# SUNROOT PSYCHIATRIC WELLNESS, A PROFESSIONAL NURSING CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952229130
- **Authorized official:** JENNA MARIE FAZIO (CEO)
- **Authorized official phone:** (619) 792-0513

## Contact information

- **Practice address:** 12307 WILLOW RD, LAKESIDE, CA 92040-1426
- **Practice address phone:** (619) 792-0513
- **Mailing address:** 2108 N ST STE N, SACRAMENTO, CA 95816-5712
- **Mailing address phone:** (619) 792-0513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/07/2026
- **Last updated:** 07/07/2026