Healthcare Provider Details

I. General information

NPI: 1366560393
Provider Name (Legal Business Name): CAMINO HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30300 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-1304
US

IV. Provider business mailing address

30300 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-1304
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-2030
  • Fax: 949-429-7627
Mailing address:
  • Phone: 949-240-2030
  • Fax: 949-429-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number060000060
License Number StateCA

VIII. Authorized Official

Name: DEBRA LYNN DREW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 949-240-2030