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