Provider Demographics
NPI:1922048917
Name:SHAPIRO, LAWRENCE A (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
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 1:7111 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC19362AMedicare PIN