Evanescence Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

ME 29633 Issued in FL

Legal business name

EVANESCENCE INC

Practice address

11760 Bird Road
Suite 710
Kendall, FL 33165

Phone

(305) 598-8222

Fax

(305) 554-0616

NPI assigned

Jun 15, 2006

Organization subpart

No

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

Authorized official

Name

Gustavo G Leon, M.D.

Title

Medical Director

Phone

(305) 598-8222

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1780628107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 PINES BLVD",
            "address_2": "SUITE 23",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330247355",
            "telephone_number": "954-967-0107",
            "fax_number": "954-967-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 BIRD ROAD",
            "address_2": "SUITE 710",
            "city": "KENDALL",
            "state": "FL",
            "postal_code": "33165",
            "telephone_number": "305-598-8222",
            "fax_number": "305-554-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANESCENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "LEON",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "305-598-8222",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME 29633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular Surgery Physician in Kendall, FL
• Providers in Kendall, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.