Healthcare Provider Details

I. General information

NPI: 1881408185
Provider Name (Legal Business Name): SPIRIT LIFE CHURCH OF JESUS CHRIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 SINALOA RD
SIMI VALLEY CA
93065-3031
US

IV. Provider business mailing address

1482 SINALOA RD
SIMI VALLEY CA
93065-3031
US

V. Phone/Fax

Practice location:
  • Phone: 805-864-9046
  • Fax:
Mailing address:
  • Phone: 805-864-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TARYN TARVER
Title or Position: OWNER
Credential:
Phone: 805-864-9046