MEDICARE: IMPERIAL EXCELL CARE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1619519022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL EXCELL CARE MEDICAL LLC

Provider Business Mailing Address
First Line	:	4055 SPENCER ST STE 131
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5251
Country	:	US
Telephone Number	:	702-258-1384
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 SPENCER ST STE 131
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5251
Country	:	US
Telephone Number	:	702-258-1384
Fax Number	:	702-258-1387

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE IMPERIAL
Credential	:
Telephone Number	:	702-239-1592

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	03/29/2026

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