Healthcare Provider Details

I. General information

NPI: 1104758945
Provider Name (Legal Business Name): RIVANTA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR # 8139
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR # 8139
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 432-315-4720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: IVETTE CORTES
Title or Position: CEO
Credential:
Phone: 432-315-4720