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NPI Code Detail

MEDICARE: BRANDON MAGALLANEZ

MEDICARE: BRANDON MAGALLANEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse344339TX
2363LF0000XFamily Nurse Practitioner1212805TX

General Provider Information

NPI Number : 1679044259
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON MAGALLANEZ
Provider Business Mailing Address
First Line : 338 W FORMOSA BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78221-2727
Country : US
Telephone Number : 210-842-4629
Fax Number :
Provider Business Practice Location Address
First Line : 3415 PAESANOS PKWY STE 100
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78231-3501
Country : US
Telephone Number : 210-600-9766
Fax Number : 210-600-9767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2018
Last Update Date : 10/14/2025

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