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General NPI Number Information
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NPI Number | 1982820221
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Entity Type | Organization
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Legal Business Name | CLINICAS DEL CAMINO REAL INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 1000 NEWBURY RD SUITE 150
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6435
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Country | US
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Telephone | 805-498-3640
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Fax | 805-498-3641
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Provider Business Mailing Address
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Address Line | 200 S WELLS RD STE 150
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City | VENTURA
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State | CA
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Zip | 93004-1380
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Country | US
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Telephone | 805-659-2752
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Fax | 805-659-9959
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFICER
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Name | FARHAD BENHARASH
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Credential |
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Telephone | 805-659-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 550000384
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License Number State | CA
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