Organization
CONVIVA SPECIALTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA BONETTI (ASSOCIATE DIRECTOR)
(305) 500-2000
Entity
Organization
Contact information
Practice address
12905 SW 42ND ST STE 103, MIAMI, FL 33175-2910
(786) 801-5620
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
ME116882
FL
208100000X
Physical Medicine & Rehabilitation Physician
ME129977
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021709600
—
FL
Enumeration date
06/17/2016
Last updated
10/29/2025
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