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General NPI Number Information
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NPI Number | 1710706924
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Entity Type | Organization
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Legal Business Name | OUR ROOTS
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/20/2024
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Provider Practice Location Address
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Address Line | 4047 HARDING WAY
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City | OAKLAND
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State | CA
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Zip | 94602-1919
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Country | US
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Telephone | 510-946-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 PARK ST # 1020
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City | ALAMEDA
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State | CA
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Zip | 94501-4507
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Country | US
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Telephone | 510-946-0283
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | PRIYA IYER
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Credential |
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Telephone | 510-946-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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