Healthcare Provider Details

I. General information

NPI: 1710612338
Provider Name (Legal Business Name): TANIA RAYGOZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21634 RETREAT PKWY
CORONA CA
92883-6100
US

IV. Provider business mailing address

21634 RETREAT PKWY
TEMESCAL VALLEY CA
92883-6100
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6370
  • Fax:
Mailing address:
  • Phone: 951-683-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.5801R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA201639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: