Healthcare Provider Details

I. General information

NPI: 1013337906
Provider Name (Legal Business Name): KELSEY HAUNANI BAINS ATC, CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30270 RANCHO VIEJO RD STE F
SAN JUAN CAPISTRANO CA
92675-1556
US

IV. Provider business mailing address

8045 E CHAPMAN AVE
ORANGE CA
92869-4512
US

V. Phone/Fax

Practice location:
  • Phone: 818-422-8842
  • Fax:
Mailing address:
  • Phone: 714-628-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number030702110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: