Healthcare Provider Details

I. General information

NPI: 1427991496
Provider Name (Legal Business Name): SOVEREIGHDARITY LABORATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18145 AMERICAN BEAUTY DR UNIT 102
SANTA CLARITA CA
91387-3080
US

IV. Provider business mailing address

18017 CHATSWORTH ST # 255
GRANADA HILLS CA
91344-5608
US

V. Phone/Fax

Practice location:
  • Phone: 818-903-4015
  • Fax:
Mailing address:
  • Phone: 818-903-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. LATRICE MATTHEWS
Title or Position: DOULA
Credential:
Phone: 818-903-4015