Shahriar Mabourakh, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

G61666 Issued in CA

Practice address

1561 Creekside Dr
Suite 110
Folsom, CA 95630-3492

Phone

(916) 984-1600

Fax

(916) 984-1616

NPI assigned

Jun 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creekside Surgery Suite

  • Ambulatory Surgical Clinic/Center
  • Folsom, CA
  • NPI 1326374844
  NPD (past) Authorized official
• Dameron Hospital Association

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1538163886
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Folsom, CA
  • NPI 1356389878
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Carmichael, CA
  • NPI 1972541498
  NPD (past)
• Port City Operating Company, LLC

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1528190931
  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1497791487",
    "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": {
        "last_name": "MABOURAKH",
        "first_name": "SHAHRIAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G61666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breann Lymath
• Richard Clive Lynton, M.D.
• Aaron William Lyon, D.C.
• M Aggarwal MD Inc
• M. Tavallaei, DMD,Inc.
• Mac Performance Physical Therapy Inc
• Katelyn Marie Macias
• Kaylyn Christine Macken Lynch, BACHELORS DEGREE
• Daniel Lee Maclean, MPT
• Patrick R Maddox, DDS

• Plastic Surgery Physician in Folsom, CA
• Providers in Folsom, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.