Active NPI
Itina Guidry
- Community Health Worker
- Houston, TX
National Provider Identifier
1619200409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 15011 Monrad Dr
Houston, TX 77053-1344 - Phone
- (832) 276-9238
- NPI assigned
- Sep 10, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | |||
| Medical Laboratory Technician | 246RM2200X | 165268 | TX | |
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
15011 Monrad Dr
Houston, TX 77053-1344
Mailing address
614 Shady Dale Dr
Stafford, TX 77477-5925
Phone (832) 276-9238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 165268 | TX | MD | Medical Laboratory Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252627200000",
"number": "1619200409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 SHADY DALE DR",
"city": "STAFFORD",
"state": "TX",
"postal_code": "774775925",
"telephone_number": "832-276-9238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15011 MONRAD DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770531344",
"telephone_number": "832-276-9238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUIDRY",
"first_name": "ITINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-10",
"last_updated": "2009-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "246RM2200X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "TX",
"license": "165268",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.