Provider Demographics
NPI:1104449206
Name:SHAH, KRUTI GITESH (MBBS)
Entity type:Individual
Prefix:
First Name:KRUTI
Middle Name:GITESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOUNTAIN VIEW REGIONAL MEDICAL CENTE
Mailing Address - Street 2:4351 E LOHMAN AVENUE BUILDING 3, SUITE 300
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-556-7767
Mailing Address - Fax:
Practice Address - Street 1:MOUNTAIN VIEW REGIONAL MEDICAL CENTE
Practice Address - Street 2:4351 E LOHMAN AVENUE
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-556-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2022-02-14
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program