Healthcare Provider Details

I. General information

NPI: 1013817741
Provider Name (Legal Business Name): CHARLEY BROOKE GUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W SCANDIA LN
CLOVIS CA
93619-2611
US

IV. Provider business mailing address

51 W SCANDIA LN
CLOVIS CA
93619-2611
US

V. Phone/Fax

Practice location:
  • Phone: 858-209-5443
  • Fax: 858-209-5443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: