Healthcare Provider Details

I. General information

NPI: 1073439675
Provider Name (Legal Business Name): ROOTED IN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28924 S WESTERN AVE STE 105
RANCHO PALOS VERDES CA
90275-0823
US

IV. Provider business mailing address

28924 S WESTERN AVE STE 105
RANCHO PALOS VERDES CA
90275-0823
US

V. Phone/Fax

Practice location:
  • Phone: 424-210-8583
  • Fax:
Mailing address:
  • Phone: 424-210-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOMMY ANTWAN ELLERBE
Title or Position: OWNER
Credential: OTD
Phone: 424-210-8583