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General NPI Number Information
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NPI Number | 1124905062
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Entity Type | Individual
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Provider Name | ROBERT UICHANCO
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Gender | Male
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 227 W JANSS RD STE 125
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1856
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Country | US
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Telephone | 805-449-4278
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Fax | 805-449-4277
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Provider Business Mailing Address
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Address Line | 227 W JANSS RD STE 125
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1856
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Country | US
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Telephone | 805-449-4278
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Fax | 805-449-4277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95171145
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95036525
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License Number State | CA
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