Provider Demographics
NPI:1235835174
Name:EXCELLENCE HEALTH MEDICAL SPA LLC
Entity Type:Organization
Organization Name:EXCELLENCE HEALTH MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-238-9064
Mailing Address - Street 1:1301 BEVILLE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1503
Mailing Address - Country:US
Mailing Address - Phone:386-238-9064
Mailing Address - Fax:386-238-9063
Practice Address - Street 1:1301 BEVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1503
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:386-238-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty