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General NPI Number Information
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NPI Number | 1831347152
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Entity Type | Organization
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Legal Business Name | EVANS AVENUE HEALTH CARE CLINIC, INC
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 4048 EVANS AVE SUITE 306
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City | FORT MYERS
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State | FL
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Zip | 33901-9322
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Country | US
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Telephone | 786-314-0539
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Fax |
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Provider Business Mailing Address
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Address Line | 4048 EVANS AVE SUITE 306
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City | FORT MYERS
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State | FL
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Zip | 33901-9322
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Country | US
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Telephone | 786-314-0539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALAIN LEON
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Credential |
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Telephone | 786-314-0539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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