Healthcare Provider Details

I. General information

NPI: 1174101810
Provider Name (Legal Business Name): LEAH SHAPIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E EL SEGUNDO BLVD STE 200
EL SEGUNDO CA
90245-2743
US

IV. Provider business mailing address

2110 E EL SEGUNDO BLVD STE 200
EL SEGUNDO CA
90245-2743
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA193380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: