Evanescence Inc

Vascular Surgery Physician · Kendall, FL

Organization Active NPI

NPI number 1780628107

Practice location

11760 Bird Road
Suite 710
Kendall, FL 33165
Phone
(305) 598-8222
Fax
(305) 554-0616

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NPI record

NPI
1780628107
Entity type
Organization (Type 2)
Enumeration date
June 15, 2006
Last updated
July 10, 2007
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Vascular Surgery Physician Primary 2086S0129X ME 29633 FL

Mailing address

7100 Pines Blvd
Suite 23
Pembroke Pines, FL 33024-7355
Phone
(954) 967-0107
Fax
(954) 967-0109

Authorized official

Name
Gustavo G Leon, M.D.
Title
Medical Director
Phone
(305) 598-8222

About Evanescence Inc

Evanescence Inc is a healthcare organization registered in the NPI registry with the primary taxonomy Vascular Surgery Physician (code 2086S0129X). The practice location is 11760 Bird Road, Suite 710, Kendall, FL 33165. The NPI number 1780628107 was assigned on June 15, 2006 and the record was last updated on July 10, 2007.

Evanescence Inc lists a license in the registry: #ME 29633 (FL) for Vascular Surgery Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

The authorized official for this organization is Gustavo G Leon, M.D., Medical Director.

Frequently asked questions

What is the NPI number of Evanescence Inc?

The NPI number is 1780628107.

What is the phone number of Evanescence Inc?

The phone number listed for the practice location is (305) 598-8222.

Where is Evanescence Inc located?

11760 Bird Road, Suite 710, Kendall, FL 33165.

What is the taxonomy code for Evanescence Inc?

The primary taxonomy code is 2086S0129X – Vascular Surgery Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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