Healthcare Provider Details

I. General information

NPI: 1922916485
Provider Name (Legal Business Name): REVANTA MEDICAL BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 W WILSON ST
RIALTO CA
92376-6241
US

IV. Provider business mailing address

458 BOYNTON AVE APT A2
SAN JOSE CA
95117-1426
US

V. Phone/Fax

Practice location:
  • Phone: 818-254-9621
  • Fax: 818-254-9621
Mailing address:
  • Phone: 818-254-9621
  • Fax: 818-254-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NO NAME ABHISHEK
Title or Position: OWNER
Credential:
Phone: 818-254-9621