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General NPI Number Information
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NPI Number | 1376413724
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PODIATRY PLLC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 17115 RED OAK DR STE 201B
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City | HOUSTON
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State | TX
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Zip | 77090-2607
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Country | US
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Telephone | 323-314-4271
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Fax |
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Provider Business Mailing Address
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Address Line | 102 JACOBS MEADOW DR
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City | CONROE
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State | TX
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Zip | 77384-2118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | LAURA TOLENTINO
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Credential | DPM
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Telephone | 323-314-4271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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