Provider Demographics
NPI:1922715846
Name:GASKA-GOEHRING, ANTHONY JASON
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JASON
Last Name:GASKA-GOEHRING
Suffix:
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 1:3365 HACIENDA WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5407
Mailing Address - Country:US
Mailing Address - Phone:925-522-1350
Mailing Address - Fax:
Practice Address - Street 1:3365 HACIENDA WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5407
Practice Address - Country:US
Practice Address - Phone:925-522-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician