Healthcare Provider Details

I. General information

NPI: 1053221598
Provider Name (Legal Business Name): SPROUT WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29219 CANWOOD ST # 103
AGOURA HILLS CA
91301-1560
US

IV. Provider business mailing address

12747 EMELITA ST
VALLEY VILLAGE CA
91607-1018
US

V. Phone/Fax

Practice location:
  • Phone: 310-918-3733
  • Fax:
Mailing address:
  • Phone: 310-918-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LEON
Title or Position: OWNER
Credential: OTR/L
Phone: 310-918-3733