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NPI Code Detail

MEDICARE: JORDAN GOUCHER

MEDICARE: JORDAN GOUCHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1780533208
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN GOUCHER
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 5333 MISSION CENTER RD STE 110
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1347
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2026
Last Update Date : 01/27/2026

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