health net of california san bernardino superior court members by ...

HEALTH NET OF CALIFORNIA
SAN BERNARDINO SUPERIOR COURT
MEMBERS BY PPG/PCP
PPG # PARTICIPATING PHYSICIAN GROUP
PHYSICIAN LAST
NAME
PHYSICIAN FIRST
NAME
PHYS
MI
PHYS
TITLE PHYSICIAN ADDRESS PHYSICIAN CITY
PHYS
STATE
PHYS
ZIP LICENSE NPI MEMBERS
2688 Choice Medical Group, Inc Delgado Sandra Y M.D. 13010 Hesperia Rd. B Victorville CA 92395 A 00092119 1881652030 5
0V4 San Bernardino Medical Group Desrochers Ann-Renee M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 A 00098858 1932135076 3
2946 Riverside Medical Clinic Deterville Steven M M.D. 830 Magnolia Ave. Corona CA 92879 A 00033195 1700860285 2
0B6 Beaver Medical Group Dixon Varonica L M.D. 245 Terracina Blvd. 202 Redlands CA 92373 G 00068653 1093740680 3
590 PrimeCare Medical Group of Inland Valley, Inc. Dominguez Jesse S D.O. 16465 Sierra Lakes Pkwy. 300 Fontana CA 92336 A 00008942 1467534313 1
589 Riverside Physician Network Doughten Joel D M.D. 4435 Brockton Ave. Riverside CA 92501 A 00045021 1740348226 2
0B6 Beaver Medical Group Douty Regan S D.O. 2 W. Fern Ave. Redlands CA 92373 A 00007064 1295766442 4
644 Desert Oasis Healthcare Dulalia Zosimo G M.D. 265 N. El Cielo Rd. B103 Palm Springs CA 92262 A 00049800 1104899285 1
2688 Choice Medical Group, Inc Earle Charmaine E M.D. 12332 Hesperia Rd. A Victorville CA 92395 A 00080086 1598833303 4
3204 St. Joseph Hospital Affiliated Physicians Elihu Nadia M.D. 1010 W. La Veta Ave. 750 Orange CA 92868 A 00067627 1659340156 1
3166 LaSalle Medical Associates - San Bernardino Emoto Cheryl A M.D. 565 N. Mt. Vernon Ave. San Bernardino CA 92411 G 00055837 1639267966 1
590 PrimeCare Medical Group of Inland Valley, Inc. Fagan John A M.D. 8263 Grove Ave. 203 Rancho Cucamonga CA 91730 G 00060968 1306904628 1
590 PrimeCare Medical Group of Inland Valley, Inc. Force-Obrowski Sandra K M.D. 7777 Milliken Ave. B350 Rancho Cucamonga CA 91730 G 00066813 1023034873 8
0B6 Beaver Medical Group Fox Eric R M.D. 2 W. Fern Ave. Redlands CA 92373 G 00063965 1629003991 13
3154 PrimeCare Medical Group of San Bernardino, Inc. Franco Daniel M.D. 1800 N. Western Ave. 401 San Bernardino CA 92411 A 00051653 1568494151 1
644 Desert Oasis Healthcare Fraschetti Daniel J D.O. 57445 29 Palms Hwy. 302 Yucca Valley CA 92284 A 00008445 1275538241 2
741 PrimeCare Medical Group of Chino Valley Fu Mao-Jin M.D. 5450 Jefferson Ave. 6 Chino CA 91710 A 00033783 1578596920 1
0N4 Beaver Medical Group - Highland Office Furutan Lailae M.D. 7223 Church St. C Highland CA 92346 A 00076474 1912952771 4
2946 Riverside Medical Clinic Furutan Navid P M.D. 830 Magnolia Ave. Corona CA 92879 G 00085917 1518942804 1
586 Beaver Medical Group - Banning Gayid Mamdooh Z M.D. 7000 Boulder Ave. Highland CA 92346 A 00085467 1477554988 1
2944 High Desert Primary Care Medical Group Gevorkian Artin M.D. 17095 Main St. Hesperia CA 92345 A 00094838 1578530291 1
590 PrimeCare Medical Group of Inland Valley, Inc. Goddard Dwight J M.D. 1382 E. Foothill Blvd. Upland CA 91786 G 00063539 1407835572 4
3158 Regal Medical Group of San Bernardino County Golshan Hedyeh M M.D. 1850 N. Riverside Ave. 230 Rialto CA 92376 A 00075923 1174582688 1
2743 Heritage Victor Valley Medical Group Gorges Firas H M.D. 12408 Hesperia Rd. 2 Victorville CA 92395 A 00109538 1891998118 2
0N4 Beaver Medical Group - Highland Office Goyne Arthur R M.D. 7000 Boulder Ave. Highland CA 92346 G 00067442 1770539140 10
741 PrimeCare Medical Group of Chino Valley Grady Yolanda T M.D. 13768 Roswell Ave. 202 Chino CA 91710 A 00053673 1235135518 3
590 PrimeCare Medical Group of Inland Valley, Inc. Grady Yolanda T M.D. 13768 Roswell Ave. 202 Chino CA 91710 A 00053673 1235135518 1
586 Beaver Medical Group - Banning Green Howard I M.D. 5957 W. Ramsey St. Banning CA 92220 G 00041712 1851330674 1
0N4 Beaver Medical Group - Highland Office Greene Gerald R M.D. 7000 Boulder Ave. Highland CA 92346 G 00013351 1326087552 2
