Healthcare Provider Details

I. General information

NPI: 1114710993
Provider Name (Legal Business Name): SPA PHOENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 W MANCHESTER AVE APT 12
LOS ANGELES CA
90047-2927
US

IV. Provider business mailing address

13921 YUKON AVE APT 253
HAWTHORNE CA
90250-8130
US

V. Phone/Fax

Practice location:
  • Phone: 877-756-2258
  • Fax:
Mailing address:
  • Phone: 877-756-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RO'SHAWNA RASHADA
Title or Position: OPERATIONS MANAGER/DOULA
Credential:
Phone: 877-756-2258