=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376491415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLUTION AESTHETIC ADVANCES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3383 NW 7TH ST STE 104
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-832-1167
-----------------------------------------------------
Fax | 786-404-9554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3383 NW 7TH ST STE 104
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-832-1167
-----------------------------------------------------
Fax | 786-404-9554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VIVIANA PEREZ
-----------------------------------------------------
Credential | MEDICAL DOCTOR
-----------------------------------------------------
Telephone | 786-832-1167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------