Healthcare Provider Details

I. General information

NPI: 1295434736
Provider Name (Legal Business Name): MAGENTA CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 CHAMPION FOREST DR # E510
SPRING TX
77379-8693
US

IV. Provider business mailing address

9746 KATY FWY STE 100
HOUSTON TX
77055-6220
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