Healthcare Provider Details

I. General information

NPI: 1104734565
Provider Name (Legal Business Name): GUARDIAN WHEELS CHILD TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W VIOLET ST
TAMPA FL
33603-2058
US

IV. Provider business mailing address

205 W VIOLET ST
TAMPA FL
33603-2058
US

V. Phone/Fax

Practice location:
  • Phone: 656-900-2583
  • Fax:
Mailing address:
  • Phone: 656-900-2583
  • 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: EBERKIS HERNANDEZ FRAGA
Title or Position: OWNER
Credential:
Phone: 656-900-2583