Provider Demographics
NPI:1902036635
Name:EXCELLENCE EMERGENCY GROUP CSP
Entity Type:Organization
Organization Name:EXCELLENCE EMERGENCY GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-240-7107
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0836
Mailing Address - Country:US
Mailing Address - Phone:787-240-7107
Mailing Address - Fax:
Practice Address - Street 1:URB COSTA AZUL CALLE 14 K 12
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0000
Practice Address - Country:US
Practice Address - Phone:787-240-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty