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General NPI Number Information
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NPI Number | 1295059038
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Entity Type | Individual
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Provider Name | OLGA ALEXANDROVNA RAFAELIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1803 W MARCH LN STE D
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City | STOCKTON
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State | CA
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Zip | 95207-6414
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Country | US
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Telephone | 916-364-8395
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 WESTPORT LN
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City | NAPLES
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State | FL
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Zip | 34116-5418
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Country | US
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Telephone | 239-631-9858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME128638
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License Number State | FL
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