Provider Demographics
NPI:1447208798
Name:SHAPIRO, STEPHEN MARCEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARCEL
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MAINSAIL DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1427
Mailing Address - Country:US
Mailing Address - Phone:949-244-3667
Mailing Address - Fax:206-202-0120
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE #223
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:949-244-3667
Practice Address - Fax:206-202-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079453208D00000X
CAG79453207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G794530Medicaid
G17949Medicare UPIN
CAWG79453BMedicare PIN