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General NPI Number Information
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NPI Number | 1720208499
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Entity Type | Individual
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Provider Name | MRUGESH C SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 215 W JANSS RD PATHOLOGY DEPARTMENT
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1847
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Country | US
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Telephone | 805-373-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 2190 LYNN RD SUITE 220
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1980
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Country | US
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Telephone | 805-495-8050
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Fax | 805-496-2160
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | A91950
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | A91950
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License Number State | CA
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