Healthcare Provider Details

I. General information

NPI: 1386555829
Provider Name (Legal Business Name): SOVEREIGN BIRTH CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14591 NEVADA CT
FONTANA CA
92336-0809
US

IV. Provider business mailing address

901 E WASHINGTON ST APT 328
COLTON CA
92324-8142
US

V. Phone/Fax

Practice location:
  • Phone: 310-944-0358
  • Fax:
Mailing address:
  • Phone: 310-944-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: ADRINA MERCEDES VARGAS
Title or Position: OWNER
Credential:
Phone: 310-944-0358