N/A	N/A	N/A	N/A	217 ALMA ST	200	PALO ALTO	CA	94301	0000	00	06000	37.44563438	-122.1673764	Santa Clara County
350457	Ordering, Referring, Prescribing	N/A	1881214203	0	0	RIZK, MARK A	10/28/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	DN25037	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
350492	Ordering, Referring, Prescribing	N/A	1881273159	0	0	ROBERTS, COURTNEY S MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181021	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW AVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
350509	Ordering, Referring, Prescribing	N/A	1881341352	0	0	ROSIN, DARRAH	6/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64687	N/A	N/A	N/A	N/A	N/A	7695 CARDINAL CT	STE 240	SAN DIEGO	CA	92123	3357	00	06000	32.79146985	-117.1578472	San Diego County
350551	Ordering, Referring, Prescribing	N/A	1881683928	0	0	RICO, PAMELA B NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	518955	N/A	N/A	N/A	N/A	N/A	49063 ROAD 426	STE C & D	OAKHURST	CA	93644	9487	00	06000	37.33186891	-119.6510247	Madera County
350562	Ordering, Referring, Prescribing	N/A	1881719433	0	0	RIVAS, CINDY E LCSW	5/5/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60628	N/A	N/A	N/A	N/A	N/A	1307 W 6TH STREET	SUITE 113	CORONA	CA	92882	1642	00	06000	33.87790309	-117.589666	Riverside County
350565	Ordering, Referring, Prescribing	N/A	1881721678	0	0	RAMANATHAN, ANITA S MD	4/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76096	N/A	N/A	N/A	N/A	N/A	1563 MISSION STREET	SUITE A	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
350586	Ordering, Referring, Prescribing	N/A	1881757342	0	0	RAJPUT, MUHAMMAD I MD	3/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92812	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
350590	Ordering, Referring, Prescribing	N/A	1881764223	0	0	RELIFORD, KARRI K PA	12/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	319	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
350625	Ordering, Referring, Prescribing	N/A	1881842169	0	0	RAI, POONAM P	7/7/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D57512	N/A	N/A	N/A	N/A	N/A	101 WEST COAST ROAD	# 769	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
350642	Ordering, Referring, Prescribing	N/A	1881889186	0	0	RYBURN, LINDSEY T	12/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61306	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
350648	Ordering, Referring, Prescribing	N/A	1881902146	0	0	ROE, PREEYA D LCSW	1/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29831	N/A	N/A	N/A	N/A	N/A	10850 GOLD CENTER DR	None	RANCHO CORDOVA	CA	95670	6045	00	06000	38.590353	-121.282488	Sacramento County
350652	Ordering, Referring, Prescribing	N/A	1881936656	0	0	ROSENBERG, JUDITH E LCSW	8/8/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW4551	N/A	N/A	N/A	N/A	N/A	919 THE ALAMEDA	None	BERKELEY	CA	94707	2301	00	06000	37.89099063	-122.2769728	Alameda County
350681	Ordering, Referring, Prescribing	N/A	1881970473	0	0	RIVERA, CHRISTINE M	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44894	N/A	N/A	N/A	N/A	N/A	435 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3363	00	06000	34.1360615	-117.871659	Los Angeles County
350682	Ordering, Referring, Prescribing	N/A	1881961811	0	0	RIVAS, ANGELICA M LCSW	4/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82244	N/A	N/A	N/A	N/A	N/A	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
350707	Ordering, Referring, Prescribing	N/A	1891003885	0	0	RAI, SONYA LCSW	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74299	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95992	1520	00	06000	39.15563037	-121.620091	Sutter County
350715	Ordering, Referring, Prescribing	N/A	1891029799	0	0	RAMOS, MONICA LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85640	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
350764	Ordering, Referring, Prescribing	N/A	1891102588	0	0	RODRIGUEZ, ANGEL B LCSW	6/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86635	N/A	N/A	N/A	N/A	N/A	20695 S. WESTERN AVENUE	None	TORRANCE	CA	90501	0000	00	06000	33.843258	-118.309386	Los Angeles County
350785	Ordering, Referring, Prescribing	N/A	1891140588	0	0	RAMIREZ, TANIA LPCC	7/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17030	N/A	N/A	N/A	N/A	N/A	7001 EAST PKWY	None	SACRAMENTO	CA	95823	2501	00	06000	38.497293	-121.4504235	Sacramento County
350789	Ordering, Referring, Prescribing	N/A	1891140125	0	0	ROGERS, NATHAN MD	4/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154130	N/A	N/A	N/A	N/A	N/A	9990 COUNTY FARM RD	None	RIVERSIDE	CA	92503	3542	00	06000	33.9201112	-117.4577963	Riverside County
350795	Ordering, Referring, Prescribing	N/A	1891155479	0	0	REYES, ADRIANA LMFT	2/1/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152962	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	C-2	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
350799	Ordering, Referring, Prescribing	N/A	1891162236	0	0	RAYA, OLGA A LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101196	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
350810	Ordering, Referring, Prescribing	N/A	1891171419	0	0	RIOS-KLEIN, CRISTINA MSW LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW15225	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST	None	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
350845	Ordering, Referring, Prescribing	N/A	1891226288	0	0	REYNOLDS, DESIREE L LCSW	3/21/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75066	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
350850	Ordering, Referring, Prescribing	N/A	1891242368	0	0	ROBLES, YOLANDA M LCSW	6/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97383	N/A	N/A	N/A	N/A	N/A	1300 17ST.	None	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
350863	Ordering, Referring, Prescribing	N/A	1891260105	0	0	ROTH, LAURIE A RN PHN	10/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	431493	N/A	N/A	N/A	N/A	N/A	331 SHAFTER AVE.	None	SHAFTER	CA	93263	2760	00	06000	35.50408126	-119.2783014	Kern County
350883	Ordering, Referring, Prescribing	N/A	1891309175	0	0	RIESER, LORI NP	8/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013502	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
350898	Ordering, Referring, Prescribing	N/A	1891320131	0	0	RAZAVI, PANTHEA LMFT	4/18/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146475	N/A	N/A	N/A	N/A	N/A	202 PROVIDENCE MINE RD S	STE 105	NEVADA CITY	CA	95959	2945	00	06000	39.25034906	-121.0306425	Nevada County
350908	Ordering, Referring, Prescribing	N/A	1891348777	0	0	RAMIREZ, CINDY LCSW	8/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107648	N/A	N/A	N/A	N/A	N/A	1801 S POPLAR ST	None	SANTA ANA	CA	92704	4321	00	06000	33.72358134	-117.8872543	Orange County
350973	Ordering, Referring, Prescribing	N/A	1891716494	0	0	ROJTER, SERGIO E MD	2/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63254	N/A	N/A	N/A	N/A	N/A	1245 WILSHIRE BLVD.	707	LOS ANGELES	CA	90017	4807	00	06000	34.05362775	-118.2661889	Los Angeles County
350979	Ordering, Referring, Prescribing	N/A	1891796686	0	0	ROSKAMP, DEBORAH A NP	3/7/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4825	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
350994	Ordering, Referring, Prescribing	N/A	1891821047	0	0	ROBERTSON, ELIZABETH A LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87227	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET, SU	None	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
351003	Ordering, Referring, Prescribing	N/A	1891826509	0	0	ROSAS, OSCAR V MD MPH	11/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66042	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
351026	Ordering, Referring, Prescribing	N/A	1891873378	0	0	ROYLE, KENNETH M MD	9/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43958	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
351030	Ordering, Referring, Prescribing	N/A	1891877387	0	0	RADAKOVIC, DIANA M CNP	6/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	529314	N/A	N/A	N/A	N/A	N/A	1551 E SHAW AVE	139	FRESNO	CA	93710	8024	00	06000	36.80828196	-119.7589292	Fresno County
351041	Ordering, Referring, Prescribing	N/A	1891899183	0	0	RANDALL, ROBIN R MD MPH	4/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54103	N/A	N/A	N/A	N/A	N/A	759 S.VAN NESS	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
351049	Ordering, Referring, Prescribing	N/A	1891946414	0	0	REYES, JENIFFER LCSW	4/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65041	N/A	N/A	N/A	N/A	N/A	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	00	06000	34.07140294	-118.0516061	Los Angeles County
351055	Ordering, Referring, Prescribing	N/A	1891952230	0	0	RODAS, JANICE A LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48643	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
351084	Ordering, Referring, Prescribing	N/A	1902006984	0	0	RAMIREZ-MOYA, LORERKY D MD	11/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133842	N/A	N/A	N/A	N/A	N/A	1420 ROCKY RIDGE DR	230	ROSEVILLE	CA	95661	2835	00	06000	38.75342679	-121.246502	Placer County
351103	Ordering, Referring, Prescribing	N/A	1902060908	0	0	REEVES, COLLEEN NP	7/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF17415	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
351136	Ordering, Referring, Prescribing	N/A	1902115496	0	0	REXROAT, KATHERINE M LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48998	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
351140	Ordering, Referring, Prescribing	N/A	1902130115	0	0	ROBINSON, GABRIEL LCSW	7/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70052	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	B	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
351142	Ordering, Referring, Prescribing	N/A	1902137292	0	0	RUAN, REFUGIO A LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86372	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD.	A	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
351149	Ordering, Referring, Prescribing	N/A	1902148075	0	0	ROMERO, ROWENA	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58850	N/A	N/A	N/A	N/A	N/A	404 SAND BEACH ROAD	None	ALAMEDA	CA	94501	5948	00	06000	37.76199686	-122.266552	Alameda County
351169	Ordering, Referring, Prescribing	N/A	1902170566	0	0	ROBLES, JASMINE LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90685	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
351215	Ordering, Referring, Prescribing	N/A	1902244809	0	0	RIZKALLA, MIRIAM S MD	5/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140575	N/A	N/A	N/A	N/A	N/A	4909 CENTENNIAL PLAZA WY	None	BAKERSFIELD	CA	93312	2011	00	06000	35.40410521	-119.0932287	Kern County
351264	Ordering, Referring, Prescribing	N/A	1902322894	0	0	RICE, ASHLEY M NP	2/9/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007874	N/A	N/A	N/A	N/A	N/A	2200 TYDD ST	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
351272	Ordering, Referring, Prescribing	N/A	1902332984	0	0	RAMIREZ, LESLIE M MD	12/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158629	N/A	N/A	N/A	N/A	N/A	1414 S. GRAND AVE	200	LOS ANGELES	CA	90015	3011	00	06000	34.03661142	-118.2657227	Los Angeles County
351281	Ordering, Referring, Prescribing	N/A	1902352495	0	0	RUSU, STACY J LMFT	4/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125690	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
351304	Ordering, Referring, Prescribing	N/A	1902409816	0	0	RITBLATT, NERIYAH S LMFT	6/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123105	N/A	N/A	N/A	N/A	N/A	7290 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1829	00	06000	32.76884635	-117.0406752	San Diego County
351313	Ordering, Referring, Prescribing	N/A	1902426703	0	0	RA, ESTHER DO	5/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	21073	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
351320	Ordering, Referring, Prescribing	N/A	1902453996	0	0	RUBINICH, MADOLYN CNM	8/30/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236386	N/A	N/A	N/A	N/A	N/A	71777 SAN JACINTO DR	202	RANCHO MIRAGE	CA	92270	3543	00	06000	33.74394755	-116.4124572	Riverside County
351332	Ordering, Referring, Prescribing	N/A	1902474471	0	0	ROBERTS, JUDITH C PSYD	11/8/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34665	N/A	N/A	N/A	N/A	N/A	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	00	06000	36.99191102	-122.0176744	Santa Cruz County
351411	Ordering, Referring, Prescribing	N/A	1902933468	0	0	RAMIREZ, JENNY Y LMFT	5/30/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52203	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
351416	Ordering, Referring, Prescribing	N/A	1902925019	0	0	RECHT, ANDREA R LCSW	11/22/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS17743	N/A	N/A	N/A	N/A	N/A	333 S. BEAUDRY	UNIT A	LOS ANGELES	CA	90017	2416	00	06000	34.05611213	-118.2570905	Los Angeles County
351420	Ordering, Referring, Prescribing	N/A	1902937204	0	0	REYES, LUISA A LMFT	11/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151632	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD.	201	PACOIMA	CA	91331	9998	00	06000	34.27814981	-118.4055414	Los Angeles County
351457	Ordering, Referring, Prescribing	N/A	1912028812	0	0	RICHARDSON, MATTHEW G DC	9/29/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC26478	N/A	N/A	N/A	N/A	N/A	1113 HWY 49	None	SAN ANDREAS	CA	95249	0000	00	06000	38.20809427	-120.6972437	Calaveras County
351462	Ordering, Referring, Prescribing	N/A	1912039124	0	0	RUELAS, GILDA G LMFT	2/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85166	N/A	N/A	N/A	N/A	N/A	265 S. ANITA DRIVE	STE. 102-104	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
351472	Ordering, Referring, Prescribing	N/A	1912042375	0	0	ROBERTS, TANYA MSW LCSW	11/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20414	N/A	N/A	N/A	N/A	N/A	404 W PINE ST #1	None	LODI	CA	95240	2048	00	06000	38.13437954	-121.2780387	San Joaquin County
351511	Ordering, Referring, Prescribing	N/A	1912134503	0	0	ROBINSON-PARKS, ASHA Z MD	11/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C165861	N/A	N/A	N/A	N/A	N/A	9224 EDWARDS WAY	APT 3106	HYATTSVILLE	MD	20783	3429	00	06000	39.006189	-76.9732875	Prince George's County
351520	Ordering, Referring, Prescribing	N/A	1912152042	0	0	RADICK, TRACEY E MSW LCSW	12/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26923	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
351522	Ordering, Referring, Prescribing	N/A	1912156662	0	0	ROCHELLE, LAUREN B LCSW	3/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64383	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
351533	Ordering, Referring, Prescribing	N/A	1912174442	0	0	RAMIREZ, MARTHA U LCSW	1/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28891	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
351568	Ordering, Referring, Prescribing	N/A	1912261611	0	0	RUSCH, SARAH MD	5/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137588	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	702	SAN FRANCISCO	CA	94110	4423	00	06000	37.74746923	-122.4202583	San Francisco County
351586	Ordering, Referring, Prescribing	N/A	1912284621	0	0	REEN, SANDEEP MD MPH	8/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116455	N/A	N/A	N/A	N/A	N/A	1586 W SAN MARCOS BLVD	None	SAN MARCOS	CA	92078	4019	00	06000	33.13146149	-117.203184	San Diego County
351617	Ordering, Referring, Prescribing	N/A	1912321472	0	0	RORRER, DARIN L LCSW	8/26/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71766	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
351649	Ordering, Referring, Prescribing	N/A	1912366485	0	0	REFSDAL, ELISSA LCSW	10/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97698	N/A	N/A	N/A	N/A	N/A	670 PLACERVILLE DR.	#2	PLACERVILLE	CA	95667	4200	00	06000	38.73161765	-120.8213885	El Dorado County
351651	Ordering, Referring, Prescribing	N/A	1912369208	0	0	RIVERA, MARISA E V MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151235	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
351677	Ordering, Referring, Prescribing	N/A	1912393091	0	0	RAJANI, VIVEK R	10/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170602	N/A	N/A	N/A	N/A	N/A	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	00	06000	37.698264	-122.090112	Alameda County
351692	Ordering, Referring, Prescribing	N/A	1912426701	0	0	RUVALCABA, BIANCA LMFT	10/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122544	N/A	N/A	N/A	N/A	N/A	101 SOUTH B STREET	None	LOMPOC	CA	93436	6933	00	06000	34.63860089	-120.4503641	Santa Barbara County
351721	Ordering, Referring, Prescribing	N/A	1912469032	0	0	RAMOS, JENNIFER MD	8/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A181645	N/A	N/A	N/A	N/A	N/A	9460 N NAME UNO	None	GILROY	CA	95020	3537	00	06000	37.037781	-121.570965	Santa Clara County
351727	Ordering, Referring, Prescribing	N/A	1912472747	0	0	RIVERA ORELLANA, HIMELDA PA-C	10/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56112	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST	101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
351741	Ordering, Referring, Prescribing	N/A	1912488073	0	0	ROBLES, KARINA I LCSW	8/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125191	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
351742	Ordering, Referring, Prescribing	N/A	1912497272	0	0	ROSE, JONATHAN P LMFT	11/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143160	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
351746	Ordering, Referring, Prescribing	N/A	1912498551	0	0	RITSON, CAROLINE R MD	4/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185376	N/A	N/A	N/A	N/A	N/A	1722 SOUTH LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
351779	Ordering, Referring, Prescribing	N/A	1912558297	0	0	REDDY, VISHNAVI P PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80806	N/A	N/A	N/A	N/A	N/A	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8680	00	06000	37.94947636	-121.7752571	Contra Costa County
351815	Ordering, Referring, Prescribing	N/A	1912676370	0	0	RUSSO, DANTHANH C	12/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87578	N/A	N/A	N/A	N/A	N/A	200 WILMOT RD	None	DEERFIELD	IL	60015	4620	00	06000	42.156882	-87.870654	Lake County
351845	Ordering, Referring, Prescribing	N/A	1922008556	0	0	ROSENBLATT, WENDI	2/7/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0362233	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
351868	Ordering, Referring, Prescribing	N/A	1922122050	0	0	REDDAM, MATTHEW J LMFT	5/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45681	N/A	N/A	N/A	N/A	N/A	1859 BIRD ST	None	OROVILLE	CA	95965	4854	00	06000	39.51259228	-121.5566418	Butte County
351874	Ordering, Referring, Prescribing	N/A	1922138940	0	0	RIVERA, APRIL LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41342	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	100	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
351878	Ordering, Referring, Prescribing	N/A	1922139542	0	0	ROSE, LINDA M	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT33791	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
351884	Ordering, Referring, Prescribing	N/A	1922166297	0	0	REID, AUDREY Y MD FAAP	4/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C32644	N/A	N/A	N/A	N/A	N/A	8540 ALONDRA BLVD	B2	PARAMOUNT	CA	90723	5200	00	06000	33.88915049	-118.1500515	Los Angeles County
351893	Ordering, Referring, Prescribing	N/A	1922176916	0	0	RAWITSCHER, LEE A MD	10/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60139	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
351899	Ordering, Referring, Prescribing	N/A	1922193598	0	0	RAMSY, MAGED G MD	4/14/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52502	N/A	N/A	N/A	N/A	N/A	2720 BRISTOL ST	None	SANTA ANA	CA	92704	6207	00	06000	33.710463	-117.8854565	Orange County
351940	Ordering, Referring, Prescribing	N/A	1922295401	0	0	RUTSTEIN, SANDRA G OT	10/31/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT4777	N/A	N/A	N/A	N/A	N/A	191 S. OAK PARK BLVD.	STE. # 9	GROVER BEACH	CA	93433	2265	00	06000	35.11984574	-120.6092103	San Luis Obispo County
351963	Ordering, Referring, Prescribing	N/A	1922354836	0	0	ROMERO, LIZETTE M LCSW	1/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77733	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
352026	Ordering, Referring, Prescribing	N/A	1922433556	0	0	RAMSAY, MARIELLE A LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74609	N/A	N/A	N/A	N/A	N/A	3001 INTERNATIONAL BLVD,	None	OAKLAND	CA	94601	2203	00	06000	37.77859396	-122.2279493	Alameda County
352027	Ordering, Referring, Prescribing	N/A	1922433366	0	0	ROACH, JUSTINE V LCSW	12/14/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80884	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
352028	Ordering, Referring, Prescribing	N/A	1922449602	0	0	RIVERA, LENNY LCSW	3/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80928	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
352056	Ordering, Referring, Prescribing	N/A	1922486232	0	0	RINDONE, CASEY E LMFT	1/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96712	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
352081	Ordering, Referring, Prescribing	N/A	1922508324	0	0	ROMERO, ERICA G	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	134856	N/A	N/A	N/A	N/A	N/A	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
352087	Ordering, Referring, Prescribing	N/A	1922514751	0	0	ROSEN, GYONGYVER L LCSW	3/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121583	N/A	N/A	N/A	N/A	N/A	401 W. CIVIC CENTER DR	None	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
352136	Ordering, Referring, Prescribing	N/A	1922582485	0	0	RAINE, DANIEL	8/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174504	N/A	N/A	N/A	N/A	N/A	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	00	06000	33.988536	-118.2739135	Los Angeles County
352190	Ordering, Referring, Prescribing	N/A	1922763838	0	0	REYES, LETICIA LMFT	8/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127542	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
352272	Ordering, Referring, Prescribing	N/A	1932278504	0	0	ROBIN, SHERRY LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	24396	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA STREET	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
352305	Ordering, Referring, Prescribing	N/A	1932371671	0	0	REID, KRISTEN LCSW	7/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116230	N/A	N/A	N/A	N/A	N/A	4601 TELEPHONE RD	117	VENTURA	CA	93003	5670	00	06000	34.25783504	-119.2351187	Ventura County
352307	Ordering, Referring, Prescribing	N/A	1932380821	0	0	ROMAN-AGUILAR, MAYRA C LMFT	6/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107840	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	200	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
352309	Ordering, Referring, Prescribing	N/A	1932397189	0	0	ROQUE, RONALDO V MD	8/3/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A74823	N/A	N/A	N/A	N/A	N/A	1760 TERMINO AVE	STE 104	LONG BEACH	CA	90804	2169	00	06000	33.78889871	-118.1458784	Los Angeles County
352315	Ordering, Referring, Prescribing	N/A	1932402435	0	0	ROACH, JEANNIE	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	39541	N/A	N/A	N/A	N/A	N/A	18649 VIA PRINCESSA	None	CANYON COUNTRY	CA	91387	4935	00	06000	34.40368985	-118.4618432	Los Angeles County
352331	Ordering, Referring, Prescribing	N/A	1932432655	0	0	RODRIGUEZ, CARMEN M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106996	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
352335	Ordering, Referring, Prescribing	N/A	1932439908	0	0	ROWAN, ERIC LMFT	5/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97525	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
352424	Ordering, Referring, Prescribing	N/A	1932577848	0	0	RAMIREZ, LAURA J LCSW	2/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100302	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
352467	Ordering, Referring, Prescribing	N/A	1932646122	0	0	RAY, ANDREW J PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76988	N/A	N/A	N/A	N/A	N/A	275 INTERNATIONAL CIR	625	SAN JOSE	CA	95119	1101	00	06000	37.2403027	-121.8019202	Santa Clara County
352491	Ordering, Referring, Prescribing	N/A	1932683588	0	0	RESENDEZ, SALVADOR R LCSW	9/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110764	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	0000	00	06000	37.34293689	-121.9270392	Santa Clara County
352498	Ordering, Referring, Prescribing	N/A	1932700655	0	0	RAMOS, CHRISTOPHER R PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83630	N/A	N/A	N/A	N/A	N/A	1405 W CAMERON AVE	None	VISALIA	CA	93277	9527	00	06000	36.292698	-119.306538	Tulare County
352504	Ordering, Referring, Prescribing	N/A	1932708153	0	0	REID, KAREN M LCSW	12/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95236	N/A	N/A	N/A	N/A	N/A	3100 PONTE MORINO DR	None	CAMERON PARK	CA	95682	7432	00	06000	38.66252014	-120.9672091	El Dorado County
352517	Ordering, Referring, Prescribing	N/A	1932731841	0	0	ROSALES, LERRENA D NP	10/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015150	N/A	N/A	N/A	N/A	N/A	8530 FIRESTONE BLVD	None	DOWNEY	CA	90241	4926	00	06000	33.93782301	-118.1288691	Los Angeles County
352519	Ordering, Referring, Prescribing	N/A	1932726585	0	0	ROSS, TINA LMFT	8/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105967	N/A	N/A	N/A	N/A	N/A	335 EAST AVENUE I, AREA	None	LANCASTER	CA	93535	5140	00	06000	34.7041113	-118.1247548	Los Angeles County
352536	Ordering, Referring, Prescribing	N/A	1932742376	0	0	RILEY, JEREN	10/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012588	N/A	N/A	N/A	N/A	N/A	2630 1ST AVE	None	SAN DIEGO	CA	92103	2910	00	06000	32.73288727	-117.1639712	San Diego County
352539	Ordering, Referring, Prescribing	N/A	1932753142	0	0	RADEVICH, MAJA LMFT	8/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134248	N/A	N/A	N/A	N/A	N/A	438 EDDIE LN	None	SEBASTOPOL	CA	95472	3425	00	06000	38.40853221	-122.8216073	Sonoma County
352552	Ordering, Referring, Prescribing	N/A	1932787538	0	0	ROTTO, TORSTEN J MD	8/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL6703	N/A	N/A	N/A	N/A	N/A	455 O' CONNOR DRIVE	SUITE 200	SAN JOSE	CA	95128	1632	00	06000	37.326654	-121.939897	Santa Clara County
352612	Ordering, Referring, Prescribing	N/A	1942257936	0	0	RAHIMI, STEVE G MD	10/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32400	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	SUITE 250	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
352625	Ordering, Referring, Prescribing	N/A	1942321377	0	0	ROBINSON, CAROL S LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112348	N/A	N/A	N/A	N/A	N/A	1400 W MINTHORN ST	None	LAKE ELSINORE	CA	92530	2808	00	06000	33.68269545	-117.3326588	Riverside County
352632	Ordering, Referring, Prescribing	N/A	1942334024	0	0	ROMO, WENDY C LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40486	N/A	N/A	N/A	N/A	N/A	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	00	06000	34.43847322	-118.5729968	Los Angeles County
352651	Ordering, Referring, Prescribing	N/A	1942361548	0	0	ROMERO, ELIOTT MD	8/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G48383	N/A	N/A	N/A	N/A	N/A	8800 ALONDRA BLVD	STE C	BELLFLOWER	CA	90706	4302	00	06000	33.88918249	-118.1446785	Los Angeles County
352655	Ordering, Referring, Prescribing	N/A	1942363379	0	0	RUSSELL, STEPHEN A MD	4/27/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11675	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
352673	Ordering, Referring, Prescribing	N/A	1942415138	0	0	RITTER, VADAN T LAC	1/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	6989	N/A	N/A	N/A	N/A	N/A	50 IVY STREET	None	SAN FRANCISCO	CA	94102	4506	00	06000	37.77797898	-122.4185591	San Francisco County
352680	Ordering, Referring, Prescribing	N/A	1942435649	0	0	RAMONES, SYLVIA DDS	4/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	56114	N/A	N/A	N/A	N/A	N/A	7092 KATELLA AVE	None	STANTON	CA	90680	2805	00	06000	33.8027637	-118.0093239	Orange County
352708	Ordering, Referring, Prescribing	N/A	1942491634	0	0	REKUC, EMILY K DO	8/31/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11655	N/A	N/A	N/A	N/A	N/A	79440 HIGHWAY 111	105	LA QUINTA	CA	92253	4500	00	06000	33.70748202	-116.2785511	Riverside County
352713	Ordering, Referring, Prescribing	N/A	1942495213	0	0	ROZENBLAT, ZINOVI MD	12/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99473	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
352770	Ordering, Referring, Prescribing	N/A	1942608732	0	0	RODRIGUEZ-CAMPOS, RAQUEL LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110591	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
352817	Ordering, Referring, Prescribing	N/A	1942676622	0	0	ROCKWELL, JAMES LCSW	9/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97031	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
352829	Ordering, Referring, Prescribing	N/A	1942691266	0	0	ROSE, BOBBY G NP	12/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	345573	N/A	N/A	N/A	N/A	N/A	1955 LONG BEACH BLVD	SUITE 200	LONG BEACH	CA	90806	5501	00	06000	33.79290697	-118.1895017	Los Angeles County
352835	Ordering, Referring, Prescribing	N/A	1942695655	0	0	REYES, EMMANUEL LMFT	11/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111814	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD STE 3	None	LOS ANGELES	CA	90017	1905	00	06000	34.05307427	-118.2651099	Los Angeles County
352844	Ordering, Referring, Prescribing	N/A	1942720222	0	0	RANDALL, NATHAN CNP	2/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011888	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
352847	Ordering, Referring, Prescribing	N/A	1942707633	0	0	ROXAS, NICHOLE G MD MPH	11/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179137	N/A	N/A	N/A	N/A	N/A	4701 E. CESAR CHAVEZ AVE	SECOND FLOOR	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
352848	Ordering, Referring, Prescribing	N/A	1942723119	0	0	REYNA CHAVEZ, MARTHA LCSW	7/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124060	N/A	N/A	N/A	N/A	N/A	215 W BEAMER ST	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
352860	Ordering, Referring, Prescribing	N/A	1942738786	0	0	ROJAS, SHANNON R	10/21/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33738	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
352863	Ordering, Referring, Prescribing	N/A	1942741699	0	0	REYES, DANIEL J NP	9/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006299	N/A	N/A	N/A	N/A	N/A	524 W VISTA WAY	None	VISTA	CA	92083	5704	00	06000	33.19635191	-117.2517899	San Diego County
352866	Ordering, Referring, Prescribing	N/A	1942746359	0	0	REYNOSO, JANET LCSW	3/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120540	N/A	N/A	N/A	N/A	N/A	4137 VERDUGO RD	None	LOS ANGELES	CA	90065	3820	00	06000	34.1261475	-118.2319835	Los Angeles County
352868	Ordering, Referring, Prescribing	N/A	1942746128	0	0	RIOS, SIERRA K LCSW	9/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91970	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	N/A	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
352889	Ordering, Referring, Prescribing	N/A	1942788476	0	0	ROMERO, CHEYENNE J LCSW	10/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118722	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	7285	00	06000	33.5676365	-117.2174559	Riverside County
352891	Ordering, Referring, Prescribing	N/A	1942788641	0	0	ROTH, KARRIE RN PHN	4/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	358437	N/A	N/A	N/A	N/A	N/A	1525 DOUGLASS ST	None	RED BLUFF	CA	96080	2506	00	06000	40.17816402	-122.2524037	Tehama County
352927	Ordering, Referring, Prescribing	N/A	1942873450	0	0	ROMERO, RAQUEL A PA-C	1/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59662	N/A	N/A	N/A	N/A	N/A	2420 CASTILLO ST	STE 100	SANTA BARBARA	CA	93105	5307	00	06000	34.431079	-119.7249253	Santa Barbara County
352934	Ordering, Referring, Prescribing	N/A	1942889167	0	0	RIVKIN, LAUREN MD	3/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194972	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
352976	Ordering, Referring, Prescribing	N/A	1952044703	0	0	ROMO, MELISSA LCSW	1/31/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128434	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
352977	Ordering, Referring, Prescribing	N/A	1952034811	0	0	RESENDIZ RIOS, FAUSTINO R MD	2/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P12	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
353005	Ordering, Referring, Prescribing	N/A	1952180291	0	0	ROSENBERG, MARINA S NP	9/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027384	N/A	N/A	N/A	N/A	N/A	837 ADDISON STREET	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
353027	Ordering, Referring, Prescribing	N/A	1952410615	0	0	RABOURN, ALEXIS M LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT15570	N/A	N/A	N/A	N/A	N/A	1652 WEST TEXAS STREET	SUITE 258	FAIRFIELD	CA	94533	5952	00	06000	38.24929745	-122.0578065	Solano County
353077	Ordering, Referring, Prescribing	N/A	1952514531	0	0	REIMERS, NICOLE M LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46512	N/A	N/A	N/A	N/A	N/A	2575 FOREST AVE	None	CHICO	CA	95928	7686	00	06000	39.71801447	-121.7927912	Butte County
353078	Ordering, Referring, Prescribing	N/A	1952523870	0	0	RICHARDSON, RUBY N LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42557	N/A	N/A	N/A	N/A	N/A	2620 INDUSTRY WAY	C	LYNWOOD	CA	90262	4024	00	06000	33.92360701	-118.2254995	Los Angeles County
353091	Ordering, Referring, Prescribing	N/A	1952551574	0	0	RYAN, COLLEEN J LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53441	N/A	N/A	N/A	N/A	N/A	2121 W. TEMPLE ST.	C BUILDING	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
353115	Ordering, Referring, Prescribing	N/A	1952609901	0	0	RICHARDSON, ALICIA M	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47607	N/A	N/A	N/A	N/A	N/A	3480 BUSKIRK AVE	210	PLEASANT HILL	CA	94523	4341	00	06000	37.94004473	-122.0590134	Contra Costa County
353119	Ordering, Referring, Prescribing	N/A	1952602732	0	0	RAMIREZ, ADELINA LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91299	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE 2ND F	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
353124	Ordering, Referring, Prescribing	N/A	1952626830	0	0	RAMBO, CHELSEA R LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76935	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
353136	Ordering, Referring, Prescribing	N/A	1952652133	0	0	RIDGWAY, SHYLAH K LCSW	12/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99134	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
353207	Ordering, Referring, Prescribing	N/A	1952765489	0	0	RUBIN, NICOLE MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169331	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
353211	Ordering, Referring, Prescribing	N/A	1952775728	0	0	RECINOS, DAVID E LCSW	7/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95624	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
353232	Ordering, Referring, Prescribing	N/A	1952800781	0	0	REYNA-TOBAR, RENE NP	8/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006656	N/A	N/A	N/A	N/A	N/A	148 E KINGS ST	None	AVENAL	CA	93204	1529	00	06000	36.00249425	-120.1366109	Kings County
353244	Ordering, Referring, Prescribing	N/A	1952825903	0	0	RUIZ MERCADO, EMMA LCSW	8/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109813	N/A	N/A	N/A	N/A	N/A	725 E MAIN ST	None	SANTA PAULA	CA	93060	2748	00	06000	34.35240876	-119.0649129	Ventura County
353347	Ordering, Referring, Prescribing	N/A	1962013003	0	0	ROJO, JOANNA G LMFT	4/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145476	N/A	N/A	N/A	N/A	N/A	6850 MORRO RD	None	ATASCADERO	CA	93422	4123	00	06000	35.48202343	-120.6660628	San Luis Obispo County
353352	Ordering, Referring, Prescribing	N/A	1962030106	0	0	ROSSI, JORDAN MD	5/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180662	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	#300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
353355	Ordering, Referring, Prescribing	N/A	1962031005	0	0	RANDHAWA, HARJOT S MD	8/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188736	N/A	N/A	N/A	N/A	N/A	2740 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70101129	-119.7908643	Fresno County
353358	Ordering, Referring, Prescribing	N/A	1962038398	0	0	RYAN, MICHELE L LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118453	N/A	N/A	N/A	N/A	N/A	11565 LAUREL CANYON BOUL	None	SAN FERNANDO	CA	91340	1234	00	06000	34.28018218	-118.4549135	Los Angeles County
353364	Ordering, Referring, Prescribing	N/A	1962039321	0	0	RANDHAWA, KARANBIR MD	8/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188493	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
353395	Ordering, Referring, Prescribing	N/A	1962109603	0	0	RODRIGUEZ, NORMA NP	5/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95030227	N/A	N/A	N/A	N/A	N/A	12110 SLAUSON AVE	16	SANTA FE SPRINGS	CA	90670	2692	00	06000	33.96224395	-118.0575774	Los Angeles County
353410	Ordering, Referring, Prescribing	N/A	1962175398	0	0	RIZK, ALEXANDRA DDS	11/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108313	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
353443	Ordering, Referring, Prescribing	N/A	1962479824	0	0	RODRIGUEZ, MICHELLE E LCSW	2/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23999	N/A	N/A	N/A	N/A	N/A	38 QUAIL CT	100	WALNUT CREEK	CA	94596	8791	00	06000	37.88799501	-122.0554422	Contra Costa County
353445	Ordering, Referring, Prescribing	N/A	1962500108	0	0	RAMOS, KATHY LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38150	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
353476	Ordering, Referring, Prescribing	N/A	1962572743	0	0	RARAS, TERESA C MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87653	N/A	N/A	N/A	N/A	N/A	500 N. 9TH STREET	SUITE A	MODESTO	CA	95350	5814	00	06000	37.65145793	-121.0156971	Stanislaus County
353487	Ordering, Referring, Prescribing	N/A	1962587493	0	0	RUSSELL, ROBB DC	4/13/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC14749	N/A	N/A	N/A	N/A	N/A	16200 AMBER VALLEY DRIVE	None	WHITTIER	CA	90604	4051	00	06000	33.92458653	-117.9826605	Los Angeles County
353538	Ordering, Referring, Prescribing	N/A	1962684100	0	0	ROJAS, PATRICIA LCSW	8/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117564	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
353549	Ordering, Referring, Prescribing	N/A	1962719401	0	0	RAMIREZ, SYLVIA M PSY	4/24/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25804	N/A	N/A	N/A	N/A	N/A	650 ZEDIKER AVE	None	PARLIER	CA	93648	2666	00	06000	36.60500164	-119.5210273	Fresno County
353578	Ordering, Referring, Prescribing	N/A	1962755124	0	0	ROSAS, JONATHAN LMFT	12/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151686	N/A	N/A	N/A	N/A	N/A	202 N. 8TH ST	None	EL CENTRO	CA	92243	4403	00	06000	32.794335	-115.5614775	Imperial County
353596	Ordering, Referring, Prescribing	N/A	1962780601	0	0	RUIZ, SARAH A LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88354	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
353617	Ordering, Referring, Prescribing	N/A	1962798447	0	0	RAHNAVARDAN-CHALAK, ANGELIN	1/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60753	N/A	N/A	N/A	N/A	N/A	33961 DOHENY PARK RD	None	SAN JUAN CAPISTRA	CA	92675	4835	00	06000	33.469758	-117.6781095	Orange County
353624	Ordering, Referring, Prescribing	N/A	1962805952	0	0	RANDALL, JOVAN CNP	8/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95002728	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
353680	Ordering, Referring, Prescribing	N/A	1962887554	0	0	RAJSINGH, GURMEET LMFT	10/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89469	N/A	N/A	N/A	N/A	N/A	3145 GOLDEN POPPY LN	None	STOCKTON	CA	95209	3785	00	06000	38.05725499	-121.3540381	San Joaquin County
353738	Ordering, Referring, Prescribing	N/A	1962992081	0	0	RICCI, EMILY PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77809	N/A	N/A	N/A	N/A	N/A	200 E SEPULVEDA BLVD	None	CARSON	CA	90745	6323	00	06000	33.80793675	-118.2727856	Los Angeles County
353759	Ordering, Referring, Prescribing	N/A	1972018950	0	0	ROBINSON, CHRISTIANA LMFT	1/9/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152556	N/A	N/A	N/A	N/A	N/A	22704 VENTURA BLVD	SUITE 1029	WOODLAND HILLS	CA	91364	1333	00	06000	34.16679108	-118.6208714	Los Angeles County
353809	Ordering, Referring, Prescribing	N/A	1972120780	0	0	RICKS, LAVONNE L	10/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89442	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
353839	Ordering, Referring, Prescribing	N/A	1972180727	0	0	RAMIREZ, EDNITA Y LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98962	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	#200	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
353842	Ordering, Referring, Prescribing	N/A	1972173359	0	0	RAU, KELSI M NP	1/30/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028896	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
353863	Ordering, Referring, Prescribing	N/A	1972253276	0	0	RUBIN, SHOSHANNAH C MD	9/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22017	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
353899	Ordering, Referring, Prescribing	N/A	1972576189	0	0	ROSENBURG, JEFFREY MD	8/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G53269	N/A	N/A	N/A	N/A	N/A	1453 W TEMPLE ST	None	LOS ANGELES	CA	90026	5648	00	06000	34.06757953	-118.2579864	Los Angeles County
353912	Ordering, Referring, Prescribing	N/A	1972621225	0	0	RUGGIERO, MARK S MD	9/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68210	N/A	N/A	N/A	N/A	N/A	10956 DONNER PASS RD	SUITE 310	TRUCKEE	CA	96161	4861	00	06000	39.32625521	-120.2012059	Nevada County
353927	Ordering, Referring, Prescribing	N/A	1972632727	0	0	RANDLE, PAULA Y LMFT	7/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35136	N/A	N/A	N/A	N/A	N/A	1350 3RD ST	None	LA VERNE	CA	91750	5201	00	06000	34.10427088	-117.7847615	Los Angeles County
353932	Ordering, Referring, Prescribing	N/A	1972644227	0	0	ROACH, JANINE MD	11/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94511	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR.	COTTAGE H1	SYLMAR	CA	91342	0000	00	06000	34.32450186	-118.4456317	Los Angeles County
353952	Ordering, Referring, Prescribing	N/A	1972684744	0	0	RODRIGUEZ, ELIAS MD	11/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A066783	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
353953	Ordering, Referring, Prescribing	N/A	1972691384	0	0	ROBINSON, MANDA B PA-C	5/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	18522	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
353973	Ordering, Referring, Prescribing	N/A	1972734853	0	0	RAPS, VALERIE C LMFT	9/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102598	N/A	N/A	N/A	N/A	N/A	1889 LAWRENCE RD	None	SANTA CLARA	CA	95051	2162	00	06000	37.35761102	-121.9947195	Santa Clara County
354004	Ordering, Referring, Prescribing	N/A	1972796563	0	0	REDDY, MANDEEP G MD	12/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117051	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
354014	Ordering, Referring, Prescribing	N/A	1972810422	0	0	RAGER, VINCENT J PSYD	5/16/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33357	N/A	N/A	N/A	N/A	N/A	1022 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	00	06000	35.36767613	-119.1111388	Kern County
354019	Ordering, Referring, Prescribing	N/A	1972814507	0	0	RIVAS, VANESSA LCSW	11/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78144	N/A	N/A	N/A	N/A	N/A	522 S. SAN PEDRO STREET	None	LOS ANGELES	CA	90013	2101	00	06000	34.0436196	-118.2442541	Los Angeles County
354040	Ordering, Referring, Prescribing	N/A	1972858363	0	0	RILEY, RENEE L PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67186	N/A	N/A	N/A	N/A	N/A	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
354071	Ordering, Referring, Prescribing	N/A	1972899466	0	0	ROWE, ZENOBIA LCSW	4/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS27125	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	8TH FLOOR	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
354136	Ordering, Referring, Prescribing	N/A	1972979078	0	0	RAZAQ, ARZO PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63026	N/A	N/A	N/A	N/A	N/A	1300 FOUNTAIN SPRINGS CI	None	DANVILLE	CA	94526	5625	00	06000	37.79152333	-121.9847086	Contra Costa County
354168	Ordering, Referring, Prescribing	N/A	1982029427	0	0	RECENDEZ, KRISTINE A LPCC	5/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	8405	N/A	N/A	N/A	N/A	N/A	4946 E. YALE AVE	SUITE 103	FRESNO	CA	93727	1526	00	06000	36.7701095	-119.7296595	Fresno County
354169	Ordering, Referring, Prescribing	N/A	1982032660	0	0	ROPER, AMBER LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92771	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS STE 22	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
354173	Ordering, Referring, Prescribing	N/A	1982040283	0	0	ROMO, KIMBERLY A LMFT	1/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106412	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
354211	Ordering, Referring, Prescribing	N/A	1982087789	0	0	RAI, NIRMEET S MD	10/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152046	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
354225	Ordering, Referring, Prescribing	N/A	1982132023	0	0	REYES, SHERRY LMFT	8/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120159	N/A	N/A	N/A	N/A	N/A	44359 PALM STREET	None	INDIO	CA	92201	3116	00	06000	33.72570919	-116.2274384	Riverside County
354253	Ordering, Referring, Prescribing	N/A	1982166393	0	0	REECE, TYRA P MD	4/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177468	N/A	N/A	N/A	N/A	N/A	403 S LONG BEACH BLVD	B	COMPTON	CA	90221	3449	00	06000	33.89318091	-118.2078742	Los Angeles County
354291	Ordering, Referring, Prescribing	N/A	1982231205	0	0	REGODON WALLIN, AMANDA MATILDA MD MPH	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190935	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
354292	Ordering, Referring, Prescribing	N/A	1982232518	0	0	RAHBAN, HABIB MD	2/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184586	N/A	N/A	N/A	N/A	N/A	12740 HESPERIA RD	SUITE A	VICTORVILLE	CA	92395	8306	00	06000	34.48256788	-117.2905361	San Bernardino County
354310	Ordering, Referring, Prescribing	N/A	1982266649	0	0	RICHARDSON, ERRISHA M MD	10/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199332	N/A	N/A	N/A	N/A	N/A	3234 MARYSVILLE BLVD,	None	SACRAMENTO	CA	95815	1411	00	06000	38.626371	-121.4322615	Sacramento County
354358	Ordering, Referring, Prescribing	N/A	1982630885	0	0	ROBERTS, JENNIFER CNP	10/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12495	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
354376	Ordering, Referring, Prescribing	N/A	1982709432	0	0	REIS, MARK MD	5/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88836	N/A	N/A	N/A	N/A	N/A	1345 A PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3159	00	06000	40.43531297	-120.6557201	Lassen County
354377	Ordering, Referring, Prescribing	N/A	1982721411	0	0	ROSENBERG, LAUREN LCSW	8/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24855	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD	SUITE 102	VAN NUYS	CA	91405	3937	00	06000	34.19649	-118.448787	Los Angeles County
354389	Ordering, Referring, Prescribing	N/A	1982732749	0	0	RODRIGUEZ, ROBERTO A	2/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102180	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
354413	Ordering, Referring, Prescribing	N/A	1982773354	0	0	RAO, ASHOK R MD	3/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A95270	N/A	N/A	N/A	N/A	N/A	800 N. SCENIC DR,	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
354420	Ordering, Referring, Prescribing	N/A	1982786265	0	0	REDONDO, DONNA L CNP	4/20/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14418	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	MAIL STOP P-505	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
354457	Ordering, Referring, Prescribing	N/A	1982856696	0	0	ROMERO, MARTHA E LCSW	4/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72553	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
354481	Ordering, Referring, Prescribing	N/A	1982924684	0	0	RIBBLE, LYSSA	5/23/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0672238	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
354517	Ordering, Referring, Prescribing	N/A	1982981221	0	0	RAMIREZ-CEJA, LUPE LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94462	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
354527	Ordering, Referring, Prescribing	N/A	1982987491	0	0	RICHMOND, DEMITRI LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27119	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVENUE	SUITE 200	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
354557	Ordering, Referring, Prescribing	N/A	1992045322	0	0	ROMERO, BEATRIZ LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93554	N/A	N/A	N/A	N/A	N/A	828 S. BASCOM AVE.	100	SAN JOSE	CA	95128	0000	00	06000	37.31225204	-121.9317854	Santa Clara County
354566	Ordering, Referring, Prescribing	N/A	1992057814	0	0	RUIZ, DEANNA LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94473	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
354593	Ordering, Referring, Prescribing	N/A	1992090609	0	0	RODRIGUEZ, EDNA LMFT	8/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127833	N/A	N/A	N/A	N/A	N/A	13853 SENECA ROAD	None	VICTORVILLE	CA	92392	9339	00	06000	34.51396327	-117.3612064	San Bernardino County
354594	Ordering, Referring, Prescribing	N/A	1992094478	0	0	RICHEE EASTLAND, SETIVA M LCSW	3/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88006	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
354604	Ordering, Referring, Prescribing	N/A	1992107353	0	0	RAMSEY, TAMAIRA LCSW	5/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115198	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
354618	Ordering, Referring, Prescribing	N/A	1992130009	0	0	ROMERO, JEANETTE LCSW	2/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99962	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
354622	Ordering, Referring, Prescribing	N/A	1992130827	0	0	RIMULAR, LIZA L NP	6/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23486	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
354632	Ordering, Referring, Prescribing	N/A	1992152896	0	0	RANA, TALVINDER S MD	2/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171733	N/A	N/A	N/A	N/A	N/A	2951 FULTON AVE	None	SACRAMENTO	CA	95821	4909	00	06000	38.618991	-121.402692	Sacramento County
354639	Ordering, Referring, Prescribing	N/A	1992153761	0	0	RHO, SHARON PHARMD	3/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71329	N/A	N/A	N/A	N/A	N/A	250 E PARKCENER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
354671	Ordering, Referring, Prescribing	N/A	1992223606	0	0	RIOS, JENNIFER LMFT	7/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126791	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	2301	00	06000	34.70150394	-118.1452081	Los Angeles County
354680	Ordering, Referring, Prescribing	N/A	1992237622	0	0	RAVINDRAN, USHAANTHY MD	3/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169435	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	5817	00	06000	38.555181	-121.4566785	Sacramento County
354684	Ordering, Referring, Prescribing	N/A	1992236566	0	0	RAUCH, STACY LPCC	2/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13301	N/A	N/A	N/A	N/A	N/A	3517 CAMINO DEL RIO S	SUITE 407	SAN DIEGO	CA	92108	4026	00	06000	32.77777042	-117.1179225	San Diego County
354693	Ordering, Referring, Prescribing	N/A	1992250070	0	0	RAMIREZ, IRENE A LCSW	6/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101759	N/A	N/A	N/A	N/A	N/A	650 N STATE ST	None	HEMET	CA	92543	2960	00	06000	33.757695	-116.9717535	Riverside County
354711	Ordering, Referring, Prescribing	N/A	1992296537	0	0	RECINOS, LIGIA L LCSW	7/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91338	N/A	N/A	N/A	N/A	N/A	23461 SOUTH POINTE DRIVE	SUITE 220	LAGUNA HILLS	CA	92653	0102	00	06000	33.62535142	-117.7206568	Orange County
354735	Ordering, Referring, Prescribing	N/A	1992350102	0	0	ROMAN, LIDIA M LMFT	3/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146048	N/A	N/A	N/A	N/A	N/A	725 W LA VETA AVE	260	ORANGE	CA	92868	0000	00	06000	33.78063949	-117.8603285	Orange County
354775	Ordering, Referring, Prescribing	N/A	1992448864	0	0	ROSCOE, SYDNEY NP	9/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027107	N/A	N/A	N/A	N/A	N/A	4050 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.5582775	-117.046881	San Diego County
354785	Ordering, Referring, Prescribing	N/A	1992455166	0	0	ROSENMOSS, SOPHIA J MD	9/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190939	N/A	N/A	N/A	N/A	N/A	345 SAN PEDRO ST	None	LOS ANGELES	CA	90013	1633	00	06000	34.04602976	-118.2429461	Los Angeles County
354789	Ordering, Referring, Prescribing	N/A	1992476279	0	0	RAMIREZ HERNANDEZ, MARVIN I NP	8/26/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018204	N/A	N/A	N/A	N/A	N/A	780 ATLANTIC AVE.	None	LONG BEACH	CA	90813	2156	00	06000	33.776325	-118.1850235	Los Angeles County
354798	Ordering, Referring, Prescribing	N/A	1992574628	0	0	RANDHAWA, KAMALDEEP DDS	12/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109639	N/A	N/A	N/A	N/A	N/A	1000 SKYLINE BLVD	STE B	AVENAL	CA	93204	1529	00	06000	36.00790722	-120.1216067	Kings County
354825	Ordering, Referring, Prescribing	N/A	1992809180	0	0	RAO, CHARMI P MD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A91272	N/A	N/A	N/A	N/A	N/A	3665 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1953	00	06000	32.80816826	-117.1510112	San Diego County
354831	Ordering, Referring, Prescribing	N/A	1992814610	0	0	RAYPON, RAMON Q MD	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39769	N/A	N/A	N/A	N/A	N/A	209 E 7TH ST	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
354852	Ordering, Referring, Prescribing	N/A	1992850317	0	0	RE, SEAN A LMFT	9/19/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48843	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
354866	Ordering, Referring, Prescribing	N/A	1992868152	0	0	RANGCHI, ATOOSA PHARMD	2/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53385	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
354873	Ordering, Referring, Prescribing	N/A	1992876759	0	0	ROWHANI, NAGHMEH MD	2/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92037	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
354875	Ordering, Referring, Prescribing	N/A	1992888259	0	0	RANDALL, CRAIG M DO	6/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2013021815	N/A	N/A	N/A	N/A	N/A	525 BRANSON LANDING BLVD	None	BRANSON	MO	65616	2052	00	06000	36.65109796	-93.2204608	Taney County