Healthcare Provider Details

I. General information

NPI: 1073456372
Provider Name (Legal Business Name): SOIL & SPROUT PERINATAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 HIDDEN LAKES DR
MARTINEZ CA
94553-5417
US

IV. Provider business mailing address

613 HIDDEN LAKES DR
MARTINEZ CA
94553-5417
US

V. Phone/Fax

Practice location:
  • Phone: 925-255-3132
  • Fax:
Mailing address:
  • Phone: 925-255-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAHLA DE LEON
Title or Position: OWNER
Credential: FISHER DE LEON
Phone: 925-255-3132