Healthcare Provider Details

I. General information

NPI: 1902710320
Provider Name (Legal Business Name): KALISI ULUAKIMATA KUPU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALISI FIFITA

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BRADFORD ST
REDWOOD CITY CA
94063-1530
US

IV. Provider business mailing address

101 MC LELLAN DR APT 4025
SOUTH SAN FRANCISCO CA
94080-7528
US

V. Phone/Fax

Practice location:
  • Phone: 650-363-4000
  • Fax:
Mailing address:
  • Phone: 650-781-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: