Individual
MR. STEPHEN J DAILLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
1191 CRESTON RD STE 115, PASO ROBLES, CA 93446-3033
(805) 239-3696
(805) 239-3697
Mailing address
1191 CRESTON RD STE 115, PASO ROBLES, CA 93446-3033
(805) 239-3696
(805) 239-3697
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT27175
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001411
—
CA
01
—
OPT271750
BLUE SHIELD
CA
01
—
PT27175
BLUE CROSS
CA
01
—
ZZZ06333Z
BLUE SHIELD GROUP
CA
Enumeration date
12/05/2006
Last updated
12/10/2019
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