Provider Demographics
NPI:1134920663
Name:UCHIHA, SASUKE
Entity type:Individual
Prefix:
First Name:SASUKE
Middle Name:
Last Name:UCHIHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LOS FELIZ ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4207
Mailing Address - Country:US
Mailing Address - Phone:702-573-6762
Mailing Address - Fax:
Practice Address - Street 1:1800 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5106
Practice Address - Country:US
Practice Address - Phone:702-573-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner