MEDICARE: CLINICAS DEL CAMINO REAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	050000511	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	BCP70777F	OTHER	CA	EDS CDP EVERY WOMAN COUNT
3	HAP70777F	OTHER	CA	HEALTH ACCESS PROGRAM FAM
4	ZZZ79971Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1023234465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAS DEL CAMINO REAL INC

Provider Business Mailing Address
First Line	:	200 S WELLS RD
Second Line	:	SUITE 200
City	:	VENTURA
State	:	CA
Zip	:	93004-1302
Country	:	US
Telephone Number	:	805-659-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E MAIN ST
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-2607
Country	:	US
Telephone Number	:	805-933-0895
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	FARHAD BENHARASH
Credential	:
Telephone Number	:	805-659-1740

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	06/07/2022

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Directions to “CLINICAS DEL CAMINO REAL INC ” Practice Location

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