Provider Demographics
NPI:1942789359
Name:CLINICAS DEL CAMINO REAL INC
Entity Type:Organization
Organization Name:CLINICAS DEL CAMINO REAL INC
Other - Org Name:CLINICAS DEL CAMINO REAL, INC., LA COLONIA
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 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-659-1740
Mailing Address - Fax:
Practice Address - Street 1:801 COOPER RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5445
Practice Address - Country:US
Practice Address - Phone:805-330-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAS DEL CAMINO REAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)