Healthcare Provider Details

I. General information

NPI: 1053135871
Provider Name (Legal Business Name): AMARIS GISELLE ARMENDARIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 FRICOT CITY RD
SAN ANDREAS CA
95249-9642
US

IV. Provider business mailing address

1128 PARADISE PEAK RD
VALLEY SPRINGS CA
95252-8543
US

V. Phone/Fax

Practice location:
  • Phone: 209-736-4500
  • Fax:
Mailing address:
  • Phone: 209-242-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: