Basic Information
| Provider Information | |||||||||
| NPI: | 1477909463 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EXCEL HEALTH SERVICES CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3850 SW 87TH AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331655400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864427575 | ||||||||
| FaxNumber: | 3052804171 | ||||||||
| Practice Location | |||||||||
| Address1: | 3850 SW 87TH AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331655400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864427575 | ||||||||
| FaxNumber: | 3052804171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | CASTANEDO | ||||||||
| AuthorizedOfficialFirstName: | DANNY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7864427575 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.