Individual provider Active NPI

Nicholas Frederick Rachlow, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Gardena, CA
National Provider Identifier
1659232809
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95037581 Issued in CA
Practice address
1225 W 190TH St Ste 208
Gardena, CA 90248-4336
Phone
(877) 515-8113
Fax
(877) 538-2102
NPI assigned
Nov 18, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 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 95037581 CA Primary

Addresses

Primary practice location

1225 W 190TH St Ste 208
Gardena, CA 90248-4336

Mailing address

1225 W 190TH St Ste 208
Gardena, CA 90248-4336
Phone (877) 515-8113

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
I20260223000892 CA Practitioner - Nurse Practitioner 2567943194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95037581CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Feb 9, 2026 Accepting new patients

Locations

1320 Willow Pass Rd
Ste 600
Concord, CA 94520
Phone (925) 434-4858

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

3031 Tisch Way
San Jose, CA 95128
Phone (408) 260-0208

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1763424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1659232809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 208",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484336",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 208",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484336",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACHLOW",
        "first_name": "NICHOLAS",
        "middle_name": "FREDERICK",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-11-18",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95037581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.