Healthcare Provider Details

I. General information

NPI: 1316163736
Provider Name (Legal Business Name): CLINICAS DEL CAMINO REAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MARICOPA HWY
OJAI CA
93023-3129
US

IV. Provider business mailing address

200 S WELLS RD SUITE 200
VENTURA CA
93004-1302
US

V. Phone/Fax

Practice location:
  • Phone: 805-640-8293
  • Fax:
Mailing address:
  • Phone: 805-659-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number050000307
License Number StateCA

VIII. Authorized Official

Name: FARHAD BENHARASH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 805-659-1740