MEDICARE: SHIELD CALIFORNIA HEALTH CARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	100025	CA
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	10025	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316051337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELD CALIFORNIA HEALTH CARE CENTER INC

Provider Business Mailing Address
First Line	:	27911 FRANKLIN PKWY
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4110
Country	:	US
Telephone Number	:	661-294-4200
Fax Number	:	661-294-1042

Provider Business Practice Location Address
First Line	:	9520 NORWALK BLVD
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-2930
Country	:	US
Telephone Number	:	562-908-9000
Fax Number	:	562-803-0755

Authorized Official
Title or Position	:	VP GENERAL MANAGER
Name	:	MIKE SUOR
Credential	:
Telephone Number	:	661-294-4200

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	01/14/2025

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