MEDICARE: JOSEPH R SHAPIRO MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	A77622	CA

General Provider Information

NPI Number	:	1033549589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH R SHAPIRO MD, INC.

Provider Business Mailing Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 325
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-769-5998
Fax Number	:	818-769-5004

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 325
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-769-5998
Fax Number	:	818-769-5004

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOSEPH ROBERT SHAPIRO
Credential	:	MD
Telephone Number	:	818-769-5998

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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