NPPES file of Aug 9, 2026

Revive Pathway in El Cajon, CA

This organization bills under NPI 1962117440, an organization record issued on Jan 18, 2023 with the primary taxonomy Substance Use Disorder Rehabilitation Clinic/Center. Each clinician who works there has their own NPI and license.

CMS NPPES registry, file of Aug 9, 2026 · method · Verify with CMS →

Organization recordNPPES, Aug 2026
1962117440
Legal name
Revive Pathway
Entity
Type 2 · organization
Primary taxonomy
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Practice location
1240 BROADWAY, El Cajon, CA 92021
Phone
619-841-1310
Mailing address
Boulder, CO
Enumerated
Jan 18, 2023
Record updated
May 6, 2026
Authorized official
Coo (title as filed)
Public record from the NPPES NPI Registry (open it on CMS). An NPI identifies who bills; it is not a facility license.

12 clinicians CMS lists with Revive Pathway in El Cajon

  1. Lakai Banks-Dean, MDAddiction Medicine (Family Medicine) Physician1346746930
  2. Adrianna Caballero, AMFT 103139Mental Health Counselor1013389188
  3. Greg Greenberg, MDHospitalist Physician1013927441
  4. Tarek Haidar, MDAddiction Medicine (Family Medicine) Physician1093330599
  5. Mckenzie Hinshaw, NPFamily Nurse Practitioner1124388103
  6. Waseem Khader, DOAddiction Medicine (Preventive Medicine) Physician1124476270
  7. De Courcy Luckett, FNPFamily Nurse Practitioner1023410578
  8. Ataa Maty, NPPsychiatric/Mental Health Nurse Practitioner1598446601
  9. Tracey NutterAcute Care Nurse Practitioner1215568076
  10. Carl Salka, MDInfectious Disease Physician1699749051
  11. Michelle Wilcox, FNPNurse Practitioner1194418012
  12. Tynan Wyatt, MDFamily Medicine Physician1306231840

Source: CMS Doctors and Clinicians group affiliations, matched by practice name and city.

Checking an organization

  1. Confirm the business with the California secretary of state.
  2. Check the HHS-OIG exclusion list for the organization.
  3. Verify each clinician on their own record and the state license search.

All taxonomies on this record

  • 208D00000X General Practice Physician
  • 261QM0801X Mental Health Clinic/Center (Including Community Mental Health Center)
  • 261QR0405X Substance Use Disorder Rehabilitation Clinic/Center

Common questions

Why is the mailing address in Colorado?

The mailing address in the record (Boulder, CO) is where the organization receives mail. Care is given at the practice location in El Cajon.

Is an organization NPI a license?

No. An NPI identifies who bills. Facilities and the clinicians who work there are licensed separately by the state.

Source: CMS National Plan and Provider Enumeration System (NPPES), monthly file of Aug 9, 2026 (NPPES files on CMS.gov). An NPI identifies who bills; it is not a license.