Healthcare Provider Details

I. General information

NPI: 1629905351
Provider Name (Legal Business Name): OPAL MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JUNE LOOP
LAKE HAMILTON FL
33851
US

IV. Provider business mailing address

1305 JUNE LOOP
LAKE HAMILTON FL
33851
US

V. Phone/Fax

Practice location:
  • Phone: 813-474-8386
  • Fax: --
Mailing address:
  • Phone: 813-474-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: DANIELA PEREZ-CARRALERO
Title or Position: GM
Credential:
Phone: 813-474-8386