Healthcare Provider Details

I. General information

NPI: 1801791199
Provider Name (Legal Business Name): EXCELENTDX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KALMUS DR STE E150
COSTA MESA CA
92626-7947
US

IV. Provider business mailing address

151 KALMUS DR STE E150
COSTA MESA CA
92626-7947
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-5513
  • Fax:
Mailing address:
  • Phone: 949-500-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN CHAVEZ
Title or Position: MANAGER
Credential:
Phone: 949-500-5513