Healthcare Provider Details

I. General information

NPI: 1699285346
Provider Name (Legal Business Name): LA MAGNA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

IV. Provider business mailing address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

V. Phone/Fax

Practice location:
  • Phone: 940-687-5000
  • Fax: 940-263-3018
Mailing address:
  • Phone: 940-687-5000
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDRE DESIRE
Title or Position: OWNER
Credential: MD
Phone: 940-263-3001