Healthcare Provider Details

I. General information

NPI: 1609393537
Provider Name (Legal Business Name): JAMES R. SHIELDS, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MEDICAL CENTER DRIVE, #206
WEST HILLS CA
91307
US

IV. Provider business mailing address

7301 MEDICAL CENTER DR STE 206
WEST HILLS CA
91307-1948
US

V. Phone/Fax

Practice location:
  • Phone: 818-312-9790
  • Fax: 818-312-9795
Mailing address:
  • Phone: 818-312-9790
  • Fax: 818-312-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG40378
License Number StateCA

VIII. Authorized Official

Name: JAMES ROBERT SHIELDS
Title or Position: PHYSICIAN
Credential: MD
Phone: 818-312-9790