Healthcare Provider Details

I. General information

NPI: 1790066355
Provider Name (Legal Business Name): MYRON S SHAPERO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD SUITE 107
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

PO BOX 67307
LOS ANGELES CA
90067-0307
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-1047
  • Fax: 310-659-8797
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA19800
License Number StateCA

VIII. Authorized Official

Name: MYRON SHAPERO
Title or Position: OWNER
Credential: MD
Phone: 310-273-7365