Healthcare Provider Details

I. General information

NPI: 1063950459
Provider Name (Legal Business Name): MAGNIFICAT PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17833 KUYKENDAHL RD
SPRING TX
77379-1109
US

IV. Provider business mailing address

17833 KUYKENDAHL RD
SPRING TX
77379-1109
US

V. Phone/Fax

Practice location:
  • Phone: 328-698-2127
  • Fax: 832-698-2976
Mailing address:
  • Phone: 832-610-7225
  • Fax: 832-698-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARACELI AMADOR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 832-698-2127