Provider Demographics
NPI:1609589845
Name:GOCHE, CHAD WESLEY I
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:WESLEY
Last Name:GOCHE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CITRUS GLN
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4173
Mailing Address - Country:US
Mailing Address - Phone:619-396-9246
Mailing Address - Fax:
Practice Address - Street 1:35 CITRUS GLN
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4173
Practice Address - Country:US
Practice Address - Phone:619-396-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician