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General NPI Number Information
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NPI Number | 1700596541
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Entity Type | Organization
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Legal Business Name | EXCELLENCE MEDICAL & RESEARCH
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 111 NW 183RD ST STE 206
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4579
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Country | US
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Telephone | 786-320-5229
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Fax | 786-320-5279
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Provider Business Mailing Address
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Address Line | 111 NW 183RD ST STE 206
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4579
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Country | US
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Telephone | 786-320-5229
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Fax | 786-320-5279
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MIGUEL ANGEL TRUJILLO PEREZ
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Credential | FNP-C
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Telephone | 714-931-9877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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