| Rooted Life | |
|
6315 Connie Dr San Diego CA 92115-2521 | |
| (619) 915-4186 | |
| (619) 810-9201 |
| Full Name | Rooted Life |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6315 Connie Dr, San Diego, California |
| Authorized Official Name and Position | Tracey Wilson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6193576472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rooted Life 864 Grand Ave # 802 San Diego CA 92109-3906 Ph: (619) 648-1600 | Rooted Life 6315 Connie Dr San Diego CA 92115-2521 Ph: (619) 915-4186 |
| NPI Number | 1679357685 |
|---|---|
| Provider Enumeration Date | 08/21/2023 |
| Last Update Date | 08/06/2024 |
| Certification Date | 08/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679357685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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