Healthcare Provider Details

I. General information

NPI: 1508038175
Provider Name (Legal Business Name): PREETI PRAKASH MATHUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PREETI RAVI PRAKASH

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12865 POINTE DEL MAR WAY STE 210
DEL MAR CA
92014-3860
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0599
  • Fax: 858-794-7218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: