Healthcare Provider Details

I. General information

NPI: 1649037474
Provider Name (Legal Business Name): PREETHY JOSEPH MATHEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE # CSB4403
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

590 MINNESOTA ST APT 540
SAN FRANCISCO CA
94107-3025
US

V. Phone/Fax

Practice location:
  • Phone: 415-312-4769
  • Fax:
Mailing address:
  • Phone: 415-312-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberSPI809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: