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General NPI Number Information
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NPI Number | 1790972040
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Entity Type | Individual
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Provider Name | RENATO MERCADO RAFI APRN BC
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Gender | Male
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD STE 320
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-878-7610
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Fax | 703-878-7614
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Provider Business Mailing Address
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Address Line | 14701 STONE CREEK CT
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City | CENTREVILLE
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State | VA
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Zip | 20120-2928
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Country | US
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Telephone | 703-817-9847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024167480
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License Number State | WY
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