Healthcare Provider Details

I. General information

NPI: 1659326775
Provider Name (Legal Business Name): PREETI J. SRIVATSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PREETI JAHAGIRDAR MD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E YOSEMITE AVE STE C
MANTECA CA
95336-5071
US

IV. Provider business mailing address

PO BOX 1090
LODI CA
95241-1090
US

V. Phone/Fax

Practice location:
  • Phone: 209-824-2202
  • Fax: 209-824-2205
Mailing address:
  • Phone: 209-334-1800
  • Fax: 209-334-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number31833
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA83242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: