Healthcare Provider Details

I. General information

NPI: 1457011777
Provider Name (Legal Business Name): MAGENTA CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9746 KATY FWY STE 100
HOUSTON TX
77055-6220
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 TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
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