Provider Demographics
NPI:1134362312
Name:SHAH, HAIMESH (MD)
Entity type:Individual
Prefix:
First Name:HAIMESH
Middle Name:
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 1:2460 N PONDEROSA DR
Mailing Address - Street 2:SUTIE A101
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2398
Mailing Address - Country:US
Mailing Address - Phone:805-389-5944
Mailing Address - Fax:
Practice Address - Street 1:2460 N PONDEROSA DR
Practice Address - Street 2:SUTIE A101
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2398
Practice Address - Country:US
Practice Address - Phone:805-389-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108019202K00000X, 208M00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine