Healthcare Provider Details

I. General information

NPI: 1760310866
Provider Name (Legal Business Name): EXCELSIOR HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5359 BIRCH GROVE DR
SAN JOSE CA
95123-1707
US

IV. Provider business mailing address

5359 BIRCH GROVE DR
SAN JOSE CA
95123-1707
US

V. Phone/Fax

Practice location:
  • Phone: 408-614-6649
  • Fax:
Mailing address:
  • Phone: 408-614-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: BERNELLET TAA
Title or Position: CEO
Credential: EXCELSIOR HEALTHCARE
Phone: 408-614-6649