Healthcare Provider Details

I. General information

NPI: 1083534010
Provider Name (Legal Business Name): ROOTED RELATIONS SPEECH THERAPY, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 MISSION CENTER RD APT 214
SAN DIEGO CA
92108-4366
US

IV. Provider business mailing address

5773 MISSION CENTER RD APT 214
SAN DIEGO CA
92108-4366
US

V. Phone/Fax

Practice location:
  • Phone: 786-210-9132
  • Fax:
Mailing address:
  • Phone: 786-210-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRYSTAL CANELLAS
Title or Position: PRESIDENT
Credential: CCC-SLP
Phone: 786-210-9132