MEDICARE: DAILLY ALLEE MACK CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist	5699	CA
2	222Z00000X	Orthotist	5699	CA

General Provider Information

NPI Number	:	1831028067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAILLY ALLEE MACK CPO

Provider Business Mailing Address
First Line	:	5206 ALAMOSA PARK DR
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-6307
Country	:	US
Telephone Number	:	808-292-7739
Fax Number	:

Provider Business Practice Location Address
First Line	:	23961 CALLE DE LA MAGDALENA STE 115
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3616
Country	:	US
Telephone Number	:	949-581-3890
Fax Number	:	949-581-6067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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