| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 801 Cooper Rd, Oxnard, California |
| Authorized Official Name and Position | Farhad Benharash (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8056591740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1040 Flynn Rd Camarillo CA 93012-5092 Ph: (805) 659-1740 | 801 Cooper Rd Oxnard CA 93030-5445 Ph: (805) 330-8100 |
| NPI Number | 1942789359 |
|---|---|
| Provider Enumeration Date | 08/08/2018 |
| Last Update Date | 06/07/2022 |
| Medicare PECOS PAC ID | 3173434396 |
|---|---|
| Medicare Enrollment ID | O20201021002911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942789359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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