Provider Demographics
NPI:1063621787
Name:EXCEL MEDICAL DIAGNOSTICS INC
Entity type:Organization
Organization Name:EXCEL MEDICAL DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-455-7711
Mailing Address - Street 1:10000 SW 56TH ST STE 29
Mailing Address - Street 2:SUITE 29
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7163
Mailing Address - Country:US
Mailing Address - Phone:305-455-7711
Mailing Address - Fax:305-455-7713
Practice Address - Street 1:10000 SW 56TH ST STE 29
Practice Address - Street 2:SUITE 29
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7163
Practice Address - Country:US
Practice Address - Phone:305-455-7711
Practice Address - Fax:305-455-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4640261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care