Healthcare Provider Details

I. General information

NPI: 1063516144
Provider Name (Legal Business Name): ROSA TAYAPAD BASCON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSA BASCON LOYOLA M.D.

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27861 CANYON HILLS WAY
MURRIETA CA
92563-5094
US

IV. Provider business mailing address

27861 CANYON HILLS WAY
MURRIETA CA
92563
US

V. Phone/Fax

Practice location:
  • Phone: 951-760-3196
  • Fax:
Mailing address:
  • Phone: 951-760-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: