Healthcare Provider Details

I. General information

NPI: 1326090457
Provider Name (Legal Business Name): CAMINO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FREMONT AVE
SUNNYVALE CA
94087-2315
US

IV. Provider business mailing address

301 OLD SAN FRANCISCO RD
SUNNYVALE CA
94086-6386
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD SLAVIN
Title or Position: CEO
Credential:
Phone: 408-739-6000