MEDICARE: AMARIS MEDICAL TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1114875325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARIS MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	12230 SHADY HOLLOW LN
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-3862
Country	:	US
Telephone Number	:	818-612-8511
Fax Number	:

Provider Business Practice Location Address
First Line	:	12230 SHADY HOLLOW LN
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-3862
Country	:	US
Telephone Number	:	818-612-8511
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDY TACAY
Credential	:	RN,BSN
Telephone Number	:	818-612-8511

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “AMARIS MEDICAL TRANSPORT LLC ” Practice Location

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