2743 Heritage Victor Valley Medical Group Greer Betina G M.D. 12408 Hesperia Rd. 2 Victorville CA 92395 G 00080364 1316924582 2
3499 Pinnacle Medical Group Guadiz Jesse L M.D. 1850 N. Riverside Ave. 240 Rialto CA 92376 A 00053509 1558317933 1
3454 Upland Medical Group Guevara-Channell Patricia M.D. 8008 Haven Ave. 100 Rancho Cucamonga CA 91730 A 00069633 1841266392 1
3165 High Desert Primary Care - Premier Guevarra Loida V M.D. 12760 Hesperia Rd A Victorville CA 92395 A 00053408 1346329331 2
2944 High Desert Primary Care Medical Group Gutierrez David M.D. 17095 Main St. Hesperia CA 92345 A 00050633 1780684910 3
3006 Pomona Valley Medical Group, Inc. Hall Roger D D.O. 790 E. Bonita Ave. Pomona CA 91767 A 00005507 1336118579 1
2902 Regal Medical Group of the San Fernando Valley Hammar Susan K M.D. 2211 W. Magnolia Blvd. 210 Burbank CA 91506 G 00053696 1518076538 1
2688 Choice Medical Group, Inc Hansen Eric R D.O. 14575 Main St. Hesperia CA 92345 A 00008138 1770562506 3
589 Riverside Physician Network Harasti Eva M.D. 800 Magnolia Ave. 109 Corona CA 92879 A 00049724 1144279753 2
0T5 Beaver Medical Group - Cooley Ranch Office Hay Douglas J M.D. 1300 E. Cooley Dr. Colton CA 92324 G 00047396 1386690980 4
0V4 San Bernardino Medical Group Hellwig Thomas M M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 G 00022531 1275503963 2
3184 PrimeCare of Citrus Valley, Inc. Hicks Calvin H M.D. 1860 Hamner Ave. Norco CA 92860 A 00034455 1205911229 1
0D9 Beaver Medical Group - Yucaipa Office Hill Richard M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 G 00086123 1518907617 4
0D9 Beaver Medical Group - Yucaipa Office Hoch John R M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 G 00070570 1770523995 2
3170 Beaver Medical Group - BAHC Hoenshell Wesley L M.D. 1600 E. Citrus Ave. A Redlands CA 92374 G 00040469 1518914316 5
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
2946 Riverside Medical Clinic Hwang Janine M M.D. 7117 Brockton Ave. Riverside CA 92506 A 00088132 1346221710 1
0T5 Beaver Medical Group - Cooley Ranch Office Ibrahim Ireny I M.D. 1300 E. Cooley Dr. Colton CA 92324 A 00064541 1811944598 3
2944 High Desert Primary Care Medical Group Izadi Mehdi D.O. 12550 Hesperia Rd. Victorville CA 92395 A 00005509 1235139437 1
3029 Desert Valley Medical Group, Inc. Jacobson William A M.D. 12276 Hesperia Rd. D Victorville CA 92395 A 00018012 1982655494 5
3006 Pomona Valley Medical Group, Inc. Jacoby Robyn D D.O. 430 W. Baseline Rd. Claremont CA 91711 A 00007474 1487623575 2
0B6 Beaver Medical Group Jahromi Mehdi S M.D. 33758 Yucaipa Blvd. Yucaipa CA 92399 A 00064559 1356388177 1
3029 Desert Valley Medical Group, Inc. Jegapragasan Vannithamby M.D. 11499 Bartlett Ave. Adelanto CA 92301 A 00054047 1811072978 5
3348 Arroyo Seco Medical Group, A Division of Healthcare Partners Jiao Lu M.D. 301 S. Fair Oaks Ave. 300 Pasadena CA 91105 A 00073573 1023162187 1
2743 Heritage Victor Valley Medical Group Johnson Norman E M.D. 41949 Big Bear Blvd. Big Bear Lake CA 92315 C 00037654 1497704506 3
3170 Beaver Medical Group - BAHC Jones Gregory M M.D. 1600 E. Citrus Ave. A Redlands CA 92374 A 00043544 1366484362 11
2944 High Desert Primary Care Medical Group Jones Richard F D.O. 18660 US Hwy. 18 Apple Valley CA 92307 A 00005831 1750388195 3
3132 Redlands - Yucaipa Medical Group Jones Walter M.D. 33423 Yucaipa Blvd. D Yucaipa CA 92399 A 00054962 1164593372 1
644 Desert Oasis Healthcare Jones-Poland Edith A M.D. 57475 29 Palms Hwy. 101 Yucca Valley CA 92284 A 00076482 1740283084 9
0V4 San Bernardino Medical Group Jordan Aaron S M.D. 1700 N. Waterman Ave. San Bernardino CA 92404 G 00048703 1972573756 4
2688 Choice Medical Group, Inc Kamath Ram K M.D. 19015 Town Center Dr. 101 Apple Valley CA 92308 A 00046329 1386649556 1
2688 Choice Medical Group, Inc Kamath Udaya R M.D. 19015 Town Center Dr. 101 Apple Valley CA 92308 A 00050460 1346204104 4
Provider Service Operations
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