Provider Demographics
NPI:1679631907
Name:CLINICAS DEL CAMINO REAL INC
Entity Type:Organization
Organization Name:CLINICAS DEL CAMINO REAL INC
Other - Org Name:CLINICAS DEL CAMINO REAL, INC., VENTURA
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 SOUTH WELLS ROAD
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:805-659-9959
Practice Address - Street 1:200 S WELLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1302
Practice Address - Country:US
Practice Address - Phone:805-647-6322
Practice Address - Fax:805-647-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000116261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03908FMedicaid
CA014657OtherHEALTHY FAMILIES ACCESS D
CAHAP03908FOtherHEALTH ACCESS PROGRAM FAM
CAW3731OtherMEDICARE NHIC
CABCP03908FOtherEDS CDP EVERY WOMAN COUNT
CA201251OtherDELTA DENTAL
CAG9088402OtherHEALTHY FAMILIES DELTA DE
CAZZZ06124ZOtherBLUE SHIELD
CAHAP03908FOtherHEALTH ACCESS PROGRAM FAM