Provider Demographics
NPI:1801815899
Name:DELESKE, MICHELE MESMIC (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MESMIC
Last Name:DELESKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:3460 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2334
Practice Address - Country:US
Practice Address - Phone:562-594-6599
Practice Address - Fax:562-594-7116
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP6935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM479ZMedicare PIN