Provider Demographics
NPI:1326509779
Name:EXCEL MEDICAL DIAGNOSTICS 2 INC
Entity Type:Organization
Organization Name:EXCEL MEDICAL DIAGNOSTICS 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-3203
Mailing Address - Street 1:941 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4408
Mailing Address - Country:US
Mailing Address - Phone:786-409-3203
Mailing Address - Fax:786-399-8030
Practice Address - Street 1:941 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4408
Practice Address - Country:US
Practice Address - Phone:786-409-3203
Practice Address - Fax:786-399-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25957OtherBLUE CROSS
FL66905Medicaid