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NPI Code Detail

MEDICARE: CLINICAS DEL CAMINO REAL INC

MEDICARE: CLINICAS DEL CAMINO REAL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center550001982CA
2261QF0400XFederally Qualified Health Center (FQHC)550001982CA

General Provider Information

NPI Number : 1841556404
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICAS DEL CAMINO REAL INC
Provider Business Mailing Address
First Line : 200 S WELLS RD
Second Line : SUITE 200
City : VENTURA
State : CA
Zip : 93004-1377
Country : US
Telephone Number : 805-659-1740
Fax Number : 805-659-9959
Provider Business Practice Location Address
First Line : 4279 TIERRA REJADA RD
Second Line :
City : MOORPARK
State : CA
Zip : 93021-3775
Country : US
Telephone Number : 805-222-2323
Fax Number : 805-372-0107
Authorized Official
Title or Position : CHIEF FINANCIAL OFFCIER
Name : FARHAD BENHARASH
Credential :
Telephone Number : 805-659-1740
Provider Enumeration Date : 04/09/2012
Last Update Date : 06/07/2022

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