Healthcare Provider Details

I. General information

NPI: 1407794357
Provider Name (Legal Business Name): GABRIEL GIFFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1449
UKIAH CA
95482-1449
US

IV. Provider business mailing address

320 BUCKEYE CIR
CLOVERDALE CA
95425-5448
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-0350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: