Healthcare Provider Details

I. General information

NPI: 1760302111
Provider Name (Legal Business Name): ROOTED AND RISING PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 5TH AVE STE 800
SAN DIEGO CA
92101-2792
US

IV. Provider business mailing address

PO BOX 120126
SAN DIEGO CA
92112-0126
US

V. Phone/Fax

Practice location:
  • Phone: 619-330-9195
  • Fax: 619-330-7699
Mailing address:
  • Phone: 619-330-9195
  • Fax: 619-330-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BARTELL RIVERA
Title or Position: OWNER
Credential: PSY.D.
Phone: 619-330-9195