MEDICARE: DR. RACHEL CHUNDENU KIENTCHA -TITA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0003310	DE
2	207Q00000X	Family Medicine Physician	M9410	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207Q00000X	OTHER	TX	FAMILY MEDICINE TAXONOMY CODE

General Provider Information

NPI Number	:	1306919162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL CHUNDENU KIENTCHA -TITA M.D

Provider Business Mailing Address
First Line	:	2424 HAMILTON ST STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1203
Country	:	US
Telephone Number	:	713-485-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 HAMILTON ST STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1203
Country	:	US
Telephone Number	:	281-933-4447
Fax Number	:	281-933-5557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	11/01/2023

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