Healthcare Provider Details

I. General information

NPI: 1053238469
Provider Name (Legal Business Name): TAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 FERNWOOD AVE
CALIFORNIA CITY CA
93505-2505
US

IV. Provider business mailing address

7840 FERNWOOD AVE
CALIFORNIA CITY CA
93505-2505
US

V. Phone/Fax

Practice location:
  • Phone: 661-434-8759
  • Fax: 661-434-8759
Mailing address:
  • Phone: 661-434-8759
  • Fax: 661-434-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THANDI SMITH
Title or Position: OWNER
Credential:
Phone: 661-434-8759