Healthcare Provider Details

I. General information

NPI: 1508561531
Provider Name (Legal Business Name): ANNA DEBONAVENTURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MIDDLE RIVER DR STE 209
FORT LAUDERDALE FL
33304-3559
US

IV. Provider business mailing address

915 MIDDLE RIVER DR STE 209
FORT LAUDERDALE FL
33304-3559
US

V. Phone/Fax

Practice location:
  • Phone: 954-300-1736
  • Fax: 954-676-1405
Mailing address:
  • Phone: 954-300-1736
  • Fax: 954-676-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME181584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: