Healthcare Provider Details

I. General information

NPI: 1316964992
Provider Name (Legal Business Name): JARROD MATTHEW SHAPIRO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E SECOND ST SUITE 7
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E SECOND ST SUITE 5
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-3877
  • Fax: 909-706-3942
Mailing address:
  • Phone: 909-706-3877
  • Fax: 909-706-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4884
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4884
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberRHD00169584
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE4884
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4884
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: