21D2300152 CLIA NUMBER - ROOTED HEALTHCARE

Laboratory Demographics

  • CLIA Code: 21D2300152
  • Facility Name: ROOTED HEALTHCARE
  • Facility Address: 1106 BUSINESS PKWY S #B
    WESTMINSTER, MD
    ZIP 21157
  • Facility Phone: 917 861-2531
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KISUN PETERS-DIAZ
  • NPI Number: 1891576591
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2300152
LAB Type Practitioner Other
Facility Name ROOTED HEALTHCARE
Street 1106 BUSINESS PKWY S #B
City WESTMINSTER
State MD
ZIP 21157
Phone 917 861-2531
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Practitioner Other
Lab Director KISUN PETERS-DIAZ

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This page was last updated on: 9/29/2025