Provider Demographics
NPI:1063516144
Name:BASCON, ROSA TAYAPAD (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:TAYAPAD
Last Name:BASCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:BASCON
Other - Last Name:LOYOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27861 CANYON HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:951-760-3196
Mailing Address - Fax:
Practice Address - Street 1:27861 CANYON HILLS WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5094
Practice Address - Country:US
Practice Address - Phone:951-760-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics