Healthcare Provider Details

I. General information

NPI: 1053305193
Provider Name (Legal Business Name): MARGUERITE RAFFIO POREDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 CLASSICS DRIVE
NAPLES FL
34113-3345
US

IV. Provider business mailing address

7703 CLASSICS DRIVE
NAPLES FL
34113-3345
US

V. Phone/Fax

Practice location:
  • Phone: 239-234-5978
  • Fax: 781-459-8187
Mailing address:
  • Phone: 239-234-5978
  • Fax: 781-459-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME84634
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number015074
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number46680
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberME84634
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number46680
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number015074
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46680
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number015074
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number015074
License Number StateLA
# 10
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME84634
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number46680
License Number StateMA
# 12
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME84634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: