General: IND- LIC HC SERV PRO
Specialty: NURSE/NURSES AIDE
Address: 20874 SERRANO CREEK, #64
City: LAKE FOREST
State: CA
Zip code: 92630
Exclusion type: License revocation, suspension, or surrender. Minimum Period: Period imposed by the state licensing authority. (Social Security Act: 1128(b)(4), 42 USC §: 1320a-7(b)(4))
Exclusion date: 2014-05-20

General: HOME HEALTH AGENCY
Specialty: HEALTH CARE AIDE
Address: 3001 LAKE EAST DRIVE, #1
City: LAS VEGAS
State: NV
Zip code: 89117
Exclusion type: Conviction of program-related crimes. Minimum Period: 5 years (Social Security Act: 1128(a)(1), 42 USC §: 1320a-7(a)(1))
Exclusion date: 2007-07-19

General: EMPLOYEE - PRIVATE S
Specialty: PHARMACY
Address: 91 DONA STREET
City: BUFFALO
State: NY
Zip code: 14218
Exclusion type: Felony conviction relating to health care fraud. Minimum Period: 5 years (Social Security Act: 1128(a)(3), 42 USC §: 1320a-7(a)(3))
Exclusion date: 2022-09-20

General: SKILLED NURSING FAC
Specialty: NURSE/NURSES AIDE
Address: 2787 SOUTH 9TH STREET
City: OMAHA
State: NE
Zip code: 68108
Exclusion type: License revocation, suspension, or surrender. Minimum Period: Period imposed by the state licensing authority. (Social Security Act: 1128(b)(4), 42 USC §: 1320a-7(b)(4))
Exclusion date: 2002-10-20

HOLD COURTESY HOLD FOR OUTSIDE AGENCY ( Bond: 0.00 )

Name	Source	YOB
AR Antonio Rivera	USA - Health and Human Services List of Excluded Individuals and Entities	1951
JA Jose Antonio Rivera	USA - Health and Human Services List of Excluded Individuals and Entities	1982
AM Antonio M Rivera	USA - Health and Human Services List of Excluded Individuals and Entities	1983
MA Marco Antonio Rivera	USA - Health and Human Services List of Excluded Individuals and Entities	1969
Javier Antonio Bolanos Rivera	USA - mugshots.zone	1989

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