Healthcare Provider Details

I. General information

NPI: 1881708899
Provider Name (Legal Business Name): SHIELD CALIFORNIA HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27911 FRANKLIN PKWY
VALENCIA CA
91355-4110
US

IV. Provider business mailing address

27911 FRANKLIN PKWY
VALENCIA CA
91355-4110
US

V. Phone/Fax

Practice location:
  • Phone: 661-294-4200
  • Fax:
Mailing address:
  • Phone: 661-294-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY 36848
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY 36848
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 36848
License Number StateCA

VIII. Authorized Official

Name: MIKE SUOR
Title or Position: VP GENERAL MANAGER
Credential:
Phone: 661-294-4200