Provider Demographics
NPI:1568985281
Name:EXCEL MEDICAL DIAGNOSTICS 1 , INC
Entity Type:Organization
Organization Name:EXCEL MEDICAL DIAGNOSTICS 1 , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSLAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RIVERA.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-295-4799
Mailing Address - Street 1:2244 NW 7TH STREET,
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:786-409-3203
Mailing Address - Fax:786-615-3811
Practice Address - Street 1:2244 NW 7TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:786-409-3203
Practice Address - Fax:786-615-3811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEL MEDICAL DIAGNOSTICS 1 , INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11068261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service