Provider Demographics
NPI:1134262074
Name:CENTRAL TEXAS KIDNEY ASSOC.
Entity type:Organization
Organization Name:CENTRAL TEXAS KIDNEY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAVIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-451-5800
Mailing Address - Street 1:408 W.45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751
Mailing Address - Country:US
Mailing Address - Phone:512-451-5800
Mailing Address - Fax:512-451-6341
Practice Address - Street 1:408 W.45TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-451-5800
Practice Address - Fax:512-451-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9536246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrologyGroup - Single Specialty