Healthcare Provider Details

I. General information

NPI: 1043122419
Provider Name (Legal Business Name): RAFI NADI PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 ELEMENT WAY
CHULA VISTA CA
91915-2800
US

IV. Provider business mailing address

2114 ELEMENT WAY
CHULA VISTA CA
91915-2800
US

V. Phone/Fax

Practice location:
  • Phone: 619-384-3551
  • Fax:
Mailing address:
  • Phone: 619-384-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2026058652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: