Provider Demographics
NPI:1083318448
Name:PROTECTED ROOTS INTEGRATIVE
Entity Type:Organization
Organization Name:PROTECTED ROOTS INTEGRATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUYEU
Authorized Official - Middle Name:
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:925-269-7451
Mailing Address - Street 1:7817 HERSCHEL AVE UNIT 101-102
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7817 HERSCHEL AVE UNIT 101-102
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4454
Practice Address - Country:US
Practice Address - Phone:858-295-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty