Individual
INA SHALTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1062 S K ST, TULARE, CA 93274-6421
(559) 685-2614
Mailing address
5957 S MOONEY BLVD, VISALIA, CA 93277-9394
(559) 737-4669
(559) 737-4697
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A56321
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A563210
—
CA
Enumeration date
11/08/2006
Last updated
07/09/2007
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