Healthcare Provider Details

I. General information

NPI: 1144297516
Provider Name (Legal Business Name): MARISSA CASTRO FERNANDEZ KIEMELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA CASTRO FERNANDEZ MD

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ELISEO DR STE 201
GREENBRAE CA
94904-2153
US

IV. Provider business mailing address

50 STANIFORD ST FL 9
BOSTON MA
02114-2506
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-1780
  • Fax:
Mailing address:
  • Phone: 617-724-6610
  • Fax: 603-929-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number292453
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18726
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC192860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: