Healthcare Provider Details

I. General information

NPI: 1033549589
Provider Name (Legal Business Name): JOSEPH R SHAPIRO MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12660 RIVERSIDE DR SUITE 325
STUDIO CITY CA
91607-3429
US

IV. Provider business mailing address

12660 RIVERSIDE DR SUITE 325
STUDIO CITY CA
91607-3429
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-5998
  • Fax: 818-769-5004
Mailing address:
  • Phone: 818-769-5998
  • Fax: 818-769-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA77622
License Number StateCA

VIII. Authorized Official

Name: JOSEPH ROBERT SHAPIRO
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 818-769-5998