Provider Demographics
NPI:1104834217
Name:SHAH, NILESH HIMAT (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:HIMAT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 VILLAGE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3905
Mailing Address - Country:US
Mailing Address - Phone:858-549-0225
Mailing Address - Fax:
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1622
Practice Address - Country:US
Practice Address - Phone:619-400-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine