Healthcare Provider Details

I. General information

NPI: 1386164663
Provider Name (Legal Business Name): ALYSSA AYA SELF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 RIVERBEND RD STE 100
BOULDER CO
80301-2618
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-5399
  • Fax: 303-297-5808
Mailing address:
  • Phone: 303-415-4101
  • Fax: 303-415-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberDR.0072562
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017020317
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDR.0072562
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0072562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: