Provider Demographics
NPI:1982820221
Name:CLINICAS DEL CAMINO REAL INC
Entity Type:Organization
Organization Name:CLINICAS DEL CAMINO REAL INC
Other - Org Name:CLINICAS DEL CAMINO REAL INC NEWBURY PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFICER
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 STE 150
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1380
Mailing Address - Country:US
Mailing Address - Phone:805-659-2752
Mailing Address - Fax:805-659-9959
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-498-3640
Practice Address - Fax:805-498-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000384261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71164FMedicaid
CAFHC71164FMedicaid
CAHAP71164FOtherHEALTH ACCESS PROGRAM
CAZZZ62823ZOtherBLUE SHIELD
CABCP71164FOtherEDS CANCER DETECTION PROG
CAHAP71164FOtherHEALTH ACCESS PROGRAM