MEDICARE: OLGA ALEXANDROVNA RAFAELIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME128638	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295059038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA ALEXANDROVNA RAFAELIAN M.D.

Provider Business Mailing Address
First Line	:	5940 WESTPORT LN
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-5418
Country	:	US
Telephone Number	:	239-631-9858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 W MARCH LN STE D
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6414
Country	:	US
Telephone Number	:	916-364-8395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	04/13/2022

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