Individual
DR. JACK SHENOUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 N ROSE AVE, OXNARD, CA 93030-3722
(717) 577-3938
(785) 354-6349
Mailing address
1016 CACTUS CT, THOUSAND OAKS, CA 91320-5907
(717) 557-3938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A140119
CA
208M00000X
Hospitalist Physician
Primary
A140119
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002171
MEDICARE PTAN
KS
05
—
200962510A
—
KS
Enumeration date
07/14/2009
Last updated
11/29/2021
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