# CREEKSIDE SURGERY SUITE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326374844
- **Authorized official:** DR. SHAHRIAR MABOURAKH MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (916) 984-1600

## Contact information

- **Practice address:** 1561 CREEKSIDE DR, SUITE 110, FOLSOM, CA 95630-3492
- **Practice address phone:** (916) 984-1600
- **Practice address fax:** (916) 984-1616
- **Mailing address:** 1561 CREEKSIDE DR, SUITE 110, FOLSOM, CA 95630-3492
- **Mailing address phone:** (916) 984-1600
- **Mailing address fax:** (916) 984-1616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 10176 | CA | Yes |

## Other

- **Enumeration date:** 10/19/2009
- **Last updated:** 10/19/2009