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General NPI Number Information
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NPI Number | 1710485255
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Entity Type | Organization
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Legal Business Name | EXCELSIOR MEDICAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 18441 NW 2ND AVE STE 103
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4517
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Country | US
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Telephone | 305-650-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 NW 204TH ST
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City | MIAMI
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State | FL
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Zip | 33169-2452
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Country | US
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Telephone | 786-564-9438
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. GERALDA PHANOR FLEURANVIL
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Credential | PA-C
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Telephone | 786-564-9438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA9104039
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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