Healthcare Provider Details

I. General information

NPI: 1528745379
Provider Name (Legal Business Name): TAPROOT HEALING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SUPERIOR AVE STE 200
NEWPORT BEACH CA
92663-3639
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 949-534-6950
  • Fax: 949-229-6471
Mailing address:
  • Phone: 818-550-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ATUL GROVER
Title or Position: CEO
Credential: MD
Phone: 949-229-3369