Provider Demographics
| NPI: | 1417003195 |
|---|---|
| Name: | CAMINO MEDICAL GROUP |
| Entity type: | Organization |
| Organization Name: | CAMINO MEDICAL GROUP |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | RICHARD |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | SLAVIN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 408-739-6000 |
| Mailing Address - Street 1: | 301 OLD SAN FRANCISCO RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SUNNYVALE |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 94086-6386 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 301 OLD SAN FRANCISCO RD |
| Practice Address - Street 2: | |
| Practice Address - City: | SUNNYVALE |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94086-6386 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 408-739-6000 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-26 |
| Last Update Date: | 2008-04-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | ========= | Other | TAX ID |
| ZZZ00945Z | Medicare PIN | ||
| ZZZ28599Z | Medicare PIN | ||
| ZZZ32546Z | Medicare PIN | ||
| ZZZ92002Z | Medicare PIN | ||
| CA | ========= | Other | TAX ID |
| ZZZ58493Z | Medicare PIN | ||
| ZZZ13440Z | Medicare PIN | ||
| ZZZ20702Z | Medicare PIN | ||
| ZZZ00292Z | Medicare PIN | ||
| ZZZ00270Z | Medicare PIN | ||
| ZZZ14945Z | Medicare PIN | ||
| ZZ00704Z | Medicare PIN | ||
| ZZZ00271Z | Medicare PIN | ||
| ZZZ25913Z | Medicare PIN | ||
| ZZZ42327Z | Medicare PIN | ||
| CA | ZZZ99423Z | Medicare PIN |
