Organization Active NPI

Excellent Lifestyle Services Inc

  • Clinic/Center
  • Miami, FL
National Provider Identifier
1376426924
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EXCELLENT LIFESTYLE SERVICES INC
Practice address
777 NW 72 Ave
R2102
Miami, FL 33126-3009
Phone
(954) 669-4235
NPI assigned
Jul 30, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ludmila De la Concepcion, MDNPI 1467846295
Title
Director
Phone
(954) 669-4235

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

777 NW 72 Ave
R2102
Miami, FL 33126-3009

Mailing address

777 NW 72 Ave
R2102
Miami, FL 33126-3009
Phone (954) 669-4235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250820003240 FL Part B Supplier - Clinic/Group Practice 5698275121 Receives reassigned benefits from 1 practitioner
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

777 NW 72nd Ave
#R2102
Miami, FL 33126
Phone (954) 669-4235

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1376426924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 NW 72 AVE",
            "address_2": "R2102",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263009",
            "telephone_number": "954-669-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 NW 72 AVE",
            "address_2": "R2102",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263009",
            "telephone_number": "954-669-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENT LIFESTYLE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-30",
        "last_updated": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "DE LA CONCEPCION",
        "authorized_official_first_name": "LUDMILA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-669-4235",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.