Healthcare Provider Details

I. General information

NPI: 1477620300
Provider Name (Legal Business Name): WARREN L. SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 BIRMINGHAM WAY BLDG 28
SAN DIEGO CA
92123-2758
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE #210
SAN DIEGO CA
92123-4800
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-4003
  • Fax:
Mailing address:
  • Phone: 858-309-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA45622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: