Healthcare Provider Details

I. General information

NPI: 1619885324
Provider Name (Legal Business Name): ROBERTO ANAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

8330 KIRK DR
COLORADO SPRINGS CO
80908-2995
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5000
  • Fax:
Mailing address:
  • Phone: 719-355-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPN.1002417-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1002417-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: