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HEALTH NET OF CALIFORNIA<br />
SAN BERNARDINO SUPERIOR COURT<br />
MEMBERS BY PPG/PCP<br />
PPG # PARTICIPATING PHYSICIAN GROUP<br />
PHYSICIAN LAST<br />
NAME<br />
PHYSICIAN FIRST<br />
NAME<br />
PHYS<br />
MI<br />
PHYS<br />
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY<br />
PHYS<br />
STATE<br />
PHYS<br />
ZIP LICENSE NPI MEMBERS<br />
644 Desert Oasis Healthcare Afable Jessica G M.D. 265 N. El Cielo Rd. B104 Palm Springs CA 92262 A 00062534 1487648929 1<br />
644 Desert Oasis Healthcare Agarwal Dimple M.D. 7281 Dumosa Ave. 2 Yucca Valley CA 92284 A 00066261 1275632887 1<br />
3425 Alliance Desert Physicians Ahmed Kelly J M.D. 14285 Amargosa Rd. Victorville CA 92392 A 00051407 1659303998 4<br />
0V4 San Bernardino Medical Group Ali Nesib M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00061789 1497725261 3<br />
0P8 My Family Medical Group Alonzo Joseph M M.D. 5475 Walnut Ave. Chino CA 91710 A 00045798 1225077050 1<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Alparce, Jr. Jackson S M.D. 15341 Central Ave Bldg B Chino CA 91710 C 00043079 1427162437 3<br />
644 Desert Oasis Healthcare Anderson III Albert R M.D. 552 S. Paseo Dorotea 2 Palm Springs CA 92264 A 00056013 1013002435 1<br />
644 Desert Oasis Healthcare Arano Vicente J M.D. 57445 29 Palms Hwy. 303 Yucca Valley CA 92284 A 00055658 1790885259 2<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Armada, Jr. Cris A D.O. 10832 Laurel St. 102 Rancho Cucamonga CA 91730 A 00005158 1902823701 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Armour Richard L D.O. 1113 Alta Ave. 110 Upland CA 91786 A 00005860 1366488215 1<br />
0V4 San Bernardino Medical Group Awan Tamseela T M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 C 00051379 1720059413 3<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Azzawi Zaher M.D. 10841 White Oak Ave. 107 Rancho Cucamonga CA 91730 A 00048743 1184809337 3<br />
3397 Phys Assoc Greater San Gabriel Valley - Citrus / Div HCP Bachoura Norma E M.D. 931 Buena Vista St 310 Duarte CA 91010 G 00075576 1235191131 4<br />
2781 Regal Medical Group <strong>of</strong> South Los Angeles Bailey Cristina G M.D. 28780 Single Oak Dr. 160 Temecula CA 92590 A 00067263 1598715823 1<br />
0B6 Beaver Medical Group Ballou Ken<strong>net</strong>h A M.D. 2 W. Fern Ave. Redlands CA 92373 G 00085841 1831145374 8<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Banquerigo Eldine A M.D. 91710 19th St. Rancho Cucamonga CA 91737 A 00053530 1851367528 2<br />
0B6 Beaver Medical Group Banta Craig S M.D. 2 W. Fern Ave. Redlands CA 92373 G 00038986 1235174087 2<br />
3006 Pomona Valley Medical Group, Inc. Barag Steven H D.O. 7974 Haven Ave. 250 Rancho Cucamonga CA 91730 A 00003825 1366444838 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Barag Steven H D.O. 7974 Haven Ave. 250 Rancho Cucamonga CA 91730 A 00003825 1366444838 4<br />
0P5 HealthCare Partners Medical Group - Glendora Barrett Virginia L M.D. 2025 E. Route 66 Glendora CA 91740 G 00035230 1750474557 1<br />
2743 Heritage Victor Valley Medical Group Baumgartner Richard A M.D. 42002 Fox Farm Rd. 200 Big Bear Lake CA 92315 G 00058592 1295816684 1<br />
0P8 My Family Medical Group Be Hing M D.O. 5475 Walnut Ave. Chino CA 91710 A 00007045 1780623512 1<br />
3006 Pomona Valley Medical Group, Inc. Benavidez Michael A D.O. 984 W. Foothill Blvd. Upland CA 91786 A 00006396 1205987914 1<br />
605 Prospect Medical Group Berry Jason D.O. 500 S. Anaheim Hills Rd. 242 Anaheim CA 92807 A 00007047 1598742710 2<br />
2946 Riverside Medical Clinic Berry Ravi K M.D. 7117 Brockton Ave. Riverside CA 92506 A 00042441 1407838220 3<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Beseth Douglas J M.D. 1382 E. Foothill Blvd. Upland CA 91786 C 00030121 1336259720 2<br />
0N4 Beaver Medical Group - Highland Office Beshara Marian N M.D. 7000 Boulder Ave. Highland CA 92346 A 00091972 1982649448 3<br />
2946 Riverside Medical Clinic Bhanu Archana M.D. 6405 Day St. Riverside CA 92507 A 00048082 1598748402 4<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Biegel Su<strong>san</strong> C M.D. 1113 Alta Ave. 220 Upland CA 91786 G 00066575 1710956412 1<br />
3165 High Desert Primary Care - Premier Biswas Nanda M.D. 12677 Hesperia Rd. 170 Victorville CA 92395 A 00047740 1043316656 1<br />
3154 PrimeCare Medical Group <strong>of</strong> San Bernardino, Inc. Bolivar Samuel A M.D. 555 N. D St. 130 San Bernardino CA 92401 A 00041590 1144251067 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Botros Nancy E M.D. 440 N. Mountain Ave. 112 Upland CA 91786 A 00045610 1134179401 2<br />
