Healthcare Provider Details

I. General information

NPI: 1396181384
Provider Name (Legal Business Name): JORGE C MAGALLON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CAMDEN ST 102
SAN ANTONIO TX
78215-2012
US

IV. Provider business mailing address

12446 WEST AVE 200
SAN ANTONIO TX
78216-2517
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE C MAGALLON
Title or Position: OWNER
Credential: MD
Phone: 210-281-9800