Healthcare Provider Details

I. General information

NPI: 1720683246
Provider Name (Legal Business Name): CARLOS DAVID FRAUSTO MSPA, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29645 RANCHO CALIFORNIA RD STE 118
TEMECULA CA
92591-5285
US

IV. Provider business mailing address

31740 SILK VINE DR
WINCHESTER CA
92596-8626
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-0187
  • Fax: 951-506-0189
Mailing address:
  • Phone: 951-538-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA58908
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: