Provider Demographics
NPI:1427276278
Name:CLINICAS DEL CAMINO REAL INC
Entity type:Organization
Organization Name:CLINICAS DEL CAMINO REAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENHARASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-659-1740
Mailing Address - Street 1:200 S WELLS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1302
Mailing Address - Country:US
Mailing Address - Phone:805-659-1740
Mailing Address - Fax:
Practice Address - Street 1:4400 OLDS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-8061
Practice Address - Country:US
Practice Address - Phone:805-986-5551
Practice Address - Fax:805-986-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000573261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70990FMedicaid
CAZZZ07599ZOtherBLUE SHIELD
CABCP70990FOtherEDS CDP EVERY WOMAN COUNT
CA104686OtherHEALTHY FAMILIES ACCESS D
CA301251OtherDELTA DENTAL
CAG9088404OtherHEALTHY FAMILIES DELTA DE
CAHAP70990FOtherHEALTH ACCESS PROGRAM FAM
CABCP70990FOtherEDS CDP EVERY WOMAN COUNT
CAW3731Medicare ID - Type UnspecifiedMEDICARE NHIC