MEDICARE: MRS. DAPHNE ANTILLON DO

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	2084P0800X	Psychiatry Physician	DO2968	NV

General Provider Information

NPI Number	:	1831620269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAPHNE ANTILLON DO

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	SUITE 290
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-671-5127
Fax Number	:	702-671-6440

Provider Business Practice Location Address
First Line	:	8321 W SAHARA AVE APT 2058
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1885
Country	:	US
Telephone Number	:	626-862-4201
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	08/07/2025

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