Provider Demographics
NPI:1790252385
Name:TAYAG, CARLA ABIGAIL RUMBAOA (LVN, RN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA ABIGAIL
Middle Name:RUMBAOA
Last Name:TAYAG
Suffix:
Gender:F
Credentials:LVN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 ROSEBUD LN APT D
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6236
Mailing Address - Country:US
Mailing Address - Phone:408-479-1625
Mailing Address - Fax:
Practice Address - Street 1:655 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95200298163W00000X
CA283720164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163W00000XNursing Service ProvidersRegistered Nurse