Clinicas del Camino Real, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Simi Valley, CA
NPI 1609291996 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1609291996
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 550003227 (CA)
- Legal business name
- CLINICAS DEL CAMINO REAL, INC
- Practice address
- 4370 Eve Rd
Simi Valley, CA 93063-2323 - Phone
- (805) 915-4400
- Fax
- (805) 915-4401
- NPI assigned
- Feb 24, 2014
- Organization subpart
- No
Authorized official
- Name
- Farhad Benharash
- Title
- Chief Financial Officer
- Phone
- (805) 659-1740
Owners & managing parties with NPI records 1
-
Gagan Pawar, MD
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 16
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 5
Practitioners 112
-
Mary Tuthill Ambler, LCSW
-
Nasr N Anees, MD
-
Jesse De la O, PA-C
-
Eeman Hasan, PA-C
-
Zhonghuan Ma, MD
-
Maria D Soto, AMFT
-
Adetoun Adebule, M.D.
-
Samiha Ali, OD
-
Sandra Alvarado, PHD
-
Yolande Marie Brizendine, LCSW
-
Claudio Cardenas, FNP
-
Timothy M. Chen, MD
-
Ivy Chereze Cruz, FNP-BC
-
Michelle Maree Dore, FNP-C
-
Menashe Ehrenburg, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 751841
- Legal name
- CLINICAS DEL CAMINO REAL INC
- Doing business as
- CLINICAS DEL CAMINO REAL, INC EAST SIMI VALLEY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 23, 2016
- Last certification
- Mar 23, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1975 in CA
- Enrollment address
- 4370 Eve Rd
Simi Valley, CA 93063-2323
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Kirstin Cady Benites |
Corporate Director |
Feb 22, 2012 | 100% |
| Tim a Hagel |
Corporate Director |
Nov 30, 2020 | 100% |
| Charles H Hookstra |
Corporate Director |
Jan 1, 2013 | 100% |
| Adolfo Murillo |
Corporate Director |
Jan 1, 2013 | 100% |
| Daniel Gonzalez |
Corporate Director |
Dec 16, 2022 | 100% |
| Javier M Ochoa |
Corporate Director |
Jan 1, 2013 | 100% |
| Farhad Benharash |
Corporate Officer |
Mar 1, 2022 | 100% |
| W-2 Managing Employee |
Mar 1, 2022 | 100% | |
| Operational/Managerial Control |
Mar 1, 2022 | 100% | |
| Gagan Pawar |
Corporate Officer |
Nov 1, 2021 | 100% |
| W-2 Managing Employee |
Nov 1, 2021 | 100% | |
| Operational/Managerial Control |
Nov 1, 2021 | 100% | |
| Arminda Lopez |
Corporate Director |
May 22, 2024 | 100% |
| Barbara a Journet |
Corporate Director |
Jan 1, 2013 | 100% |
| Kathryn G Adams |
Corporate Officer |
Jul 25, 2022 | 100% |
| W-2 Managing Employee |
Jul 25, 2022 | 100% | |
| Operational/Managerial Control |
Jul 25, 2022 | 100% | |
| Anna Bell Monroy |
Corporate Officer |
Jan 16, 2020 | 100% |
| W-2 Managing Employee |
Jan 16, 2020 | 100% | |
| Operational/Managerial Control |
Jan 16, 2020 | 100% | |
| Alexander Nguyen |
Corporate Director |
Dec 20, 2023 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Clinicas del Camino Real Inc-Paseo Camarillo |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 12, 2019 |
| Clinicas del Camino Real Inc la Colonia |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 1, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20160210001848 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 3173434396 | Practice locations: Simi Valley, CA |
National Provider Directory
- Tax ID family
- Saticoy Family Health
Locations
1000 Newbury Rd
Ste 150
Newbury Park, CA 91320
Phone (805) 498-3640
500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 550003227 | CA | Yes |
Addresses
Primary practice location
4370 Eve Rd
Simi Valley, CA 93063-2323
Mailing address
200 S Wells Rd
Suite 200
Ventura, CA 93004-1377
Phone (805) 659-1740
Other names
- Clinicas del Camino Real, Inc., East Simi Valley
Other providers in Simi Valley, CA
- Alice Clark
- Clayton Hinshaw M.D., Inc
- Brian Charles Clements
- Sarah Clifford
- Clinicas del Camino Real Inc
- Coastal Cities Nutrition Group
- Coastal Radiation Oncology Medical Group, Inc.
- Coastal Rheumatology Center Apc
- Randa L Cobey
- Cochran Congregate Living, Inc.
All providers in Simi Valley, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.