Provider Demographics
NPI:1538549449
Name:CAMINO HEALTH CENTER
Entity type:Organization
Organization Name:CAMINO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-240-2030
Mailing Address - Street 1:30300 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1304
Mailing Address - Country:US
Mailing Address - Phone:949-240-2030
Mailing Address - Fax:949-429-7627
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA STE 250
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6340
Practice Address - Country:US
Practice Address - Phone:949-240-2030
Practice Address - Fax:949-429-7627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMINO HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000060261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health