Healthcare Provider Details

I. General information

NPI: 1194538264
Provider Name (Legal Business Name): GAP POST-ACUTE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 WETHERBY LN
LOS ANGELES CA
90077-1348
US

IV. Provider business mailing address

PO BOX 241040
LOS ANGELES CA
90024-1046
US

V. Phone/Fax

Practice location:
  • Phone: 310-597-9705
  • Fax:
Mailing address:
  • Phone: 310-597-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK GOBRIAL
Title or Position: PRESIDENT
Credential: MD
Phone: 818-667-6488