Healthcare Provider Details

I. General information

NPI: 1841279643
Provider Name (Legal Business Name): OMAIRA COLON RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3976 UNIVERSITY LAKE DR STE 300
ANCHORAGE AK
99508-4644
US

IV. Provider business mailing address

3976 UNIVERSITY LAKE DR STE 300
ANCHORAGE AK
99508-4644
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-9930
  • Fax: 907-222-9931
Mailing address:
  • Phone: 907-222-9930
  • Fax: 907-222-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number142557
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: