Provider Demographics
NPI:1356409312
Name:TAYAG, EMILIO CARREON (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:CARREON
Last Name:TAYAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE STE A2006
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-4460
Mailing Address - Fax:951-486-6510
Practice Address - Street 1:26520 CACTUS AVE STE A2006
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4460
Practice Address - Fax:951-486-6510
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117473207T00000X
CAA54615207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00604464Medicare PIN
ILK44302Medicare PIN