0T5 Beaver Medical Group - Cooley Ranch Office Bourne Robert C M.D. 1300 E. Cooley Dr. Colton CA 92324 A 00031522 1417985847 8<br />
3132 Redlands - Yucaipa Medical Group Bradshaw Tonda D D.O. 35237 Yucaipa Blvd. Yucaipa CA 92399 A 00006282 1760574123 1<br />
0B6 Beaver Medical Group Brandstater Cherry L M.D. 2 W. Fern Ave. Redlands CA 92373 G 00033366 1699707935 11<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Brenner Louis M.D. 1113 Alta Ave. 110 Upland CA 91786 G 00036509 1003852815 3<br />
3169 Hemet Community Medical Group - Temecula Valley Brown Christina A M.D. 25109 Jefferson Ave. 100 Murrieta CA 92562 A 00113838 1598969057 1<br />
2944 High Desert Primary Care Medical Group Brown Philip S M.D. 12550 Hesperia Rd. Victorville CA 92395 C 00041896 1295735413 2<br />
3499 Pinnacle Medical Group Buhay Carina D M.D. 300 S. Highland Springs Ave. 2D Banning CA 92220 A 00049063 1639143530 1<br />
0B6 Beaver Medical Group Campos Ernesto U D.O. 1300 E. Cooley Dr. Colton CA 92324 A 00009956 1346420999 4<br />
3201 Greater Covina - Regal Medical Group Carcamo Rafael M.D. 647 E. Arrow Hwy. Azusa CA 91702 A 00066675 1821007055 1<br />
0B6 Beaver Medical Group Carritte James A M.D. 2 W. Fern Ave. Redlands CA 92373 G 00048091 1417989757 3<br />
3397 Phys Assoc Greater San Gabriel Valley - Citrus / Div HCP Castellanos Jose Gabriel M.D. 234 E. Badillo St. Covina CA 91723 A 00062398 1669486783 1<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Chai Michael M.D. 1113 Alta Ave. 106 Upland CA 91786 G 00079965 1083748727 1<br />
609 PrimeCare Medical Group <strong>of</strong> Sun City, Inc. Chau Mary C D.O. 28125 Bradley Rd. 240B Sun City CA 92586 A 00007618 1255365888 1<br />
0D9 Beaver Medical Group - Yucaipa Office Chen Charles M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 A 00063693 1124050463 2<br />
2879 Gateway Medical Group Anaheim Memorial Medical Center NeChen Vey M D.O. 8615 Knott Ave. 3 Buena Park CA 90620 A 00007272 1922140201 1<br />
2898 Prospect Pr<strong>of</strong>essional Care Medical Group, Inc. Chung Peter H M.D. 15651 Imperial Hwy. 202 La Mirada CA 90638 G 00036420 1528126752 2<br />
3451 Alpha Care Medical Group Con<strong>net</strong>t David A D.O. 8112 Milliken Ave. 101-2 Rancho Cucamonga CA 91730 A 00009771 1396942983 1<br />
0N4 Beaver Medical Group - Highland Office Coriell Randall E M.D. 7000 Boulder Ave. Highland CA 92346 G 00045041 1912931056 15<br />
586 Beaver Medical Group - Banning Cuni Jill R M.D. 5957 W. Ramsey St. Banning CA 92220 A 00089631 1063442952 2<br />
3169 Hemet Community Medical Group - Temecula Valley Curley Michael P M.D. 39755 Murrieta Hot Springs Rd. B-110 Murrieta CA 92563 A 00045008 1184698003 2<br />
586 Beaver Medical Group - Banning Dalili Irada M.D. 5957 W. Ramsey St. Banning CA 92220 A 00096583 1528092459 2<br />
3154 PrimeCare Medical Group <strong>of</strong> San Bernardino, Inc. Damirchi Cyrus M.D. 399 E. Highland Ave. 212 San Bernardino CA 92404 A 00050298 1891883401 4<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Damirchi Cyrus M.D. 399 E. Highland Ave. 212 San Bernardino CA 92404 A 00050298 1891883401 1<br />
0V4 San Bernardino Medical Group Dao Hai N M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00097539 1033312202 6<br />
609 PrimeCare Medical Group <strong>of</strong> Sun City, Inc. Darnell Duane R D.O. 27994 Bradley Rd. F Sun City CA 92586 A 00004863 1831199728 1<br />
3165 High Desert Primary Care - Premier David Jaime C M.D. 18419 US Highway 18 6 Apple Valley CA 92307 A 00095834 1912056177 2<br />
3397 Phys Assoc Greater San Gabriel Valley - Citrus / Div HCP Davis Steven E D.O. 1125 Via Verde San Dimas CA 91773 A 00005217 1154300978 1<br />
589 Riverside Physician Network Davis III Thomas L M.D. 4646 Brockton Ave. 201 Riverside CA 92506 G 00030895 1376530501 5<br />
2743 Heritage Victor Valley Medical Group De La Cruz Celestina S M.D. 15247 11th St. 800 Victorville CA 92395 A 00033966 1356430730 1<br />
Provider Service Operations<br />
January 2012 1 <strong>of</strong> 5
HEALTH NET OF CALIFORNIA<br />
SAN BERNARDINO SUPERIOR COURT<br />
MEMBERS BY PPG/PCP<br />
PPG # PARTICIPATING PHYSICIAN GROUP<br />
PHYSICIAN LAST<br />
NAME<br />
PHYSICIAN FIRST<br />
NAME<br />
PHYS<br />
MI<br />
PHYS<br />
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY<br />
PHYS<br />
STATE<br />
PHYS<br />
ZIP LICENSE NPI MEMBERS<br />
2688 Choice Medical Group, Inc Delgado Sandra Y M.D. 13010 Hesperia Rd. B Victorville CA 92395 A 00092119 1881652030 5<br />
0V4 San Bernardino Medical Group Desrochers Ann-Renee M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00098858 1932135076 3<br />
2946 Riverside Medical Clinic Deterville Steven M M.D. 830 Magnolia Ave. Corona CA 92879 A 00033195 1700860285 2<br />
