Healthcare Provider Details

I. General information

NPI: 1568306736
Provider Name (Legal Business Name): MERCEDES MARIA SHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

IV. Provider business mailing address

4330 PONCA AVE
TOLUCA LAKE CA
91602-2916
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-2270
  • Fax: 626-681-0835
Mailing address:
  • Phone: 626-437-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: