Provider Demographics
NPI:1013337906
Name:BAINS, KELSEY HAUNANI (ATC, CPM, LM)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:HAUNANI
Last Name:BAINS
Suffix:
Gender:F
Credentials:ATC, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4512
Mailing Address - Country:US
Mailing Address - Phone:714-628-4704
Mailing Address - Fax:
Practice Address - Street 1:30270 RANCHO VIEJO RD STE F
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1556
Practice Address - Country:US
Practice Address - Phone:818-422-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0307021102255A2300X
CA769176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer