Healthcare Provider Details

I. General information

NPI: 1609798941
Provider Name (Legal Business Name): KALEY GOSUICO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 REILLY DR
HUNTINGTON BEACH CA
92646-5512
US

IV. Provider business mailing address

8442 REILLY DR
HUNTINGTON BEACH CA
92646-5512
US

V. Phone/Fax

Practice location:
  • Phone: 661-300-1272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: