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Organization Active NPI

Clinicas del Camino Real Inc

Doing business as Clinicas del Camino Real Inc Roberto S Juarez

  • Community Health Clinic/Center
  • Oxnard, CA
National Provider Identifier
1235866138
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real Inc Roberto S Juarez
Practice address
2100 Statham Blvd
Oxnard, CA 93033
Phone
(805) 659-1750
Fax
(805) 656-9959
NPI assigned
Aug 2, 2022
Last updated
Sep 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Farhad Benharash
Title
Chief Financial Officer
Phone
(805) 659-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

2100 Statham Blvd
Oxnard, CA 93033

Mailing address

2100 Statham Blvd
Oxnard, CA 93033
Phone (805) 330-8680

Other names 1

  • Clinicas del Camino Real Inc Roberto S Juarez Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205001238 CA Part B Supplier - Clinic/Group Practice 3173434396 Receives reassigned benefits from 249 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxnard, CA; Santa Paula, CA; Simi Valley, CA; Ventura, CA; Ojai, CA; Newbury Park, CA; Moorpark, CA; Fillmore, CA…
O20230216000941 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Oxnard, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235866138. Details of each certification follow.

Federally qualified health center certification: CCN A01815

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL, INC-ROBERTO S JUAREZ HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 23, 2023
Last certification
Feb 23, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1975 in CA
Enrollment address
2100 Statham Blvd
Oxnard, CA 93033

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory

Locations

1000 Newbury Rd
Ste 150
Newbury Park, CA 91320
Phone (805) 498-3640

1300 N Ventura Rd
Ste 14
Oxnard, CA 93030
Phone (805) 988-1180

1300 N Ventura Rd
Ste 5
Oxnard, CA 93030
Phone (805) 988-1225

2600 E Vineyard Ave
Oxnard, CA 93036
Phone (805) 436-3444

4440 Olds Rd
Oxnard, CA 93033
Phone (805) 986-5551

200 S Wells Rd
Ste 250
Ventura, CA 93004
Phone (805) 647-0991

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kirstin Cady Benites Individual Corporate DirectorSecretary of the Board of Direct Feb 22, 2012 100%
Tim a Hagel Individual Corporate DirectorBoard Member Nov 30, 2020 100%
Charles H Hookstra Individual Corporate DirectorPresident of the Board of Direct Jan 1, 2013 100%
Candelaria Franco Individual Corporate DirectorBoard Member Jan 23, 2019 100%
Adolfo Murillo Individual Corporate DirectorVice-President of the Board of D Jan 1, 2013 100%
Javier M Ochoa Individual Corporate DirectorParliamentarian of the Board of Jan 1, 2013 100%
Farhad Benharash Individual Corporate OfficerChief Financial Officer Mar 1, 2022 100%
W-2 Managing EmployeeChief Financial Officer Mar 1, 2022 100%
Operational/Managerial ControlChief Financial Officer Mar 1, 2022 100%
Gagan Pawar Individual Corporate OfficerChief Executive Officer Nov 1, 2021 100%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2021 100%
Operational/Managerial ControlChief Executive Officer Nov 1, 2021 100%
Angel Arreola Individual Corporate DirectorBoard Member Jan 1, 2013 100%
Barbara a Journet Individual Corporate DirectorTreasurer of the Board of Direct Jan 1, 2013 100%
Robert Cunningham Streeter Individual Corporate OfficerChief Medical Officer Aug 15, 2022 100%
W-2 Managing EmployeeChief Medical Officer Aug 15, 2022 100%
Operational/Managerial ControlChief Medical Officer Aug 15, 2022 100%
Kathryn G Adams Individual Corporate OfficerChief Human Resources Officer Jul 25, 2022 100%
W-2 Managing EmployeeChief Human Resources Officer Jul 25, 2022 100%
Operational/Managerial ControlChief Human Resources Officer Jul 25, 2022 100%
Anna Bell Monroy Individual Corporate OfficerChief of Operations Jan 16, 2020 100%
W-2 Managing EmployeeChief of Operations Jan 16, 2020 100%
Operational/Managerial ControlChief of Operations Jan 16, 2020 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clinicas del Camino Real Inc-Paseo CamarilloCamarillo, CA, CCN 921181 Federally qualified health center Operational/Managerial Control (100%) Nov 12, 2019
Clinicas del Camino Real Inc la ColoniaOxnard, CA, CCN 921908 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2026

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 224

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 224

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1235866138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 STATHAM BLVD",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "93033",
            "telephone_number": "805-330-8680",
            "fax_number": "805-728-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 STATHAM BLVD",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "93033",
            "telephone_number": "805-659-1750",
            "fax_number": "805-656-9959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "BENHARASH",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-659-1740"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real Inc Roberto S Juarez",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real Inc Roberto S Juarez",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.