Healthcare Provider Details

I. General information

NPI: 1306584792
Provider Name (Legal Business Name): DAYLI D OTANO PADRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MAXEY RD APT 2603
HOUSTON TX
77013-5083
US

IV. Provider business mailing address

414 MAXEY RD APT 2603
HOUSTON TX
77013-5083
US

V. Phone/Fax

Practice location:
  • Phone: 713-459-3901
  • Fax:
Mailing address:
  • Phone: 713-459-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1079761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: