MEDICARE: XIOMARA SUSTAITA

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	172V00000X	Community Health Worker		TX

General Provider Information

NPI Number	:	1962361493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIOMARA SUSTAITA

Provider Business Mailing Address
First Line	:	7457 HARWIN DR STE 132
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7457 HARWIN DR STE 132
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2024
Country	:	US
Telephone Number	:	713-274-6077
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ XIOMARA SUSTAITA ” Practice Location

Language	Start Address	Practice Location

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