Healthcare Provider Details

I. General information

NPI: 1437837077
Provider Name (Legal Business Name): MAGENTA CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 41ST ST
AUSTIN TX
78751-4810
US

IV. Provider business mailing address

646 S FLORES ST
SAN ANTONIO TX
78204-1219
US

V. Phone/Fax

Practice location:
  • Phone: 210-938-9355
  • Fax:
Mailing address:
  • Phone: 210-938-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ESTELLE AMELIA MATHEY
Title or Position: OPERATIONS ADVISOR
Credential:
Phone: 512-917-6559