Healthcare Provider Details

I. General information

NPI: 1609649672
Provider Name (Legal Business Name): CARISA MARISOL BORROMEO DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 GOLD ST
ALVISO CA
95002-3530
US

IV. Provider business mailing address

3866 PALOS VERDES WAY
SOUTH SAN FRANCISCO CA
94080-3945
US

V. Phone/Fax

Practice location:
  • Phone: 415-948-4974
  • Fax:
Mailing address:
  • Phone: 415-948-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: