Provider Demographics
NPI:1760722110
Name:SAKA, VIVIAN GORGES I (H,C,P)
Entity Type:Individual
Prefix:MR
First Name:VIVIAN
Middle Name:GORGES
Last Name:SAKA
Suffix:I
Gender:F
Credentials:H,C,P
Other - Prefix:MRS
Other - First Name:FIFIAN
Other - Middle Name:GORGES
Other - Last Name:PUTRUS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1704 SILVER KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3841
Mailing Address - Country:US
Mailing Address - Phone:702-336-5495
Mailing Address - Fax:702-444-3966
Practice Address - Street 1:1704 SILVER KNOLL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3841
Practice Address - Country:US
Practice Address - Phone:702-336-5495
Practice Address - Fax:702-444-3966
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker