Healthcare Provider Details

I. General information

NPI: 1194515940
Provider Name (Legal Business Name): KATHERINE VANESA QUINTANILLA MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE 120
SPRING TX
77379-5803
US

IV. Provider business mailing address

14355 CORNERSTONE VILLAGE DR APT 1008
HOUSTON TX
77014-1229
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone: 832-739-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number44335
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: