Provider Demographics
NPI:1609291996
Name:CLINICAS DEL CAMINO REAL, INC
Entity Type:Organization
Organization Name:CLINICAS DEL CAMINO REAL, INC
Other - Org Name:CLINICAS DEL CAMINO REAL, INC., EAST SIMI VALLEY
Other - Org Type:Doing Business As
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:93004-1377
Mailing Address - Country:US
Mailing Address - Phone:805-659-1740
Mailing Address - Fax:805-659-9959
Practice Address - Street 1:4370 EVE RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2323
Practice Address - Country:US
Practice Address - Phone:805-915-4400
Practice Address - Fax:805-915-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003227261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751841Medicare Oscar/Certification
CAW3731Medicare PIN