SOUTH COUNTY PAIN & REHAB
Maureen D. Miner. M.D.
Diplomate, American Board of Physical Medicine & Rehabilitation
Diplomate, American Board of Pain Medicine
Sub-Specialty Board Certified, Spinal Cord Medicine
Qualified Medical Evaluator
 
  7091 Monterey St., Suite A
Gilroy, CA 95020
Phone: (408) 842-9296
FAX: (408) 842-6878
Date 2020-06-29 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		CARDENAS, REGINA NAVA 


36586 Deborah Street
Newark, CA 94560

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
WC648-C39351 
ADJ11528428 
12/05/2016 
xxx-xx-xxxx 
Phone
(home/cell) 		510-449-3381  Phone
(work) 		  Birth Date 09/20/1982 


Adjuster Name


INS. Address 		Christina Roth   

Employer Name


Address

 Yadav Enterprises Inc. 


 
Liberty Mutual
P.O. Box 29073
Glendale, CA 91209 
Phone D: 503-736-8568 O: 714-937-1400  Fax 603-334-0307  Phone   Fax  
Appt. TYPE ✔ QME Panel   QME Re–Eval   QME
Applicant		   AME   Med legal   Consult ONLY   Consult&Treat   EMG/NCS
Appt. DATE: 0000-00-00  Appt. TIME  
Interpreter required?   No   Yes Agency/Language   

Referring Physician
Address 		 
Case Manager

Address
  panel: 7251792

PALO ALTO 
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		Yuvanna Davis, Esq. 


Defense Attorney
Address 		Timothy T. Huynh, Esq. 
Ratto Law Frim 
600 16Th Street, Ste. 100
Oakland, CA 94612 		LFL&M 
One Capitol Mall, Suite 400
Sacramento, CA 95814
Phone 510-444-4600  Fax 510-444-3604  Phone 925-499-4999  Fax 925-348-9710 
PROVIDE MEDICAL RECORDS 3 weeks IN ADVANCE
PLEASE DO NOT SEND ORIGIANALS OR CD’S
NO SHOW FEE: $300.00
  
ACKNOWLEDGE ABOVE WITH YOUR INITIALS_____
AND FAX BACK TO OUR OFFICE. THANK YOU