Creekside Surgery Suite

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

10176 Issued in CA

Legal business name

CREEKSIDE SURGERY SUITE

Practice address

1561 Creekside Dr
Suite 110
Folsom, CA 95630-3492

Phone

(916) 984-1600

Fax

(916) 984-1616

NPI assigned

Oct 19, 2009

Last updated

Oct 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shahriar Mabourakh, MDNPI 1497791487

Title

Medical Director

Phone

(916) 984-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shahriar Mabourakh, MD

  • Plastic Surgery Physician
  • Folsom, CA
  • NPI 1497791487
  NPD (past) Authorized official

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255910400000",
    "number": "1326374844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1561 CREEKSIDE DR",
            "address_2": "SUITE 110",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303492",
            "telephone_number": "916-984-1600",
            "fax_number": "916-984-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 CREEKSIDE DR",
            "address_2": "SUITE 110",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303492",
            "telephone_number": "916-984-1600",
            "fax_number": "916-984-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE SURGERY SUITE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-19",
        "last_updated": "2009-10-19",
        "status": "A",
        "authorized_official_last_name": "MABOURAKH",
        "authorized_official_first_name": "SHAHRIAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "916-984-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "10176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IMQ IDENTIFICATION NUMBER",
            "identifier": "10176",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leahi Cragg
• Janel B. Crawford, MD
• Margaret J. Crawford, M.S. SLP
• Creekside Endodontics, a Young Dental Group, Inc.
• Creekside Osteopathic Family Practice Inc
• Lina Olivia Crescione
• Isabelle Creste, PSYD
• Kelly M Crider, DDS
• Rhiannon Crimmins
• Paul Andrew Cripe, M.D.

• Ambulatory Surgical Clinic/Center in Folsom, CA
• Providers in Folsom, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; 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.