Healthcare Provider Details

I. General information

NPI: 1831620269
Provider Name (Legal Business Name): DAPHNE ANTILLON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8321 W SAHARA AVE APT 2058
LAS VEGAS NV
89117-1885
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD SUITE 290
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 626-862-4201
  • Fax:
Mailing address:
  • Phone: 702-671-5127
  • Fax: 702-671-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO2968
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: