Healthcare Provider Details

I. General information

NPI: 1548649080
Provider Name (Legal Business Name): DANIEL DAYLAMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 S VINE ST # 1031
CENTENNIAL CO
80122-3171
US

IV. Provider business mailing address

6767 S VINE ST # 1031
CENTENNIAL CO
80122-3171
US

V. Phone/Fax

Practice location:
  • Phone: 720-292-7885
  • Fax: 720-222-5149
Mailing address:
  • Phone: 720-292-7885
  • Fax: 720-222-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0062021
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60969938
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR8720
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10054454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: