Table family_pact_providers_profile_cy_2021

Table: family_pact_providers_profile_cy_2021_2022 , provider_business_legal_name like G*

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

provider_number	npi_provider_number	owner_number	service_location_number	provider_business_legal_name	enrollment_status_effective_date	provider_type_code	provider_type_code_desc	provider_license_number	provider_specialty_code	provider_specialty_code_desc	out_of_state_ind_desc	provider_address_county_code	provider_address_county_desc	attention_line	provider_address_line1	provider_address_line2	provider_address_city	provider_address_state	provider_address_zip	provider_address_latitude	provider_address_longitude	mssa_id	tract_id
1003955519	1003955519	1	1	GARCIA-NIQUE, LUIS O MD	31Aug1988	026	PHYSICIANS	A00033647	None	UNKNOWN	In state provider	30	Orange	None	3010 W ORANGE AVE	STE 202	ANAHEIM	CA	928043171	33.824750	-117.993763	116c	869.02
1023380425	1023380425	1	1	GEORGE DELSHAD MD A PROFESSI	07May2012	026	PHYSICIANS	G00083566	None	UNKNOWN	In state provider	19	Los Angeles	IC	15211 VANOWEN STREET	SUITE 310	VAN NUYS	CA	914053615	34.193910	-118.464223	78.2cc	1278.05
1033240650	1033240650	1	1	GALDAMEZ, LUIS A MD INC	29Sep2004	022	PHYSICIANS GROUP	FNP020761	08	Family Practice	In state provider	19	Los Angeles	CLINICA MEDICA VIRGEN DE	6831 SEVILLE AVE	None	HUNTINGTON PARK	CA	902554805	33.977480	-118.222551	78.2fff	5331.04
1033322771	1033322771	1	1	GOLDEN VALLEY HEALTH CTR	18Nov2005	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	None	1121 HAMMOND ST	None	MODESTO	CA	953513509	37.615276	-121.018607	215c	16.04
1043423205	1043423205	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	GUSTINE-NEWMAN	637 MERCED ST	None	NEWMAN	CA	953609603	37.314626	-121.016781	213	35
1073733879	1073733879	1	1	GOLDEN VALLEY HEALTH CTR	02Jun2021	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	24	Merced	None	3940 SANDPIPER AVENUE	None	MERCED	CA	953408372	37.307387	-120.583271	96	7.02
1083619753	1083619753	1	1	GOMEZ, HAROLD A RN	01Jun1999	007	CERTIFIED NURSE PRACTIONER	RN0487974	None	UNKNOWN	In state provider	19	Los Angeles	None	1220 S GLENDORA AVENUE	None	WEST COVINA	CA	917904924	34.055234	-117.938703	78.2www	4067.01
1124204292	1124204292	1	1	GOLDEN VALLEY HEALTH CTR	09Jul2007	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	None	2760 3RD ST	None	CERES	CA	953073220	37.591963	-120.954519	214	26.02
1144358748	1144358748	1	1	GARDNER FAMILY HLTH NTWR	14Dec2009	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	43	Santa Clara	GARDNER SO CO HEALTH CTR	7526 MONTEREY ST	None	GILROY	CA	950205826	37.008533	-121.569390	182	5126.03
1164552931	1164552931	1	1	GARDNER FAMILY HLTH NTWK	14Dec2009	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	43	Santa Clara	ALVISO HEALTH CENTER	1621 GOLD ST	None	ALVISO	CA	950021240	37.424063	-121.976109	183l	5046.02
1194048884	1194048884	1	1	GENESIS CLINICA DE LA MUJER	30Mar2010	026	PHYSICIANS	G75190	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	43	Santa Clara	INC	244 N JACKSON AVE	STE 209	SAN JOSE	CA	951161604	37.364025	-121.848918	183b	5037.12
1225168024	1225168024	1	1	GALDAMEZ, LUIS A MD INC	01Jan1995	022	PHYSICIANS GROUP	FNP020761	01	General Practice	In state provider	19	Los Angeles	CLINICA MEDICA VIRGEN DE	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	902555836	33.973308	-118.216415	78.2ccc	5331.07
1235342981	1235342981	1	1	GOLDEN VALLEY HEALTH CTR	01Feb2006	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	PO BOX 7	301 HOWARD RD	None	WESTLEY	CA	953870000	37.550060	-121.202124	213	33
1245420660	1245420660	1	1	GEORGE L MEE MEM HOSP	01Dec1977	015	COMMUNITY OUTPATIENT HOSPITAL	270700777	None	UNKNOWN	In state provider	27	Monterey	None	300 CANAL ST	None	KING CITY	CA	939303431	36.207089	-121.132356	105	113.04
1275753071	1275753071	1	1	GOLDEN VALLEY HEALTH CTR	18Nov2005	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	None	401 LESHER DR	None	MERCED	CA	953416572	37.293741	-120.504168	97.2	15.03
1275965105	1275965105	1	1	GONZALES, ROMMEL MEDICAL	04Aug2014	026	PHYSICIANS	A122760	01	General Practice	In state provider	19	Los Angeles	GROUP INC	508 S ALVARADO ST	None	LOS ANGELES	CA	900572904	34.060315	-118.274360	78.2ffff	2088.01
1285658690	1285658690	1	1	GUMBS, JOSLYN L MD	06Feb2013	026	PHYSICIANS	A00087245	None	UNKNOWN	In state provider	19	Los Angeles	None	5255 W SUNSET BLVD	None	LOS ANGELES	CA	900275716	34.098107	-118.304455	78.2g	1911.10
1285795773	1285795773	2	2	GOOD SAMARITAN MEDICAL CLINI	08Jun2020	022	PHYSICIANS GROUP	None	None	UNKNOWN	In state provider	30	Orange	C, INC	801 N HARBOR BLVD	None	ANAHEIM	CA	928051810	33.842956	-117.922468	116l	866.02
1316150576	1316150576	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	WOMEN'S HEALTH	797 W CHILDS AVE	None	MERCED	CA	953406805	37.288207	-120.496348	97.2	15.03
1316162829	1316162829	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	None	847 W CHILDS AVE	None	MERCED	CA	953410000	37.288202	-120.497174	97.2	16.02
1316393010	1316393010	1	1	GOLDEN VALLEY HEALTH CENTERS	01May2018	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	50	Stanislaus	None	1920 MEMORIAL DRIVE	None	CERES	CA	953071827	37.600357	-120.961059	215c	26.04
1366633638	1366633638	1	1	GEORGE L MEE MEM HOSP	03Nov1999	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	27	Monterey	MEDICAL CLINIC	467 EL CAMINO REAL	None	GREENFIELD	CA	939274915	36.325892	-121.247649	107	112.02
1396047775	1396047775	1	1	GOLBARI, ABRAHAM MD INC	01Oct2001	026	PHYSICIANS	A00055387	41	Internal Medicine	In state provider	19	Los Angeles	None	14030 CRENSHAW BLVD	None	GARDENA	CA	902492715	33.904231	-118.326495	78.2bbbb	6026
1407941586	1407941586	1	1	GANDHI, SHOBHANA MD INC	01Jul2003	022	PHYSICIANS GROUP	A00029540	None	UNKNOWN	In state provider	19	Los Angeles	None	1300 N VERMONT AVE	SUITE 307	LOS ANGELES	CA	900276005	34.095557	-118.291741	78.2g	1913.02
1407985534	1407985534	2	1	GARDNER FAMILY HEALTH	21Feb2011	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	43	Santa Clara	NETWORK, INC	195 E VIRGINIA ST	None	SAN JOSE	CA	951125844	37.325925	-121.877594	183d	5016
1467672253	1467672253	1	1	GOLDEN VALLEY HEALTH CTR	18Nov2005	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	None	13161 JEFFERSON ST	None	LE GRAND	CA	953339766	37.230464	-120.249626	97.3	19.02
1477020121	1477020121	1	1	GOLDEN VALLEY HEALTH CENTERS	26Aug2021	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	39	San Joaquin	None	302 NORTHGATE DR	None	MANTECA	CA	953363139	37.819087	-121.220536	164.1	51.26
1497968010	1497968010	1	1	GOLDEN VALLEY HEALTH CTR	19Feb2020	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	WEST MODESTO MEDICAL CTR	1114 6TH ST	None	MODESTO	CA	953542203	37.638749	-121.005396	215c	17
1497969166	1497969166	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	PATTERSON MEDICAL CTR	200 C ST	None	PATTERSON	CA	953632701	37.467494	-121.125671	213	32.02
1518187319	1518187319	1	1	GOLDEN VALLEY HLTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	LOS BANOS	821 TEXAS AVE	None	LOS BANOS	CA	936353453	37.064774	-120.860329	94	22.01
1548568421	1548568421	1	1	GOLDEN VALLEY HEALTH CENTERS	22Jun2012	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	50	Stanislaus	None	4150 PATTERSON ROAD	None	RIVERBANK	CA	953672566	37.732634	-120.919841	211	4.02
1558491043	1558491043	1	1	GARDNER FAMILY HEALTH	01Mar1997	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	43	Santa Clara	NETWORK INC	3030 ALUM ROCK AVE	None	SAN JOSE	CA	951272807	37.365085	-121.829369	183e	5040.01
1649292715	1649292715	1	1	GALSTYAN, KEVIN G MD INC	24Jan2012	026	PHYSICIANS	A00087568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	1420 S CENTRAL AVE	None	GLENDALE	CA	912042508	34.128432	-118.257800	78.2ee	3024.01
1649386707	1649386707	1	1	GUPTA, PRAVEEN DR	01Jan1979	026	PHYSICIANS	A00025680	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	9435 VENICE BLVD	None	CULVER CITY	CA	902322623	34.025348	-118.395423	78.2y	2701
1679013726	1679013726	1	1	GOLDEN VALLEY HEALTH CENTERS	02Oct2018	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	39	San Joaquin	None	250 NORTHGATE DRIVE	None	MANTECA	CA	953363161	37.819051	-121.219685	164.1	51.26
1699041566	1699041566	1	1	GARDNER FAMILY HEALTH	18May2012	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	43	Santa Clara	NETWORK INC	725 E SANTA CLARA ST	None	SAN JOSE	CA	951121900	37.343203	-121.875735	183d	5013
1740299833	1740299833	2	1	GARVEY HEALTHY FAMILY	14Dec2015	026	PHYSICIANS	A54127	01	General Practice	In state provider	19	Los Angeles	MEDICAL CLINIC INC	705 E GARVEY AVE	None	MONTEREY PARK	CA	917553024	34.062637	-118.112845	78.2qqq	4817.12
1770703571	1770703571	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	24	Merced	DOS PALOS	1405 CALIFORNIA AVE	None	DOS PALOS	CA	936202300	36.987480	-120.629074	94	24.02
1841476652	1841476652	1	1	GROSSMONT SPRING VALLEY	24Nov1999	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	37	San Diego	None	8788 JAMACHA RD	None	SPRING VALLEY	CA	919774035	32.714791	-117.009764	161i	139.06
1851465256	1851465256	1	1	GEORGIOU, STEPHEN J MD	28Jun1995	026	PHYSICIANS	G81674	None	UNKNOWN	In state provider	24	Merced	None	502 WASHINGTON AVE	None	LOS BANOS	CA	936354649	37.055966	-120.853095	94	23.01
1871779934	1871779934	1	1	GOLDEN VALLEY HEALTH CTR	09Jul2007	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	None	1141 N OLIVE AVE	None	TURLOCK	CA	953803365	37.503653	-120.839809	212.1	39.06
1891724993	1891724993	1	1	GHALILI, SAMAN MD	26Apr2005	026	PHYSICIANS	A00088734	41	Internal Medicine	In state provider	19	Los Angeles	None	2101 S SAN PEDRO ST	None	LOS ANGELES	CA	900111125	34.025797	-118.258617	78.2mmm	2264.10
1891839270	1891839270	1	1	GARDENS MEDICAL CENTER INC	15Aug2012	026	PHYSICIANS	None	08	Family Practice	In state provider	19	Los Angeles	None	7218 GARFIELD AVE	None	BELL GARDENS	CA	902014812	33.966210	-118.151108	78.2c	5339.02
1891904686	1891904686	1	1	GAGE MEDICAL CENTER	16Aug2004	022	PHYSICIANS GROUP	FNP033884	40	Pediatrics	In state provider	19	Los Angeles	None	2719 E GAGE AVE	None	HUNTINGTON PARK	CA	902554202	33.981669	-118.222164	78.2ccc	5326.06
1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	02Jan2010	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	50	Stanislaus	None	1200 W MAIN ST	None	TURLOCK	CA	953803411	37.504718	-120.831871	212.1	39.07
1932399441	1932399441	1	1	GUPTA, ARUNA MD APC	01Jul2007	026	PHYSICIANS	A00088415	None	UNKNOWN	In state provider	33	Riverside	None	6850 BROCKTON AVE	STE 108	RIVERSIDE	CA	925063816	33.949252	-117.396777	135c	311
1942413786	1942413786	1	1	GOLDEN VALLEY HEALTH CTR	18Nov2005	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	None	1717 LAS VEGAS ST	None	MODESTO	CA	953585500	37.605347	-121.002716	215c	24.02
1942414214	1942414214	1	1	GOLDEN VALLEY HEALTH CTR	01Mar1997	058	HEALTH ACCESS PROGRAM	None	None	UNKNOWN	In state provider	50	Stanislaus	MCHENRY	1510 FLORIDA AVE	STE B	MODESTO	CA	953504437	37.665699	-120.996216	215a	13
1952323800	1952323800	1	1	GOODFAITH FAMILY MEDICAL	01Aug1998	022	PHYSICIANS GROUP	None	40	Pediatrics	In state provider	19	Los Angeles	GROUP, A MEDICAL CORP	7770 GARVEY AVE	None	ROSEMEAD	CA	917703061	34.062585	-118.100159	78.2qqq	4825.02
1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	30Mar2009	200	DEVELOPMENTAL SCREENING AND TRAUMA	None	None	UNKNOWN	In state provider	50	Stanislaus	None	2101 TENAYA DR	None	MODESTO	CA	953543930	37.632392	-120.959098	215c	21
1992970016	1992970016	1	1	GERKE, THOMAS J MD INC	01Apr1998	026	PHYSICIANS	G00059290	01	General Practice	In state provider	19	Los Angeles	None	10811 S GREVILLEA AVE	None	LENNOX	CA	903042325	33.938069	-118.354856	78.2r	6017