| Conviva Care Center | |
|
3641 Clyde Morris Blvd Suite 100 Port Orange FL 32129-2357 | |
| (305) 500-2114 | |
| (305) 370-6024 |
| Full Name | Conviva Care Center |
|---|---|
| Speciality | Family Medicine |
| Location | 3641 Clyde Morris Blvd, Port Orange, Florida |
| Authorized Official Name and Position | Gemma Rosello (VICE PRESIDENT) |
| Authorized Official Contact | 3055002000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Conviva Care Center 6101 Blue Lagoon Dr Suite 400 Miami FL 33126-2055 Ph: (305) 500-2114 | Conviva Care Center 3641 Clyde Morris Blvd Suite 100 Port Orange FL 32129-2357 Ph: (305) 500-2114 |
| NPI Number | 1134504855 |
|---|---|
| Provider Enumeration Date | 07/23/2015 |
| Last Update Date | 01/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134504855 | NPI | - | NPPES |
| CX415B | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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