Healthcare Provider Details

I. General information

NPI: 1316336522
Provider Name (Legal Business Name): ELYSE MARIE ZALESKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13522 NEWPORT AVE
TUSTIN CA
92780-3707
US

IV. Provider business mailing address

PO BOX 5532
IRVINE CA
92616-5532
US

V. Phone/Fax

Practice location:
  • Phone: 714-987-1121
  • Fax:
Mailing address:
  • Phone: 714-987-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: