Healthcare Provider Details

I. General information

NPI: 1134262074
Provider Name (Legal Business Name): CENTRAL TEXAS KIDNEY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W.45TH ST
AUSTIN TX
78751
US

IV. Provider business mailing address

408 W.45TH ST
AUSTIN TX
78751
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-5800
  • Fax: 512-451-6341
Mailing address:
  • Phone: 512-451-5800
  • Fax: 512-451-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZN0300X
TaxonomyNephrology Specialist/Technologist
License NumberL9536
License Number StateTX

VIII. Authorized Official

Name: DR. MALAVIKA VINTA
Title or Position: PRACTITIONER
Credential: MD
Phone: 512-451-5800