Healthcare Provider Details

I. General information

NPI: 1285803460
Provider Name (Legal Business Name): MARY PREETHA JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

601 W CANCION AVE
MOUNTAIN HOUSE CA
95391-2092
US

V. Phone/Fax

Practice location:
  • Phone: 209-481-4096
  • Fax:
Mailing address:
  • Phone: 209-481-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number102706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: