Provider Demographics
NPI:1790972040
Name:RAFI, RENATO MERCADO (APRN BC)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:MERCADO
Last Name:RAFI
Suffix:
Gender:M
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 STONE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2928
Mailing Address - Country:US
Mailing Address - Phone:703-817-9847
Mailing Address - Fax:
Practice Address - Street 1:2280 OPITZ BLVD STE 320
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-878-7610
Practice Address - Fax:703-878-7614
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0024167480363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health