0B6 Beaver Medical Group Dixon Varonica L M.D. 245 Terracina Blvd. 202 Redlands CA 92373 G 00068653 1093740680 3<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Dominguez Jesse S D.O. 16465 Sierra Lakes Pkwy. 300 Fontana CA 92336 A 00008942 1467534313 1<br />
589 Riverside Physician Network Doughten Joel D M.D. 4435 Brockton Ave. Riverside CA 92501 A 00045021 1740348226 2<br />
0B6 Beaver Medical Group Douty Regan S D.O. 2 W. Fern Ave. Redlands CA 92373 A 00007064 1295766442 4<br />
644 Desert Oasis Healthcare Dulalia Zosimo G M.D. 265 N. El Cielo Rd. B103 Palm Springs CA 92262 A 00049800 1104899285 1<br />
2688 Choice Medical Group, Inc Earle Charmaine E M.D. 12332 Hesperia Rd. A Victorville CA 92395 A 00080086 1598833303 4<br />
3204 St. Joseph Hospital Affiliated Physicians Elihu Nadia M.D. 1010 W. La Veta Ave. 750 Orange CA 92868 A 00067627 1659340156 1<br />
3166 LaSalle Medical Associates - San Bernardino Emoto Cheryl A M.D. 565 N. Mt. Vernon Ave. San Bernardino CA 92411 G 00055837 1639267966 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Fagan John A M.D. 8263 Grove Ave. 203 Rancho Cucamonga CA 91730 G 00060968 1306904628 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Force-Obrowski Sandra K M.D. 7777 Milliken Ave. B350 Rancho Cucamonga CA 91730 G 00066813 1023034873 8<br />
0B6 Beaver Medical Group Fox Eric R M.D. 2 W. Fern Ave. Redlands CA 92373 G 00063965 1629003991 13<br />
3154 PrimeCare Medical Group <strong>of</strong> San Bernardino, Inc. Franco Daniel M.D. 1800 N. Western Ave. 401 San Bernardino CA 92411 A 00051653 1568494151 1<br />
644 Desert Oasis Healthcare Fraschetti Daniel J D.O. 57445 29 Palms Hwy. 302 Yucca Valley CA 92284 A 00008445 1275538241 2<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Fu Mao-Jin M.D. 5450 Jefferson Ave. 6 Chino CA 91710 A 00033783 1578596920 1<br />
0N4 Beaver Medical Group - Highland Office Furutan Lailae M.D. 7223 Church St. C Highland CA 92346 A 00076474 1912952771 4<br />
2946 Riverside Medical Clinic Furutan Navid P M.D. 830 Magnolia Ave. Corona CA 92879 G 00085917 1518942804 1<br />
586 Beaver Medical Group - Banning Gayid Mamdooh Z M.D. 7000 Boulder Ave. Highland CA 92346 A 00085467 1477554988 1<br />
2944 High Desert Primary Care Medical Group Gevorkian Artin M.D. 17095 Main St. Hesperia CA 92345 A 00094838 1578530291 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Goddard Dwight J M.D. 1382 E. Foothill Blvd. Upland CA 91786 G 00063539 1407835572 4<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Golshan Hedyeh M M.D. 1850 N. Riverside Ave. 230 Rialto CA 92376 A 00075923 1174582688 1<br />
2743 Heritage Victor Valley Medical Group Gorges Firas H M.D. 12408 Hesperia Rd. 2 Victorville CA 92395 A 00109538 1891998118 2<br />
0N4 Beaver Medical Group - Highland Office Goyne Arthur R M.D. 7000 Boulder Ave. Highland CA 92346 G 00067442 1770539140 10<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Grady Yolanda T M.D. 13768 Roswell Ave. 202 Chino CA 91710 A 00053673 1235135518 3<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Grady Yolanda T M.D. 13768 Roswell Ave. 202 Chino CA 91710 A 00053673 1235135518 1<br />
586 Beaver Medical Group - Banning Green Howard I M.D. 5957 W. Ramsey St. Banning CA 92220 G 00041712 1851330674 1<br />
0N4 Beaver Medical Group - Highland Office Greene Gerald R M.D. 7000 Boulder Ave. Highland CA 92346 G 00013351 1326087552 2<br />
2743 Heritage Victor Valley Medical Group Greer Betina G M.D. 12408 Hesperia Rd. 2 Victorville CA 92395 G 00080364 1316924582 2<br />
3499 Pinnacle Medical Group Guadiz Jesse L M.D. 1850 N. Riverside Ave. 240 Rialto CA 92376 A 00053509 1558317933 1<br />
3454 Upland Medical Group Guevara-Channell Patricia M.D. 8008 Haven Ave. 100 Rancho Cucamonga CA 91730 A 00069633 1841266392 1<br />
3165 High Desert Primary Care - Premier Guevarra Loida V M.D. 12760 Hesperia Rd A Victorville CA 92395 A 00053408 1346329331 2<br />
2944 High Desert Primary Care Medical Group Gutierrez David M.D. 17095 Main St. Hesperia CA 92345 A 00050633 1780684910 3<br />
3006 Pomona Valley Medical Group, Inc. Hall Roger D D.O. 790 E. Bonita Ave. Pomona CA 91767 A 00005507 1336118579 1<br />
2902 Regal Medical Group <strong>of</strong> the San Fernando Valley Hammar Su<strong>san</strong> K M.D. 2211 W. Magnolia Blvd. 210 Burbank CA 91506 G 00053696 1518076538 1<br />
2688 Choice Medical Group, Inc Hansen Eric R D.O. 14575 Main St. Hesperia CA 92345 A 00008138 1770562506 3<br />
589 Riverside Physician Network Harasti Eva M.D. 800 Magnolia Ave. 109 Corona CA 92879 A 00049724 1144279753 2<br />
0T5 Beaver Medical Group - Cooley Ranch Office Hay Douglas J M.D. 1300 E. Cooley Dr. Colton CA 92324 G 00047396 1386690980 4<br />
0V4 San Bernardino Medical Group Hellwig Thomas M M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 G 00022531 1275503963 2<br />
3184 PrimeCare <strong>of</strong> Citrus Valley, Inc. Hicks Calvin H M.D. 1860 Hamner Ave. Norco CA 92860 A 00034455 1205911229 1<br />
0D9 Beaver Medical Group - Yucaipa Office Hill Richard M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 G 00086123 1518907617 4<br />
0D9 Beaver Medical Group - Yucaipa Office Hoch John R M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 G 00070570 1770523995 2<br />
3170 Beaver Medical Group - BAHC Hoenshell Wesley L M.D. 1600 E. Citrus Ave. A Redlands CA 92374 G 00040469 1518914316 5<br />
2743 Heritage Victor Valley Medical Group Huynh Thu-Thuy T M.D. 801 E. Mountain View St. E Barstow CA 92311 A 00093982 1740343367 2<br />
2946 Riverside Medical Clinic Hwang Janine M M.D. 7117 Brockton Ave. Riverside CA 92506 A 00088132 1346221710 1<br />
0T5 Beaver Medical Group - Cooley Ranch Office Ibrahim Ireny I M.D. 1300 E. Cooley Dr. Colton CA 92324 A 00064541 1811944598 3<br />
2944 High Desert Primary Care Medical Group Izadi Mehdi D.O. 12550 Hesperia Rd. Victorville CA 92395 A 00005509 1235139437 1<br />
3029 Desert Valley Medical Group, Inc. Jacobson William A M.D. 12276 Hesperia Rd. D Victorville CA 92395 A 00018012 1982655494 5<br />
3006 Pomona Valley Medical Group, Inc. Jaco<strong>by</strong> Ro<strong>by</strong>n D D.O. 430 W. Baseline Rd. Claremont CA 91711 A 00007474 1487623575 2<br />
0B6 Beaver Medical Group Jahromi Mehdi S M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 A 00064559 1356388177 1<br />
3029 Desert Valley Medical Group, Inc. Jegapraga<strong>san</strong> Vannitham<strong>by</strong> M.D. 11499 Bartlett Ave. Adelanto CA 92301 A 00054047 1811072978 5<br />
3348 Arroyo Seco Medical Group, A Division <strong>of</strong> Healthcare Partners Jiao Lu M.D. 301 S. Fair Oaks Ave. 300 Pasadena CA 91105 A 00073573 1023162187 1<br />
2743 Heritage Victor Valley Medical Group Johnson Norman E M.D. 41949 Big Bear Blvd. Big Bear Lake CA 92315 C 00037654 1497704506 3<br />
3170 Beaver Medical Group - BAHC Jones Gregory M M.D. 1600 E. Citrus Ave. A Redlands CA 92374 A 00043544 1366484362 11<br />
2944 High Desert Primary Care Medical Group Jones Richard F D.O. 18660 US Hwy. 18 Apple Valley CA 92307 A 00005831 1750388195 3<br />
3132 Redlands - Yucaipa Medical Group Jones Walter M.D. 33423 Yucaipa Blvd. D Yucaipa CA 92399 A 00054962 1164593372 1<br />
644 Desert Oasis Healthcare Jones-Poland Edith A M.D. 57475 29 Palms Hwy. 101 Yucca Valley CA 92284 A 00076482 1740283084 9<br />
0V4 San Bernardino Medical Group Jordan Aaron S M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 G 00048703 1972573756 4<br />
2688 Choice Medical Group, Inc Kamath Ram K M.D. 19015 Town Center Dr. 101 Apple Valley CA 92308 A 00046329 1386649556 1<br />
2688 Choice Medical Group, Inc Kamath Udaya R M.D. 19015 Town Center Dr. 101 Apple Valley CA 92308 A 00050460 1346204104 4<br />
Provider Service Operations<br />
January 2012 2 <strong>of</strong> 5
HEALTH NET OF CALIFORNIA<br />
SAN BERNARDINO SUPERIOR COURT<br />
MEMBERS BY PPG/PCP<br />
PPG # PARTICIPATING PHYSICIAN GROUP<br />
PHYSICIAN LAST<br />
NAME<br />
PHYSICIAN FIRST<br />
NAME<br />
PHYS<br />
MI<br />
PHYS<br />
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY<br />
PHYS<br />
STATE<br />
PHYS<br />
ZIP LICENSE NPI MEMBERS<br />
0B6 Beaver Medical Group Kang Junku (John) M.D. 2 W. Fern Ave. Redlands CA 92373 G 00076252 1265474225 2<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Kaura Vinod K M.D. 1800 N. Western Ave. 303 San Bernardino CA 92411 A 00032106 1225117328 1<br />
0B6 Beaver Medical Group Kennedy Casey M M.D. 2 W. Fern Ave. Redlands CA 92373 G 00073379 1801839246 1<br />
3006 Pomona Valley Medical Group, Inc. Khairullah Firhana Z D.O. 8112 Milliken Ave. 101-2 Rancho Cucamonga CA 91730 A 00009087 1558438382 2<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Khairullah Firhana Z D.O. 887 E. Second St. C Pomona CA 91766 A 00009087 1558438382 2<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Kim Albert I D.O. 4200 Chino Hills Pkwy. 910 Chino Hills CA 91709 A 00007390 1669575510 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Kim Jin M M.D. 7777 Milliken Ave. B110 Rancho Cucamonga CA 91730 A 00061463 1558371401 6<br />
0P5 HealthCare Partners Medical Group - Glendora Kim-Park Lisa H M.D. 2025 E. Route 66 Glendora CA 91740 G 00065500 1144312505 1<br />
589 Riverside Physician Network Knopke Carl G M.D. 4646 Brockton Ave. 302 Riverside CA 92506 A 00082718 1073500294 1<br />
3006 Pomona Valley Medical Group, Inc. Kona Sudhakar R M.D. 1866 N. Orange Grove Ave. 102 Pomona CA 91767 A 00034736 1619080215 4<br />
3397 Phys Assoc Greater San Gabriel Valley - Citrus / Div HCP Koumas John C D.O. 767 S. Sunset Ave. 4 West Covina CA 91790 A 00005515 1134111958 3<br />
2995 Greater Newport Physicians Krafcik Sonja M.D. 25500 Rancho Niguel Rd. 250 Laguna Niguel CA 92677 C 00051621 1598767170 1<br />
2743 Heritage Victor Valley Medical Group Krider James C M.D. 18182 US Hwy. 18 105 Apple Valley CA 92307 G 00048897 1215959945 2<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Kular Sarina H M.D. 7974 Haven Ave. 210 Rancho Cucamonga CA 91730 A 00061563 1366484883 1<br />
3205 St. Jude Heritage Medical Group Kwon Steve O M.D. 4300 Rose Dr. Yorba Linda CA 92886 A 00085597 1841399847 3<br />
0V4 San Bernardino Medical Group Lao Mariclem P M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00053653 1487624169 6<br />
0N4 Beaver Medical Group - Highland Office Lee Philip W M.D. 7000 Boulder Ave. Highland CA 92346 A 00054896 1255387320 7<br />
0V4 San Bernardino Medical Group Lee-Jackson Faith M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00063452 1699745471 6<br />
0N4 Beaver Medical Group - Highland Office Leong Michael G M.D. 7223 Church St. C1 Highland CA 92346 A 00048608 1639125354 7<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Leoni Regina M M.D. 8599 Haven Ave. 106 Rancho Cucamonga CA 91730 A 00083418 1568573582 5<br />
0D9 Beaver Medical Group - Yucaipa Office Leparulo Yolanda A M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 G 00029330 1942256664 4<br />
2946 Riverside Medical Clinic Li Albert Y M.D. 7117 Brockton Ave. Riverside CA 92506 G 00069917 1700868510 3<br />
0P8 My Family Medical Group Lira J. Alex M.D. 5475 Walnut Ave. Chino CA 91710 A 00030733 1821038985 1<br />
3006 Pomona Valley Medical Group, Inc. Loa Hedy C M.D. 9675 Monte Vista Ave. D Montclair CA 91763 A 00038337 1093720666 2<br />
2944 High Desert Primary Care Medical Group Lopa Nasrin Z M.D. 17095 Main St. Hesperia CA 92345 A 00095490 1982750014 1<br />
0V4 San Bernardino Medical Group Macedo Brynn A D.O. 17051 Sierra Lakes Pkwy. 103 Fontana CA 92336 A 00009314 1780872432 1<br />
3397 Phys Assoc Greater San Gabriel Valley - Citrus / Div HCP Madanat George M M.D. 1330 W. Covina Blvd. 106 San Dimas CA 91773 A 00026511 1962578583 1<br />
714 PrimeCare Medical Group <strong>of</strong> Riverside, Inc. Mahdi Tarek Z M.D. 4310 Orange St. Riverside CA 92501 A 00053772 1932137544 3<br />
0B6 Beaver Medical Group Mailander Mary M M.D. 245 Terracina Blvd. 202 Redlands CA 92373 G 00042342 1649218827 16<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Mak Dianna M D.O. 9089 Baseline Rd. 100 Rancho Cucamonga CA 91730 A 00005237 1104936988 2<br />
2688 Choice Medical Group, Inc Malhotra Ashish M.D. 18522 US Highway 18 208 Apple Valley CA 92307 A 00091216 1679583744 5<br />
2688 Choice Medical Group, Inc Mamo Dawit M.D. 16070 Tuscola Rd. Apple Valley CA 92307 A 00054482 1346251568 1<br />
3006 Pomona Valley Medical Group, Inc. Mantha Usha M.D. 1101 N. Euclid Ave. B Upland CA 91786 C 00052047 1306806948 1<br />
0T2 PrimeCare Medical Group <strong>of</strong> Temecula, Inc. McKerahan Kelly L D.O. 25095 Jefferson Ave. 202 Murrieta CA 92562 A 00006780 1184705790 2<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. McMillian Lothar M.D. 7777 Milliken Ave. B240 Rancho Cucamonga CA 91730 A 00045238 1588748891 11<br />
3377 Inland HealthCare Group, Inc Meltzer Elliott A M.D. 1850 N. Riverside Ave. 180 Rialto CA 92376 C 00039403 1992755284 1<br />
3165 High Desert Primary Care - Premier Melvani Ashok N M.D. 12677 Hesperia Rd. 140 Victorville CA 92395 C 00043029 1447334099 2<br />
3165 High Desert Primary Care - Premier Menon Radha M.D. 18056 Wika Rd. C Apple Valley CA 92307 A 00041126 1033104724 1<br />
3006 Pomona Valley Medical Group, Inc. Miya Glenn Y M.D. 430 W. Baseline Rd. Claremont CA 91711 G 00070876 1912967894 2<br />
0D9 Beaver Medical Group - Yucaipa Office Morales Raymundo A M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 A 00064001 1396784401 1<br />
3211 Coachella Valley Physicians Morgan Yvonne G M.D. 1080 N. Indian Canyon Dr. 200 Palm Springs CA 92262 A 00052037 1255305678 1<br />
644 Desert Oasis Healthcare Morgan Yvonne G M.D. 1080 N. Indian Canyon Dr. 200 Palm Springs CA 92262 A 00052037 1255305678 1<br />
2743 Heritage Victor Valley Medical Group Moushabek Roger A M.D. 12402 Industrial Blvd. B6 Victorville CA 92395 A 00044696 1073541157 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Mowjood Muhammad R D.O. 1175 E. Arrow Hwy. B Upland CA 91786 A 00008033 1851389464 2<br />
2743 Heritage Victor Valley Medical Group Mueller Craig R M.D. 11919 Hesperia Rd. 1 Hesperia CA 92345 G 00048718 1154375053 1<br />
2946 Riverside Medical Clinic Muradyan Ruben M.D. 6405 Day St. Riverside CA 92507 A 00051749 1124001045 1<br />
2688 Choice Medical Group, Inc Murthy Nirmala M.D. 18523 Corwin Rd. H Apple Valley CA 92307 A 00043124 1043233109 1<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Narvasa Ofelia L M.D. 3626 Grand Ave. A Chino Hills CA 91709 A 00073322 1558404558 1<br />
644 Desert Oasis Healthcare Nasr Hugh S M.D. 7281 Dumosa Ave. 4 Yucca Valley CA 92284 G 00046203 1073588737 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Nery Generoso S M.D. 1183 E Foothill Blvd 135 Upland CA 91786 A 00031007 1851408116 1<br />
0B6 Beaver Medical Group Neufeld Timothy E M.D. 2 W. Fern Ave. Redlands CA 92373 G 00068585 1255386330 1<br />
2970 United Family Care Nguyen J Duc N M.D. 8110 Mango Ave. Fontana CA 92335 A 00062436 1427018456 1<br />
586 Beaver Medical Group - Banning Nicholass Su<strong>san</strong>na R M.D. 5957 W. Ramsey St. Banning CA 92220 A 00107871 1598922882 1<br />
2743 Heritage Victor Valley Medical Group Norman Michael D.O. 41930 Garstin Rd. Big Bear Lake CA 92315 A 00006319 1912978123 1<br />
0B6 Beaver Medical Group Nutter David W M.D. 2 W. Fern Ave. Redlands CA 92373 G 00058102 1912946757 4<br />
2946 Riverside Medical Clinic Oh Samuel S M.D. 6250 Clay St. Riverside CA 92509 G 00078217 1760466197 1<br />
2743 Heritage Victor Valley Medical Group Olegario Alberta C M.D. 209 N. Second Ave. Barstow CA 92311 A 00038258 1053357012 2<br />
3006 Pomona Valley Medical Group, Inc. Olivares Gisella V D.O. 984 W. Foothill Blvd. Upland CA 91786 A 00008664 1821138405 1<br />
0B6 Beaver Medical Group ONeal Timothy R M.D. 2 W. Fern Ave. Redlands CA 92373 G 00027224 1497794119 18<br />
3029 Desert Valley Medical Group, Inc. Oo Thien M.D. 12276 Hesperia Rd Victorville CA 92395 A 00092864 1467404897 1<br />
2688 Choice Medical Group, Inc Panjwani Sonia M.D. 12760 Hesperia Rd. B Victorville CA 92395 A 00051868 1316978075 1<br />
Provider Service Operations<br />
January 2012 3 <strong>of</strong> 5
HEALTH NET OF CALIFORNIA<br />
SAN BERNARDINO SUPERIOR COURT<br />
MEMBERS BY PPG/PCP<br />
PPG # PARTICIPATING PHYSICIAN GROUP<br />
PHYSICIAN LAST<br />
NAME<br />
PHYSICIAN FIRST<br />
NAME<br />
PHYS<br />
MI<br />
PHYS<br />
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY<br />
PHYS<br />
STATE<br />
PHYS<br />
ZIP LICENSE NPI MEMBERS<br />
2781 Regal Medical Group <strong>of</strong> South Los Angeles Panossian Ayuna K M.D. 401 S. Glenoaks Blvd. 101 Burbank CA 91502 A 00086367 1952423014 1<br />
2688 Choice Medical Group, Inc Paredes Gustavo A M.D. 500 S. Seventh Ave. B Barstow CA 92311 A 00112533 1164697173 1<br />
0B6 Beaver Medical Group Park Moses I M.D. 2 W. Fern Ave. Redlands CA 92373 A 00096734 1528079639 4<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Pascual Filomena S M.D. 8710 Monroe Ct. 200 Rancho Cucamonga CA 91730 A 00042652 1275636201 3<br />
703 PrimeCare Medical Group <strong>of</strong> Corona, Inc. Patel Hitesh C M.D. 127 N. McKinley St. 101 Corona CA 92879 A 00050723 1902833734 1<br />
3377 Inland HealthCare Group, Inc Paul Carey B M.D. 7291 Boulder Ave. 2C Highland CA 92346 C 00042993 1376594804 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Perez Glenn M M.D. 630 N. 13th Ave. A Upland CA 91786 A 00046494 1841412913 4<br />
0B6 Beaver Medical Group Peterson Stephen R M.D. 2 W. Fern Ave. Redlands CA 92373 G 00039967 1326087560 2<br />
2944 High Desert Primary Care Medical Group Petrus Dana C M.D. 18031 US Hwy. 18 B Apple Valley CA 92307 A 00079858 1851391080 2<br />
2944 High Desert Primary Care Medical Group Pham Mino M.D. 17095 Main St. Hesperia CA 92345 A 00082929 1760482996 5<br />
2743 Heritage Victor Valley Medical Group Prakash Om M.D. 18056 Wika Rd. B Apple Valley CA 92307 A 00039024 1184696007 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Quan Tiffany L M.D. 7777 Milliken Ave. 150 Rancho Cucamonga CA 91730 A 00077358 1750397261 3<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Quinio Amor A M.D. 9720 19th St. Rancho Cucamonga CA 91737 A 00050109 1609075548 3<br />
3165 High Desert Primary Care - Premier Quion Agnes G M.D. 12677 Hesperia Rd. 120 Victorville CA 92395 A 00052515 1588731202 2<br />
2898 Prospect Pr<strong>of</strong>essional Care Medical Group, Inc. Rahnemun Maryam M.D. 520 N. Main St. 220 Santa Ana CA 92701 A 00053377 1114921673 1<br />
3132 Redlands - Yucaipa Medical Group Rains Roger W M.D. 245 Terracina Blvd. 101B Redlands CA 92373 G 00050811 1689776932 1<br />
3029 Desert Valley Medical Group, Inc. Rajkumar Sumitha M.D. 12276 Hesperia Rd. A Victorville CA 92395 A 00084719 1831200963 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Rashidi Wendy M M.D. 299 W. Foothill Blvd. 209 Upland CA 91786 G 00055445 1245335777 1<br />
3029 Desert Valley Medical Group, Inc. Reddy Geetha M.D. 17450 Main St. I Hesperia CA 92345 A 00063321 1043260540 5<br />
3205 St. Jude Heritage Medical Group Rioux Doreen M D.O. 4300 Rose Dr. Yorba Linda CA 92886 A 00005249 1124029020 2<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Rodriguez Jose A M.D. 742 W. Highland Ave. San Bernardino CA 92405 A 00078410 1508829185 1<br />
2944 High Desert Primary Care Medical Group Rodriguez Joseph L M.D. 12550 Hesperia Rd. 100 Victorville CA 92395 A 00087545 1760420053 1<br />
3166 LaSalle Medical Associates - San Bernardino Rodriguez Romeo N M.D. 565 N. Mt. Vernon Ave. San Bernardino CA 92411 A 00031849 1336246685 1<br />
3185 Talbert Medical Group - Lakewood Rosero Ramiro M.D. 3650 South St. 303 Lakewood CA 90712 A 00066094 1326049800 1<br />
3006 Pomona Valley Medical Group, Inc. Rude Gerald D M.D. 430 W. Baseline Rd. Claremont CA 91711 C 00023727 1174583090 1<br />
0N4 Beaver Medical Group - Highland Office Salazar Su<strong>san</strong> M M.D. 7000 Boulder Ave. Highland CA 92346 G 00051065 1457391591 23<br />
714 PrimeCare Medical Group <strong>of</strong> Riverside, Inc. Salemi-Castro Hector L M.D. 10327 Hole Ave. Riverside CA 92505 A 00073975 1841223658 1<br />
644 Desert Oasis Healthcare Salhotra Prem P M.D. 72724 29 Palms Hwy. 101 Twentynine Palms CA 92277 A 00042671 1457302812 4<br />
0B6 Beaver Medical Group Sarkis Nairy K M.D. 1600 E. Citrus Ave. A Redlands CA 92374 A 00089267 1225000755 5<br />
3170 Beaver Medical Group - BAHC Sarkis Nairy K M.D. 1600 E. Citrus Ave. A Redlands CA 92374 A 00089267 1225000755 1<br />
2743 Heritage Victor Valley Medical Group Sawan Ziad R M.D. 16003 Tuscola Rd. F Apple Valley CA 92307 G 00055163 1912958786 4<br />
546 HealthCare Partners Medical Group / Magan - Covina Scheibe Scott D M.D. 3833 Emerald Ave. La Verne CA 91750 G 00062574 1770542672 1<br />
703 PrimeCare Medical Group <strong>of</strong> Corona, Inc. Shah Rupal B M.D. 770 Magnolia Ave. 1K Corona CA 92879 A 00051553 1396730560 1<br />
2688 Choice Medical Group, Inc Sharma Akhil M.D. 17259 Jasmine St. A Victorville CA 92395 A 00075666 1619995016 4<br />
3425 Alliance Desert Physicians Sharma Anupama M.D. 17259 Jasmine St. B Victorville CA 92395 A 00054985 1851387948 6<br />
3029 Desert Valley Medical Group, Inc. Sharma Aparna M.D. 17450 Main St. E Hesperia CA 92345 A 00074104 1578581963 3<br />
714 PrimeCare Medical Group <strong>of</strong> Riverside, Inc. Shaw John R M.D. 3719 Arlington Ave. 1 Riverside CA 92506 G 00015265 1538126438 1<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Sheth Leena S M.D. 1460 E. Holt Ave. 10 Pomona CA 91767 A 00046030 1255365722 1<br />
546 HealthCare Partners Medical Group / Magan - Covina Shine Kimberly I M.D. 420 W. Rowland St. Covina CA 91723 A 00076961 1598724114 1<br />
589 Riverside Physician Network Sindher Raj K M.D. 4646 Brockton Ave. 203 Riverside CA 92506 A 00037401 1477540615 1<br />
0B6 Beaver Medical Group Singh Harpreet M.D. 1300 E. Cooley Dr. Colton CA 92324 A 00107330 1881805745 9<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Singh Ravinder M.D. 10837 Laurel St. 200 Rancho Cucamonga CA 91730 A 00083857 1528113909 4<br />
0N4 Beaver Medical Group - Highland Office Singh Ravneet K M.D. 7000 Boulder Ave. Highland CA 92346 A 00092041 1568491066 7<br />
2995 Greater Newport Physicians Siskind Andrew P M.D. 16300 Sand Canyon Ave. 410 Irvine CA 92618 G 00050342 1619917663 1<br />
644 Desert Oasis Healthcare Smith Eldene A M.D. 57463 29 Palms Hwy. 203 Yucca Valley CA 92284 A 00038944 1164424479 5<br />
3170 Beaver Medical Group - BAHC Smith Roy C M.D. 1600 E. Citrus Ave. A Redlands CA 92374 G 00036146 1073552212 2<br />
3205 St. Jude Heritage Medical Group Smith Ynolde F D.O. 2151 N. Harbor Blvd. 3200 Fullerton CA 92835 A 00009284 1013950443 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Soliguen Max V M.D. 1183 E. Foothill Blvd. 230 Upland CA 91786 A 00056150 1700866894 1<br />
2743 Heritage Victor Valley Medical Group Sood Archna M.D. 12998 Hesperia Rd. 101 Victorville CA 92395 A 00062831 1003980756 3<br />
0V4 San Bernardino Medical Group Sowell Bryan L M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00054025 1306896691 4<br />
3158 Regal Medical Group <strong>of</strong> San Bernardino County Stalmach Daniel M M.D. 720 Brookside Ave. 102 Redlands CA 92373 A 00050334 1932322880 1<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Stockford Lisa C D.O. 5253 Riverside Dr. Chino CA 91710 A 00007925 1710986328 1<br />
2743 Heritage Victor Valley Medical Group Stoops Peter J D.O. 3936 Phelan Rd. F1 Phelan CA 92371 A 00007321 1518912526 1<br />
3029 Desert Valley Medical Group, Inc. Subherwal Yash P M.D. 16850 Bear Valley Rd. 101 Victorville CA 92395 A 00053784 1689720781 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Sullivan James R M.D. 16465 Sierra Lakes Pkwy. 300 Fontana CA 92336 C 00024390 1467549436 1<br />
3006 Pomona Valley Medical Group, Inc. Ta Viet D M.D. 1101 E. Holt Ave. G Pomona CA 91767 A 00069957 1861415390 2<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Ta Viet D M.D. 7777 Milliken Ave. 150 Rancho Cucamonga CA 91730 A 00069957 1861415390 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Tampoya Florencia T M.D. 8112 Milliken Ave. 100 Rancho Cucamonga CA 91730 A 00047994 1518931450 1<br />
2946 Riverside Medical Clinic Tang Ricky P M.D. 6250 Clay St. Riverside CA 92509 A 00070284 1154305639 2<br />
2688 Choice Medical Group, Inc Telgt-Mckinney Yvonne R M.D. 11424 Chamberlaine Way 11 Adelanto CA 92301 A 00087666 1689607053 2<br />
2946 Riverside Medical Clinic Thio David H M.D. 7117 Brockton Ave. Riverside CA 92506 G 00080273 1548244965 1<br />
Provider Service Operations<br />
January 2012 4 <strong>of</strong> 5
HEALTH NET OF CALIFORNIA<br />
SAN BERNARDINO SUPERIOR COURT<br />
MEMBERS BY PPG/PCP<br />
PPG # PARTICIPATING PHYSICIAN GROUP<br />
PHYSICIAN LAST<br />
NAME<br />
PHYSICIAN FIRST<br />
NAME<br />
PHYS<br />
MI<br />
PHYS<br />
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY<br />
PHYS<br />
STATE<br />
PHYS<br />
ZIP LICENSE NPI MEMBERS<br />
0V4 San Bernardino Medical Group Thompson Donna R M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 G 00067144 1033189568 7<br />
609 PrimeCare Medical Group <strong>of</strong> Sun City, Inc. To Bryan H M.D. 24910 Las Brisas Rd. 120 Murrieta CA 92562 A 00084344 1407948474 1<br />
0T2 PrimeCare Medical Group <strong>of</strong> Temecula, Inc. To Bryan H M.D. 25395 Hancock Ave. 240 Murrieta CA 92562 A 00084344 1407948474 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. To Sean S M.D. 8283 Grove Ave. 201 Rancho Cucamonga CA 91730 A 00075204 1922163310 6<br />
2970 United Family Care Tooma Raja S M.D. 8110 Mango Ave. 102 Fontana CA 92335 A 00036223 1497714927 2<br />
2743 Heritage Victor Valley Medical Group Tran Tiffany T M.D. 12408 Hesperia Rd. 2 Victorville CA 92395 A 00116304 1831350131 1<br />
741 PrimeCare Medical Group <strong>of</strong> Chino Valley Tsai William T D.O. 4950 San Bernardino St. 218 Montclair CA 91763 A 00007115 1285620443 2<br />
589 Riverside Physician Network Tweed Rosemarie D.O. 14114 Business Center Dr. A Moreno Valley CA 92553 A 00005397 1659320497 3<br />
2743 Heritage Victor Valley Medical Group Unassigned Unassigned 2<br />
3165 High Desert Primary Care - Premier Velasquez Joel G M.D. 12677 Hesperia Rd. 130 Victorville CA 92395 A 00051953 1639175490 3<br />
2970 United Family Care Verde Herminia Q M.D. 8110 Mango Ave. Fontana CA 92335 A 00032826 1104885607 4<br />
2743 Heritage Victor Valley Medical Group Vizcarra Michael C M.D. 11919 Hesperia Rd. Hesperia CA 92345 G 00029952 1962457911 1<br />
2688 Choice Medical Group, Inc Vora Dipak G M.D. 705 E. Virginia Way I Barstow CA 92311 A 00045558 1013950658 3<br />
3029 Desert Valley Medical Group, Inc. Walia Rajeev M.D. 17450 Main St. A Hesperia CA 92345 A 00082688 1104924679 2<br />
3132 Redlands - Yucaipa Medical Group Wang Cheng M.D. 355 Terracina Blvd. Grand Terrace CA 92373 G 00063715 1205859089 1<br />
546 HealthCare Partners Medical Group / Magan - Covina Weisz Jonathon M M.D. 420 W. Rowland St. Covina CA 91723 G 00074937 1841259298 2<br />
0D9 Beaver Medical Group - Yucaipa Office West Heather D M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 A 00064937 1891805040 4<br />
0N4 Beaver Medical Group - Highland Office Whiteside Paul M M.D. 7223 Church St. C1 Highland CA 92346 A 00035353 1861432874 11<br />
3204 St. Joseph Hospital Affiliated Physicians Wong Allan M M.D. 1310 W. Stewart Dr. 506 Orange CA 92868 G 00074464 1831224450 1<br />
0T5 Beaver Medical Group - Cooley Ranch Office Yamada Robert K M.D. 1300 E. Cooley Dr. Colton CA 92324 G 00058149 1790724243 1<br />
3071 Healthcare Partners IPA - Pasadena Yi Tom Y D.O. 127 N. Madison Ave. 107 Pasadena CA 91101 A 00007811 1336198514 1<br />
590 PrimeCare Medical Group <strong>of</strong> Inland Valley, Inc. Zini Gilbert J M.D. 8283 Grove Ave. 106 Rancho Cucamonga CA 91730 A 00030191 1558375303 1<br />
Provider Service Operations<br />
January 2012 5 <strong>of</strong> 5
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