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General NPI Number Information
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NPI Number | 1659063402
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Entity Type | Organization
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Legal Business Name | SOVEREIGNDARITY LABORATION GROUP, LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 06/03/2023
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Provider Practice Location Address
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Address Line | 14521 BIRCHWOOD CT
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City | SYLMAR
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State | CA
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Zip | 91342-1469
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Country | US
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Telephone | 818-903-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 18017 CHATSWORTH ST # 255
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5608
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Country | US
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Telephone | 818-903-4015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LATRICE MATTHEWS
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Credential |
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Telephone | 818-903-4015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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