Healthcare Provider Details

I. General information

NPI: 1255620209
Provider Name (Legal Business Name): CLINICAS DEL CAMINO REAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VENTURA RD STE 4
OXNARD CA
93030-3836
US

IV. Provider business mailing address

200 S WELLS RD STE 150
VENTURA CA
93004-1380
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-1180
  • Fax:
Mailing address:
  • Phone: 805-659-1740
  • Fax: 805-659-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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