Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4884 | CA |
Y | 222Z00000X | Podiatrist | E4884 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E4884 | CA |
N | 111NR0200X | Radiology | RHD00169584 | CA |
N | 213ER0200X | Radiology | RHD00169584 | CA |
N | 2081S0010X | Sports Medicine | E4884 | CA |
N | 213ES0000X | Sports Medicine | E4884 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E4884 | CA |
N | 213ES0131X | Foot Surgery | E4884 | CA |
NPI | 1316964992 |
---|---|
Provider Name | Dr. Jarrod Matthew Shapiro |
First Address | Pomona, CA 91766-2007 |
Second Address | Pomona, CA 91766-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 03/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DL059Y | MEDICARE NO CA PTAN (01) | CA |
DL059Z | MEDICARE PTAN SO CAL (01) | CA |