Provider Demographics
NPI:1952332777
Name:SHAPIRO, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:176C AVENIDA MAJORCA UNIT C
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-4149
Mailing Address - Country:US
Mailing Address - Phone:562-208-7350
Mailing Address - Fax:
Practice Address - Street 1:5176 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:707-262-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22948207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A229480Medicaid
CAP00156275OtherRAILROAD MEDICARE
CA1952332777Medicaid
CA00A229480OtherBLUE SHIELD
CAWA22948SMedicare PIN
CAP00156275OtherRAILROAD MEDICARE
CA00A229480Medicaid
CA1952332777Medicaid
CAAY715YMedicare PIN
CAWA22948RMedicare ID - Type Unspecified
CAP00730087.Medicare PIN
CAAY715ZMedicare PIN