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General NPI Number Information
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NPI Number | 1013684992
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Entity Type | Organization
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Legal Business Name | EXCELLENCE CARE FLORIDA LLC
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 4005 NW 114TH AVE UNIT 22
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City | DORAL
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State | FL
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Zip | 33178-4373
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Country | US
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Telephone | 786-366-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 14113 SW 161ST CT
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City | MIAMI
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State | FL
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Zip | 33196-6543
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Country | US
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Telephone | 786-366-2050
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Fax |
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Authorized Official
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Title or Position | CEO/AMBR
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Name | ERNESTO GUEVARA
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Credential | PMHNP
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Telephone | 786-366-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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