Provider Demographics
NPI:1477799252
Name:TSAI, ELYSIA JANE (MED, ATC)
Entity Type:Individual
Prefix:
First Name:ELYSIA
Middle Name:JANE
Last Name:TSAI
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BONSALL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0950
Mailing Address - Country:US
Mailing Address - Phone:714-809-5109
Mailing Address - Fax:
Practice Address - Street 1:32 BONSALL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0950
Practice Address - Country:US
Practice Address - Phone:714-809-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0699027302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer