Provider Demographics
NPI:1952660185
Name:CAMINO REAL MEDICAL GROUP , INC.
Entity Type:Organization
Organization Name:CAMINO REAL MEDICAL GROUP , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PARONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-482-5500
Mailing Address - Street 1:625 N A ST # 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4919
Mailing Address - Country:US
Mailing Address - Phone:805-288-5140
Mailing Address - Fax:805-288-5138
Practice Address - Street 1:625 N A ST # 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4919
Practice Address - Country:US
Practice Address - Phone:805-288-5140
Practice Address - Fax:805-288-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366627945OtherNPI