Provider Demographics
NPI:1609991371
Name:LAWRENCE A SHAPIRO, M.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE A SHAPIRO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-657-7979
Mailing Address - Street 1:7111 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE #222
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4222
Mailing Address - Country:US
Mailing Address - Phone:714-657-7979
Mailing Address - Fax:714-657-7554
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE# 425
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-431-2556
Practice Address - Fax:562-596-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW5282Medicare ID - Type Unspecified
CAA31462Medicare UPIN