# SHASTA REGIONAL MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHASTA COMMUNITY MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861626129
- **Authorized official:** MRS. VENKAMMA REDDY M.D. (PRESIDENT)
- **Authorized official phone:** (760) 241-8000

## Contact information

- **Practice address:** 1555 EAST ST STE 210, REDDING, CA 96001-1153
- **Practice address phone:** (530) 244-8316
- **Mailing address:** 16850 BEAR VALLEY RD, VICTORVILLE, CA 92395-5794
- **Mailing address phone:** (760) 241-8000
- **Mailing address fax:** (760) 962-8021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 26633 | CA | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 26633 | CA | — |

## Other

- **Enumeration date:** 05/14/2009
- **Last updated:** 05/14/2009