Healthcare Provider Details

I. General information

NPI: 1982771655
Provider Name (Legal Business Name): MABROOK LAWANDY SHEHATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 SAN DIMAS ST
BAKERSFIELD CA
93301-1458
US

IV. Provider business mailing address

2660 CRIMSON CANYON DR STE 130
LAS VEGAS NV
89128-0846
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-8000
  • Fax: 866-265-2073
Mailing address:
  • Phone: 661-327-0692
  • Fax: 661-327-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA97348
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA97348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: