Healthcare Provider Details

I. General information

NPI: 1831028067
Provider Name (Legal Business Name): DAILLY ALLEE MACK CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA STE 115
LAGUNA HILLS CA
92653-3616
US

IV. Provider business mailing address

5206 ALAMOSA PARK DR
OCEANSIDE CA
92057-6307
US

V. Phone/Fax

Practice location:
  • Phone: 949-581-3890
  • Fax: 949-581-6067
Mailing address:
  • Phone: 808-292-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number5699
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number5699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: