Healthcare Provider Details

I. General information

NPI: 1578677985
Provider Name (Legal Business Name): TERESA E SHIELDS-SZABO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA E SHIELDS MD

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26795 PORTOLA PKWY
FOOTHILL RANCH CA
92610-1713
US

IV. Provider business mailing address

26795 PORTOLA PKWY
FOOTHILL RANCH CA
92610-1713
US

V. Phone/Fax

Practice location:
  • Phone: 949-829-9403
  • Fax: 949-829-9422
Mailing address:
  • Phone: 949-829-9403
  • Fax: 949-829-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39601
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: