Provider Demographics
NPI:1285938647
Name:TIGALAT SHALITA, D O INC.
Entity type:Organization
Organization Name:TIGALAT SHALITA, D O INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIGALAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALITA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-676-0080
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23928 LYONS AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-259-0627
Practice Address - Fax:661-259-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX90001Medicaid
CA147651Medicare UPIN
CA00AX90001Medicaid