Healthcare Provider Details

I. General information

NPI: 1912181066
Provider Name (Legal Business Name): RACHAEL C CARRICABURU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

IV. Provider business mailing address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-7200
  • Fax: 907-743-7241
Mailing address:
  • Phone: 907-743-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219012
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1952
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: