Healthcare Provider Details

I. General information

NPI: 1558669002
Provider Name (Legal Business Name): MONIKA GARG MATHUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E MAIN ST STE 113
TUSTIN CA
92780-4453
US

IV. Provider business mailing address

535 E MAIN ST STE 113
TUSTIN CA
92780-4453
US

V. Phone/Fax

Practice location:
  • Phone: 949-466-6055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberA120142
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA120142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: