MEDICARE: SPARKS SACRED BEGINNINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1407701493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS SACRED BEGINNINGS

Provider Business Mailing Address
First Line	:	15372 LORETTA DR
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-1428
Country	:	US
Telephone Number	:	562-639-7802
Fax Number	:

Provider Business Practice Location Address
First Line	:	15372 LORETTA DR
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-1428
Country	:	US
Telephone Number	:	562-639-7802
Fax Number	:

Authorized Official
Title or Position	:	DOULA
Name	:	JACQUELINE NICOLE SPARKS
Credential	:	CD-L , CD-PIC
Telephone Number	:	562-639-7802

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “SPARKS SACRED BEGINNINGS ” Practice Location

Language	Start Address	Practice Location

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