Healthcare Provider Details

I. General information

NPI: 1619676277
Provider Name (Legal Business Name): CLINICAS DEL CAMINO REAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATHAM BLVD RM 183
OXNARD CA
93033
US

IV. Provider business mailing address

2100 STATHAM BLVD RM 183
OXNARD CA
93033
US

V. Phone/Fax

Practice location:
  • Phone: 805-330-8687
  • Fax: 805-367-5251
Mailing address:
  • Phone: 805-330-8687
  • Fax: 805-367-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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