Organization
EVANESCENCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO G LEON M.D. (MEDICAL DIRECTOR)
(305) 598-8222
Entity
Organization
Contact information
Practice address
11760 BIRD ROAD, SUITE 710, KENDALL, FL 33165
(305) 598-8222
(305) 554-0616
Mailing address
7100 PINES BLVD, SUITE 23, PEMBROKE PINES, FL 33024-7355
(954) 967-0107
(954) 967-0109
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME 29633
FL
Other
Enumeration date
06/15/2006
Last updated
07/10/2007
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