| Rooted Vitality Health Collaborative A Psychological Corporation | |
|
516 W Shaw Ave Ste 200 Fresno CA 93704-2515 | |
| (559) 221-2584 | |
| (559) 494-4831 |
| Full Name | Rooted Vitality Health Collaborative A Psychological Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 516 W Shaw Ave Ste 200, Fresno, California |
| Authorized Official Name and Position | Jacinda Hernandez (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 5592212584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rooted Vitality Health Collaborative A Psychological Corporation 516 W Shaw Ave Ste 200 Fresno CA 93704-2515 Ph: (559) 221-2584 | Rooted Vitality Health Collaborative A Psychological Corporation 516 W Shaw Ave Ste 200 Fresno CA 93704-2515 Ph: (559) 221-2584 |
| NPI Number | 1780208199 |
|---|---|
| Provider Enumeration Date | 06/01/2020 |
| Last Update Date | 06/01/2020 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 6901202209 |
|---|---|
| Medicare Enrollment ID | O20210913001791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780208199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jacinda Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083143648 PECOS PAC ID: 2264838564 Enrollment ID: I20210923003359 |
| Provider Name | Jennifer Sepulveda Zizzo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295159945 PECOS PAC ID: 1355747650 Enrollment ID: I20231023003232 |
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