Organization
CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA BONETTI (ASSOCIATE DIRECTOR)
(786) 507-8556
Entity
Organization
Contact information
Practice address
12602 TOEPPERWEIN RD STE 100, LIVE OAK, TX 78233-3204
(210) 654-0030
(855) 278-4550
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350315301
—
TX
Enumeration date
10/30/2014
Last updated
06/21/2024
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