Organization · Type 2 NPI

Roots and Raices Functional Medicine Inc.

Health Service Clinic/Center · South Ogden, UT

NPI number 1952955296 Active

Practice location

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

Fax (385) 298-4027

Specialties and licenses

Taxonomy	Code	License
Health Service Clinic/Center Primary	261QH0100X	None listed

Health Service Clinic/Center: Definition to come...

Another provider at this address

Firefly Holistics PLLCPsychiatric/Mental Health Nurse Practitioner South Ogden, UT NPI 1952210759

NPI record

NPI: 1952955296
Entity type: Organization (Type 2)
Issued: Jul 25, 2019
Last updated: Jan 2, 2020
Status: Active

Other names

<unavail>
Roots and Raices Functional Medicine · other name
Roots and Raices Functional Medicine · other name

Authorized official

Susan M Naylor, FNP-C
President
(435) 267-7668

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1952955296

Roots and Raices Functional Medicine Inc.'s National Provider Identifier is 1952955296, issued on Jul 25, 2019. The primary taxonomy on file is Health Service Clinic/Center (261QH0100X), and the practice location is in South Ogden, UT. The record was last updated on Jan 2, 2020.