Provider Demographics
NPI:1437210879
Name:HITTALMANI, SHANKAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANKAR
Middle Name:N
Last Name:HITTALMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 OLIVEVIEW DR
Mailing Address - Street 2:OLIVEVIEW UCLA MED CENTER NORTH ANNEX
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1495
Mailing Address - Country:US
Mailing Address - Phone:818-364-3632
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVEVIEW DR
Practice Address - Street 2:OLIVEVIEW UCLA MEDICAL CENTER
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1495
Practice Address - Country:US
Practice Address - Phone:818-364-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35513207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE48524Medicare UPIN