1790066355 NPI number — MYRON S SHAPERO MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790066355 NPI number — MYRON S SHAPERO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYRON S SHAPERO MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790066355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-7365
Provider Business Mailing Address Fax Number:
310-273-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 N LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-360-1047
Provider Business Practice Location Address Fax Number:
310-659-8797
Provider Enumeration Date:
09/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPERO
Authorized Official First Name:
MYRON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-273-7365

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A19800 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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