Healthcare Provider Details

I. General information

NPI: 1336836436
Provider Name (Legal Business Name): MS. KELLY PINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY PINA

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23502 LYONS AVE STE 304A
SANTA CLARITA CA
91321-2538
US

IV. Provider business mailing address

23502 LYONS AVE STE 304A
SANTA CLARITA CA
91321-2538
US

V. Phone/Fax

Practice location:
  • Phone: 661-702-0166
  • Fax: 661-702-0169
Mailing address:
  • Phone: 661-702-0166
  • Fax: 661-702-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number106S00000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: