Provider Demographics
NPI:1306404504
Name:KOTHARI, PALAK (PHD)
Entity Type:Individual
Prefix:DR
First Name:PALAK
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PALAK
Other - Middle Name:
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10937 LA ALBERCA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3319
Mailing Address - Country:US
Mailing Address - Phone:858-922-8018
Mailing Address - Fax:
Practice Address - Street 1:20 S 2ND ST UNIT 425
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-2532
Practice Address - Country:US
Practice Address - Phone:858-922-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty