Individual
GEORGINA ITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10701 CORPORATE DR STE 340-105, STAFFORD, TX 77477-4096
(281) 903-0171
Mailing address
10701 CORPORATE DR STE 340-105, STAFFORD, TX 77477-4096
(281) 903-0171
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1097436
TX
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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