Provider Demographics
NPI:1700578895
Name:TRAURIG, KELLY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRAURIG
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 CARAWAY ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1134
Mailing Address - Country:US
Mailing Address - Phone:760-560-7582
Mailing Address - Fax:
Practice Address - Street 1:123 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2049
Practice Address - Country:US
Practice Address - Phone:760-645-3447
Practice Address - Fax:951-200-4396
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM709176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife