MEDICARE: CAMINO MEDICAL GROUP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073566865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMINO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	301 OLD SAN FRANCISCO RD
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94086-6386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 EL CAMINO REAL
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1449
Country	:	US
Telephone Number	:	408-739-6000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD SLAVIN
Credential	:
Telephone Number	:	408-739-6000

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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Directions to “CAMINO MEDICAL GROUP ” Practice Location

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