Shield Medical Management Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SHIELD MEDICAL MANAGEMENT SERVICES LLC

Practice address

13896 Harbor Blvd
Suite 5C
Garden Grove, CA 92843-4045

Phone

(714) 554-2222

NPI assigned

Jun 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mortezas Sourat

Title

Administrator

Phone

(714) 554-2222

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1386907749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13896 HARBOR BLVD",
            "address_2": "SUITE 5C",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13896 HARBOR BLVD",
            "address_2": "SUITE 5C",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434045",
            "telephone_number": "714-554-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIELD MEDICAL MANAGEMENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "SOURAT",
        "authorized_official_first_name": "MORTEZAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-554-2222"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariam Fady Shenouda
• Franchesca La Toya Shepard
• Darnell Lamarque Sherman
• Hawa Sherzai, RBT
• Reem Shetta
• Paul Shim
• Eriko Shimojo
• Christina Shin, OTD, OTR/L, CLT-LANA
• David Shin
• Dong Joo Shin

• Clinic/Center in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.