Provider Demographics
NPI:1043405749
Name:DAILLAK, PAULA DIANE (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:DIANE
Last Name:DAILLAK
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2315
Mailing Address - Country:US
Mailing Address - Phone:805-237-3056
Mailing Address - Fax:805-237-3057
Practice Address - Street 1:723 WALNUT DR
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2315
Practice Address - Country:US
Practice Address - Phone:805-237-3056
Practice Address - Fax:805-237-3057
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN153363163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management