Individual provider Active NPI

Raffi Matevosian, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Victorville, CA
National Provider Identifier
1396698247
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95037574 Issued in CA
Practice address
13090 3Rd Ave
Victorville, CA 92395-9013
Phone
(818) 809-7468
NPI assigned
Feb 19, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95037574 CA Primary

Addresses

Primary practice location

13090 3Rd Ave
Victorville, CA 92395-9013

Mailing address

13090 3Rd Ave
Victorville, CA 92395-9013
Phone (818) 809-7468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260616003362 CA Practitioner - Nurse Practitioner 2466924998

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

File Number
Suite 54701
Los Angeles, CA 90074-4701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95037574CAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1396698247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13090 3RD AVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923959013",
            "telephone_number": "818-809-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13090 3RD AVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923959013",
            "telephone_number": "818-809-7468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEVOSIAN",
        "first_name": "RAFFI",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-02-19",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95037574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.