Healthcare Provider Details

I. General information

NPI: 1124905062
Provider Name (Legal Business Name): ROBERT UICHANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD STE 125
THOUSAND OAKS CA
91360-1856
US

IV. Provider business mailing address

227 W JANSS RD STE 125
THOUSAND OAKS CA
91360-1856
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-4278
  • Fax: 805-449-4277
Mailing address:
  • Phone: 805-449-4278
  • Fax: 805-449-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95171145
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95036525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: