MEDICARE: CONVIVA SPECIALTY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician
2	207T00000X	Neurological Surgery Physician
3	207V00000X	Obstetrics & Gynecology Physician	ME116882	FL
4	208100000X	Physical Medicine & Rehabilitation Physician	ME129977	FL
5	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326498676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVIVA SPECIALTY, LLC

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12905 SW 42ND ST STE 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2910
Country	:	US
Telephone Number	:	786-801-5620
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	DR. JESSICA BONETTI
Credential	:
Telephone Number	:	305-500-2000

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	10/29/2025

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Directions to “CONVIVA SPECIALTY, LLC ” Practice Location

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