Healthcare Provider Details

I. General information

NPI: 1972298818
Provider Name (Legal Business Name): PREETH S ELANGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD STE 5
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

9990 COUNTY FARM RD STE 5
RIVERSIDE CA
92503-3542
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-3788
  • Fax:
Mailing address:
  • Phone: 951-358-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA208098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: