Healthcare Provider Details

I. General information

NPI: 1659631208
Provider Name (Legal Business Name): MICHELLE LISE DALEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LISE LEVESQUE LEVESQUE

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 VISTA WAY STE 106
OCEANSIDE CA
92056-4513
US

IV. Provider business mailing address

414 SHADOW TREE DR
OCEANSIDE CA
92058-7023
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003843
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0004733
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: