=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407701493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARKS SACRED BEGINNINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15372 LORETTA DR
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-639-7802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15372 LORETTA DR
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-639-7802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOULA
-----------------------------------------------------
Name | JACQUELINE NICOLE SPARKS
-----------------------------------------------------
Credential | CD-L , CD-PIC
-----------------------------------------------------
Telephone | 562-639-7802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------