Healthcare Provider Details

I. General information

NPI: 1659232809
Provider Name (Legal Business Name): NICHOLAS FREDERICK RACHLOW PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 208
GARDENA CA
90248-4336
US

IV. Provider business mailing address

1225 W 190TH ST STE 208
GARDENA CA
90248-4336
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax: 877-538-2102
Mailing address:
  • Phone: 877-515-8113
  • Fax: 877-538-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: