Provider Demographics
NPI:1316964992
Name:SHAPIRO, JARROD MATTHEW (DPM)
Entity type:Individual
Prefix:DR
First Name:JARROD
Middle Name:MATTHEW
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E SECOND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3877
Mailing Address - Fax:909-706-3942
Practice Address - Street 1:795 E SECOND ST
Practice Address - Street 2:SUITE 7
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3877
Practice Address - Fax:909-706-3942
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4884213ES0103X, 213E00000X, 213ES0131X, 213EP1101X, 213ES0000X
CARHD00169584213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL059YOtherMEDICARE NO CA PTAN
CADL059ZOtherMEDICARE PTAN SO CAL
MIV10204Medicare UPIN
CADL059YOtherMEDICARE NO CA PTAN