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General NPI Number Information
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NPI Number | 1427665967
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Entity Type | Organization
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Legal Business Name | EVOLUTION HEALTH MANAGEMENT, CORP.
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 11077 BISCAYNE BLVD STE 402
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City | MIAMI
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State | FL
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Zip | 33161-7481
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Country | US
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Telephone | 786-247-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 11077 BISCAYNE BLVD STE 402
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City | MIAMI
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State | FL
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Zip | 33161-7481
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ISSEL RAMON MORENO
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Credential |
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Telephone | 786-247-6770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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