# EVANESCENCE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780628107
- **Authorized official:** GUSTAVO G LEON M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (305) 598-8222

## Contact information

- **Practice address:** 11760 BIRD ROAD, SUITE 710, KENDALL, FL 33165
- **Practice address phone:** (305) 598-8222
- **Practice address fax:** (305) 554-0616
- **Mailing address:** 7100 PINES BLVD, SUITE 23, PEMBROKE PINES, FL 33024-7355
- **Mailing address phone:** (954) 967-0107
- **Mailing address fax:** (954) 967-0109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | ME 29633 | FL | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 07/10/2007