Healthcare Provider Details

I. General information

NPI: 1942126875
Provider Name (Legal Business Name): PAVITHRA KOTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BUTTE ST PRIME WEST CONSORTIUM SHASTA REGIONAL MEDICAL CENTER
REDDING CA
96001
US

IV. Provider business mailing address

110 BUTTE ST PRIME WEST CONSORTIUM SHASTA REGIONAL MEDICAL CENTER
REDDING CA
96001
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-5400
  • Fax:
Mailing address:
  • Phone: 530-244-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: