Basic Information
| Provider Information | |||||||||
| NPI: | 1316163736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAS DEL CAMINO REAL INC | ||||||||
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| OtherOrganizationName: | OJAI VALLEY COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S WELLS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930041302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056591740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 MARICOPA HWY | ||||||||
| Address2: | |||||||||
| City: | OJAI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930233129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056408293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | BENHARASH | ||||||||
| AuthorizedOfficialFirstName: | FARHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8056591740 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 050000307 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC70527F | 05 | CA | MEDICAID | BCP70527F | 01 | CA | EDS CDP EVERY WOMAN COUNT | OTHER | HAP70527F | 01 | CA | HEALTH ACCESS PROGRAM FAM | OTHER | ZZZ59203Z | 01 | CA | BLUE SHIELD | OTHER |