MEDICARE: MONIKA GARG MATHUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080S0012X	Pediatric Sleep Medicine Physician	A120142	CA
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	A120142	CA

General Provider Information

NPI Number	:	1558669002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIKA GARG MATHUR M.D.

Provider Business Mailing Address
First Line	:	535 E MAIN ST STE 113
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-4453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 E MAIN ST STE 113
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-4453
Country	:	US
Telephone Number	:	949-466-6055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	01/15/2025

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