Healthcare Provider Details

I. General information

NPI: 1134055643
Provider Name (Legal Business Name): ULTRAREVEAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 ZEV CT
LAS VEGAS NV
89121-5738
US

IV. Provider business mailing address

4482 ZEV CT
LAS VEGAS NV
89121-5738
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-5556
  • Fax:
Mailing address:
  • Phone: 725-204-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JAMESE RILEY
Title or Position: SONOGRAPHER/OWNER
Credential: BS, RDMS OB/GYN
Phone: 725-204-5556