Healthcare Provider Details

I. General information

NPI: 1164225371
Provider Name (Legal Business Name): RIVANI A CALATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIVANI A SIHOTANG

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 W BROADWAY ST
IDAHO FALLS ID
83402-2996
US

IV. Provider business mailing address

PO BOX 1407
IDAHO FALLS ID
83403-1407
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7400
  • Fax: 208-524-8004
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2871779
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: