Provider Demographics
NPI:1427472844
Name:EXCELLENT LABORATORIES INC
Entity type:Organization
Organization Name:EXCELLENT LABORATORIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUERVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-747-7994
Mailing Address - Street 1:7290 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4506
Mailing Address - Country:US
Mailing Address - Phone:305-223-6601
Mailing Address - Fax:305-223-6602
Practice Address - Street 1:7290 SW 42 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-223-6601
Practice Address - Fax:305-223-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2018-10-30
Deactivation Date:2018-10-17
Deactivation Code:
Reactivation Date:2018-10-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory