Evanescence INC

NPI #1780628107 in Kendall, Florida

Provider Information

NPI Number: 1780628107
Entity Type: Organization
Organization Name: Evanescence INC
Primary Specialty: Surgery - Vascular Surgery
Enumeration Date: Jun 15, 2006
Last Updated: Jul 10, 2007

Practice Location

Address: 11760 BIRD ROAD
Address 2: SUITE 710
City: Kendall
State: Florida
ZIP Code: 33165
Phone: (305) 598-8222

Authorized Official

Name: GUSTAVO G LEON, M.D.
Title: MEDICAL DIRECTOR
Phone: (305) 598-8222

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery - Vascular Surgery — Vascular Surgery	2086S0129X	Primary

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