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General NPI Number Information
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NPI Number | 1134362312
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Entity Type | Individual
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Provider Name | HAIMESH SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 08/30/2015
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Provider Practice Location Address
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Address Line | 2460 N PONDEROSA DR SUTIE A101
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City | CAMARILLO
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State | CA
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Zip | 93010-2398
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Country | US
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Telephone | 805-389-5944
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 N PONDEROSA DR SUTIE A101
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City | CAMARILLO
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State | CA
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Zip | 93010-2398
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Country | US
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Telephone | 805-389-5944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | A108019
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A108019
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | A108019
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License Number State | CA
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