NPIMap

Organization Active NPI

Clinicas del Camino Real Inc

Doing business as Clinicas del Camino Real, Inc., La Colonia

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
National Provider Identifier
1942789359
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real, Inc., La Colonia
Practice address
801 Cooper Rd
Oxnard, CA 93030-5445
Phone
(805) 330-8100
NPI assigned
Aug 8, 2018
Last updated
Jun 7, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINICAS DEL CAMINO REAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 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
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

801 Cooper Rd
Oxnard, CA 93030-5445

Mailing address

1040 Flynn Rd
Camarillo, CA 93012-5092
Phone (805) 659-1740

Other names 1

  • Clinicas del Camino Real, Inc., La Colonia 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…
O20201021002911 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 1942789359. Details of each certification follow.

Federally qualified health center certification: CCN 921908

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL INC LA COLONIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2020
Last certification
Oct 22, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
801 Cooper Rd
Oxnard, CA 93030-5445

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
Part of
Clinicas del Camino Real Inc

Locations

1040 Flynn Rd
Camarillo, CA 93012
Phone (805) 673-3930

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%
Charles H Hookstra Individual Corporate DirectorPresident of the Board of Direct Jan 1, 2013
Adolfo Murillo Individual Corporate DirectorVicep Resident of the Board of D Jan 1, 2013 100%
Daniel Gonzalez Individual Corporate DirectorBoard Member Dec 16, 2022 100%
Clinicas del Camino Real Inc Organization, Oxnard, CA Corporation, Medical provider/supplier, For-profit Operational/Managerial Control Mar 1, 2026 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%
Miguel Noriega Individual Corporate DirectorBoard Member Apr 23, 2025 100%
Gagan Pawar Individual Corporate OfficerChief Executive Officer Nov 1, 2021 100%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2021 100%
Arminda Lopez Individual Corporate DirectorBoard Member May 22, 2024 100%
Barbara a Journet Individual Corporate DirectorTreasurer of the Board of Direct Jan 1, 2013 100%
Anna Bell Monroy Individual Corporate OfficerChief of Operations Jan 16, 2020 100%
W-2 Managing EmployeeChief of Operations Jan 16, 2020 100%
Alexander Nguyen Individual Corporate DirectorBoard Member Dec 20, 2023 100%

Owners & managing parties with NPI records 16

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

View all 16

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 176

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 176

NPI Registry JSON

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1942789359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-659-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 COOPER RD",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930305445",
            "telephone_number": "805-330-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINICAS DEL CAMINO REAL INC",
        "enumeration_date": "2018-08-08",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real, Inc., La Colonia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real, Inc., La Colonia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.