Healthcare Provider Details

I. General information

NPI: 1861160962
Provider Name (Legal Business Name): NAMITA ELIZABETH MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST
LOS ANGELES CA
90033-5331
US

IV. Provider business mailing address

1450 SAN PABLO ST STE 4700
LOS ANGELES CA
90033-5331
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-6826
  • Fax:
Mailing address:
  • Phone: 323-865-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA207896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: