Provider Demographics
NPI:1205852316
Name:SHALITA, TIGALAT (DO)
Entity Type:Individual
Prefix:
First Name:TIGALAT
Middle Name:
Last Name:SHALITA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 27206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:818-676-0080
Mailing Address - Fax:213-365-6429
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-676-0080
Practice Address - Fax:818-676-0090
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9000208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265540256OtherNPI
CA20A9000OtherLICENSE
CA20A9000OtherLICENSE
CAW20A9000BMedicare ID - Type UnspecifiedGLENDALE
CAW20A9000CMedicare ID - Type UnspecifiedBURBANK
CAI47651Medicare UPIN