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General NPI Number Information
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NPI Number | 1790220846
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Entity Type | Organization
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Legal Business Name | MAGNIFICAT MEDICAL SERVICE PLLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 17833 KUYKENDAHL RD
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City | SPRING
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State | TX
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Zip | 77379-8112
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Country | US
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Telephone | 507-381-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 17833 KUYKENDAHL RD
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City | SPRING
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State | TX
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Zip | 77379-8112
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Country | US
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Telephone | 507-381-3807
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. PABLO ENRIQUE AMADOR
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Credential | M.D
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Telephone | 507-381-3807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | Q2096
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License Number State | TX
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