| Organization Name: | EVANESCENCE INC |
| NPI Number: | 1780628107 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GUSTAVO G LEON (MEDICAL DIRECTOR) |
| Mailing Address: | 11760 Bird Road Suite 710 Kendall |
| State: | FL US |
| Postal Code: | 33165 |
| Phone Number: | 3055988222 |
| Fax Number: | 3055540616 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 07/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | ME 29633 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |