Healthcare Provider Details

I. General information

NPI: 1750382552
Provider Name (Legal Business Name): MAX SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD SUITE 818
LOS ANGELES CA
90045-3807
US

IV. Provider business mailing address

12618 HAWTHORNE BLVD.
HAWTHORNE CA
90250-2325
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-3255
  • Fax: 310-531-2325
Mailing address:
  • Phone: 310-263-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG56173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: