Healthcare Provider Details

I. General information

NPI: 1962323469
Provider Name (Legal Business Name): GABRIEL W GOUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 E 4TH ST
SANTA ANA CA
92705-3804
US

IV. Provider business mailing address

8491 E SARATOGA ST
ANAHEIM CA
92808-1224
US

V. Phone/Fax

Practice location:
  • Phone: 714-683-5876
  • Fax:
Mailing address:
  • Phone: 714-350-1646
  • 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: