Organization
EXCELSIOR MEDICAL HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GERALDA PHANOR FLEURANVIL PA-C (CEO)
(786) 564-9438
Entity
Organization
Contact information
Practice address
18441 NW 2ND AVE STE 103, MIAMI GARDENS, FL 33169-4517
(305) 650-1158
Mailing address
1441 NW 204TH ST, MIAMI, FL 33169-2452
(786) 564-9438
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
PA9104039
FL
Other
Enumeration date
01/30/2018
Last updated
11/09/2021
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