Provider Demographics
NPI:1912181066
Name:CARRICABURU, RACHAEL C (MD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:C
Last Name:CARRICABURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 BUSINESS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7174
Mailing Address - Country:US
Mailing Address - Phone:907-743-7200
Mailing Address - Fax:
Practice Address - Street 1:4951 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7174
Practice Address - Country:US
Practice Address - Phone:907-743-7200
Practice Address - Fax:907-743-7241
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK219012207R00000X
AK1952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020178Medicaid