Provider Demographics
NPI:1437389053
Name:EXCELENCE HEALTHCARE, C.S.P.
Entity Type:Organization
Organization Name:EXCELENCE HEALTHCARE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-473-4100
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1366
Mailing Address - Country:US
Mailing Address - Phone:787-895-8080
Mailing Address - Fax:939-666-0390
Practice Address - Street 1:BARRIO CACAO CARRETERA 478 KM. 0.1
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-8080
Practice Address - Fax:939-666-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15676302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038260101Medicaid
I53430Medicare UPIN