Provider Demographics
NPI:1720639099
Name:EVOLUTION MED INC
Entity Type:Organization
Organization Name:EVOLUTION MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-5065
Mailing Address - Street 1:7911 NW 72ND AVE STE 215A
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2223
Mailing Address - Country:US
Mailing Address - Phone:786-409-5065
Mailing Address - Fax:786-409-5199
Practice Address - Street 1:7911 NW 72ND AVE STE 215A
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2223
Practice Address - Country:US
Practice Address - Phone:786-409-5065
Practice Address - Fax:786-409-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty