MEDICARE: DR. CHRISTINA ITATA 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	R8382	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1871932061	OTHER		INDIVIDUAL

General Provider Information

NPI Number	:	1871932061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA ITATA M.D.

Provider Business Mailing Address
First Line	:	20320 NORTHWEST FWY STE 400
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20320 NORTHWEST FWY STE 400
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:	832-299-4843
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	04/09/2025

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