Healthcare Provider Details

I. General information

NPI: 1699279307
Provider Name (Legal Business Name): EXCELLENT MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12448 SW 127TH AVE
MIAMI FL
33186-6596
US

IV. Provider business mailing address

12448 SW 127TH AVE
MIAMI FL
33186-6596
US

V. Phone/Fax

Practice location:
  • Phone: 786-864-1030
  • Fax: 305-735-7666
Mailing address:
  • Phone: 786-864-1030
  • Fax: 305-735-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXEI GOMEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-864-1030