Healthcare Provider Details

I. General information

NPI: 1114875325
Provider Name (Legal Business Name): AMARIS MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 SHADY HOLLOW LN
PORTER RANCH CA
91326-3862
US

IV. Provider business mailing address

12230 SHADY HOLLOW LN
PORTER RANCH CA
91326-3862
US

V. Phone/Fax

Practice location:
  • Phone: 818-612-8511
  • Fax:
Mailing address:
  • Phone: 818-612-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANDY TACAY
Title or Position: OWNER
Credential: RN,BSN
Phone: 818-612-8511