Healthcare Provider Details

I. General information

NPI: 1114746740
Provider Name (Legal Business Name): CHADI EL RAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

IV. Provider business mailing address

16235 SW 304TH TER
HOMESTEAD FL
33033-4138
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-7620
  • Fax:
Mailing address:
  • Phone: 904-314-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17456-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: