Healthcare Provider Details

I. General information

NPI: 1487538906
Provider Name (Legal Business Name): IRINI S KABITSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21721 GRANADA AVE
CUPERTINO CA
95014-5934
US

IV. Provider business mailing address

2024 BELLE MONTI AVE
BELMONT CA
94002-1727
US

V. Phone/Fax

Practice location:
  • Phone: 650-701-6718
  • Fax:
Mailing address:
  • Phone: 650-701-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86431376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: