Healthcare Provider Details

I. General information

NPI: 1730567108
Provider Name (Legal Business Name): MABROOK L. SHEHATA MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S OAK AVE
OAKDALE CA
95361-3519
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax:
Mailing address:
  • Phone: 661-327-8000
  • Fax: 661-327-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MABROOK L SHEHATA
Title or Position: PRESIDENT
Credential: MD
Phone: 562-577-1098