Provider Demographics
NPI:1114383650
Name:KOCH, DAVID (BCBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 OAKLINE RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2995
Mailing Address - Country:US
Mailing Address - Phone:858-748-5988
Mailing Address - Fax:
Practice Address - Street 1:12095 ALTA CARMEL CT UNIT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3802
Practice Address - Country:US
Practice Address - Phone:858-666-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst