Organization
ROOTED HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KISUN DEVON PETERS-DIAZ (EXECUTIVE DIRECTOR)
(917) 861-2531
Entity
Organization
Contact information
Practice address
1106 BUSINESS PKWY S STE B, WESTMINSTER, MD 21157-3054
(410) 751-7771
Mailing address
405 N CENTER ST STE 25, WESTMINSTER, MD 21157-5126
(917) 861-2531
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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