Provider Demographics
NPI:1497519300
Name:GAP BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GAP BEHAVIORAL HEALTH SERVICES
Other - Org Name:GAP BEHAVIROAL HEALTH SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZIRIM-SALAMIALOFOJEQ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:409-356-9778
Mailing Address - Street 1:PO BOX 2354
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-0354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1626 CENTINELA AVE STE 100
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-6930
Practice Address - Country:US
Practice Address - Phone:409-356-9778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty