Provider Demographics
NPI:1073209797
Name:PUTTAM, HARIVARSHA (MBBS)
Entity Type:Individual
Prefix:
First Name:HARIVARSHA
Middle Name:
Last Name:PUTTAM
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BUTTE STREET, SHASTA REGIONAL MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-244-8250
Mailing Address - Fax:530-244-5119
Practice Address - Street 1:1100 BUTTE STREET, SHASTA REGIONAL MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-244-8250
Practice Address - Fax:530-244-5119
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program