MEDICARE: MR. VIVIAN GORGES SAKA I H,C,P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1760722110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIVIAN GORGES SAKA I H,C,P

Provider Business Mailing Address
First Line	:	1704 SILVER KNOLL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3841
Country	:	US
Telephone Number	:	702-336-5495
Fax Number	:	702-444-3966

Provider Business Practice Location Address
First Line	:	1704 SILVER KNOLL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3841
Country	:	US
Telephone Number	:	702-336-5495
Fax Number	:	702-444-3966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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