Basic Information
| Provider Information | |||||||||
| NPI: | 1306892823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMINO MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 OLD SAN FRANCISCO RD | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940866386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087396000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20410 TOWN CENTER LN | ||||||||
| Address2: | SUITE F-150 | ||||||||
| City: | CUPERTINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950143229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087396000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SLAVIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4087396000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | GR009929D | 01 | CA | MEDI CAL SITE NUMBER | OTHER |