Healthcare Provider Details

I. General information

NPI: 1669202537
Provider Name (Legal Business Name): HEALING ROOTS CURANDO RAICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEWBURG RD STE B
FORTUNA CA
95540-2599
US

IV. Provider business mailing address

3000 NEWBURG RD STE B
FORTUNA CA
95540-2599
US

V. Phone/Fax

Practice location:
  • Phone: 707-600-6815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE ULLOA
Title or Position: LMFT
Credential:
Phone: 707-600-6815