Healthcare Provider Details

I. General information

NPI: 1063030666
Provider Name (Legal Business Name): MAGENTA HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 WISEMAN BLVD BLDG 1
SAN ANTONIO TX
78251-1668
US

IV. Provider business mailing address

646 S. FLORES ST MAGENTA HEALTH
SAN ANTONIO TX
78204
US

V. Phone/Fax

Practice location:
  • Phone: 210-938-9355
  • Fax:
Mailing address:
  • Phone: 210-938-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEID DEEN
Title or Position: DIRECTOR OF CLINICS
Credential:
Phone: 210-938-0151