Provider Demographics
NPI:1932671740
Name:EXCELLENCE HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:EXCELLENCE HEALTH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOISEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-558-9970
Mailing Address - Street 1:7925 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1827
Mailing Address - Country:US
Mailing Address - Phone:786-558-9970
Mailing Address - Fax:786-558-7768
Practice Address - Street 1:7925 NW 12TH ST STE 315
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1846
Practice Address - Country:US
Practice Address - Phone:786-558-9970
Practice Address - Fax:786-558-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105770900Medicaid