Healthcare Provider Details

I. General information

NPI: 1750359287
Provider Name (Legal Business Name): THERESA E DAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 315
SAN DIEGO CA
92130-3082
US

IV. Provider business mailing address

12395 EL CAMINO REAL STE 315
SAN DIEGO CA
92130-3082
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-5437
  • Fax: 858-794-5439
Mailing address:
  • Phone: 858-794-5437
  • Fax: 858-794-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC51771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: