Healthcare Provider Details

I. General information

NPI: 1316809783
Provider Name (Legal Business Name): GAP MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 W SHAW AVE
CLOVIS CA
93612-3601
US

IV. Provider business mailing address

1968 S COAST HWY # 4889
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 201-474-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL SALAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-474-7333