Healthcare Provider Details

I. General information

NPI: 1265937064
Provider Name (Legal Business Name): DR. JENNIFER SHAPIRO, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 DEL MAR HEIGHTS RD STE 1952
SAN DIEGO CA
92130-2199
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD STE 1952
SAN DIEGO CA
92130-2199
US

V. Phone/Fax

Practice location:
  • Phone: 619-825-0499
  • Fax: 888-551-6358
Mailing address:
  • Phone: 619-825-0499
  • Fax: 888-551-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SHAPIRO
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH. D
Phone: 619-825-0499