1679631907 NPI number — CLINICAS DEL CAMINO REAL INC

Table of content: (NPI 1679631907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679631907 NPI number — CLINICAS DEL CAMINO REAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAS DEL CAMINO REAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679631907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SOUTH WELLS ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93004-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-659-1740
Provider Business Mailing Address Fax Number:
805-659-9959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S WELLS RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93004-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-647-6322
Provider Business Practice Location Address Fax Number:
805-647-7164
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENHARASH
Authorized Official First Name:
FARHAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
805-659-1740

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  050000116 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC03908F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014657 . This is a "HEALTHY FAMILIES ACCESS D" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP03908F . This is a "HEALTH ACCESS PROGRAM FAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W3731 . This is a "MEDICARE NHIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP03908F . This is a "EDS CDP EVERY WOMAN COUNT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 201251 . This is a "DELTA DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G9088402 . This is a "HEALTHY FAMILIES DELTA DE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ06124Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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