Kalissa Marie Campbell

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

931 San Bruno Ave W RM 2
San Bruno, CA 94066-3435

Phone

(415) 681-3211

NPI assigned

Jan 14, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kalissa Marie Bandini Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547424000000",
    "number": "1639643554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 PARK PL APT 229",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031584",
            "telephone_number": "775-233-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 SAN BRUNO AVE W RM 2",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940663435",
            "telephone_number": "415-681-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KALISSA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALISSA",
            "last_name": "BANDINI",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community Health Worker in San Bruno, CA
• Providers in San Bruno, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.