Healthcare Provider Details

I. General information

NPI: 1043126501
Provider Name (Legal Business Name): HEALING ROOTS THERAPEUTICS, A PSYCHIATRIC NURSING INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W 11TH ST
TRACY CA
95376-3856
US

IV. Provider business mailing address

632 W 11TH ST
TRACY CA
95376-3856
US

V. Phone/Fax

Practice location:
  • Phone: 510-509-4059
  • Fax:
Mailing address:
  • Phone: 510-509-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA NJOROGE
Title or Position: CEO/ PMHNP
Credential: MSN, PMHNP-BC, APRN
Phone: 209-670-4142