Healthcare Provider Details

I. General information

NPI: 1033995899
Provider Name (Legal Business Name): ALYSSA RAQUEL ROGERS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA RAQUEL OJEDA

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 719-526-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number878
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: