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General NPI Number Information
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NPI Number | 1730567108
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Entity Type | Organization
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Legal Business Name | MABROOK L. SHEHATA MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 350 S OAK AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3519
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Country | US
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Telephone | 702-453-3799
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 CRIMSON CANYON DR STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89128-0846
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Country | US
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Telephone | 661-327-8000
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Fax | 661-327-8020
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Authorized Official
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Title or Position | PRESIDENT
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Name | MABROOK L SHEHATA
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Credential | MD
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Telephone | 562-577-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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