Organization
CREEKSIDE SURGERY SUITE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAHRIAR MABOURAKH MD (MEDICAL DIRECTOR)
(916) 984-1600
Entity
Organization
Contact information
Practice address
1561 CREEKSIDE DR, SUITE 110, FOLSOM, CA 95630-3492
(916) 984-1600
(916) 984-1616
Mailing address
1561 CREEKSIDE DR, SUITE 110, FOLSOM, CA 95630-3492
(916) 984-1600
(916) 984-1616
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10176
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10176
IMQ IDENTIFICATION NUMBER
CA
Enumeration date
10/19/2009
Last updated
10/19/2009
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