Healthcare Provider Details

I. General information

NPI: 1003750282
Provider Name (Legal Business Name): ROOT & BLOOM WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 NW 129TH AVE
MIAMI FL
33182-1169
US

IV. Provider business mailing address

652 NW 129TH AVE
MIAMI FL
33182-1169
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-6805
  • Fax: 305-229-1937
Mailing address:
  • Phone: 305-742-6805
  • Fax: 305-229-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXANDRA ELAINNE MARTINEZ
Title or Position: REGISTERED DIETITIAN
Credential: RDN, LDN
Phone: 305-742-6805