Roots and Raices Functional Medicine Inc.

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

ROOTS AND RAICES FUNCTIONAL MEDICINE INC.

Practice address

1452 E Ridgeline Dr Ste 5
South Ogden, UT 84405-4949

Phone

(435) 267-7668

Fax

(385) 298-4027

NPI assigned

Jul 25, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan M Naylor, FNP-C

Title

President

Phone

(435) 267-7668

Specialties & licenses 1

Addresses

Other names 1

• Roots and Raices Functional Medicine Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1952955296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1452 E RIDGELINE DR STE 5",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844054949",
            "telephone_number": "435-919-7668",
            "fax_number": "801-689-3985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 E RIDGELINE DR STE 5",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844054949",
            "telephone_number": "435-267-7668",
            "fax_number": "385-298-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS AND RAICES FUNCTIONAL MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-25",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "NAYLOR",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-267-7668",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roots and Raices Functional Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Roots and Raices Functional Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Health Service Clinic/Center in South Ogden, UT
• Providers in South Ogden, UT by specialty
• Health Service Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.