Healthcare Provider Details

I. General information

NPI: 1043405749
Provider Name (Legal Business Name): PAULA DIANE DAILLAK RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 WALNUT DR
PASO ROBLES CA
93446-2315
US

IV. Provider business mailing address

723 WALNUT DR
PASO ROBLES CA
93446-2315
US

V. Phone/Fax

Practice location:
  • Phone: 805-237-3056
  • Fax: 805-237-3057
Mailing address:
  • Phone: 805-237-3056
  • Fax: 805-237-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN153363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: