Healthcare Provider Details

I. General information

NPI: 1801583109
Provider Name (Legal Business Name): PRAFULKUMAR MAGANBHAI KOTHIYA M.B.B.S;MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

3620 HISTORIC CT
MODESTO CA
95356-3234
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone: 551-666-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA209149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: