Provider Demographics
NPI:1376064816
Name:HEALTHY ROOTS MEDICINE, LLC
Entity Type:Organization
Organization Name:HEALTHY ROOTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-523-5808
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-0871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5415 W CEDAR LN STE 204B
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1524
Practice Address - Country:US
Practice Address - Phone:301-523-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty