CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A.
NPI 1770988990
Internal Medicine in Live Oak, TX

Q: What is Conviva Medical Center Management Of Texas, P.A.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since October 30, 2014CLIA 45D1029017 · Waiver

12602 TOEPPERWEIN RD STE 100, LIVE OAK, TX 78233(210) 654-0030(855) 278-4550 Get Directions Write a Review

NPPES record last updated: June 21, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 21, 2024, Feb 15, 2022, Nov 19, 2020 and 1 more (4 updates tracked since 2018).

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About Conviva Medical Center Management Of Texas, P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A. (NPI 1770988990) is a healthcare organization registered as an internal medicine in Live Oak, Texas and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through August 8, 2026, maintains a secondary practice location in Live Oak, and lists Jessica Bonetti, Associate Director, as its authorized official.

NPPES Registry Identity

NPI1770988990

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameCONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P.A.

Location Address12602 TOEPPERWEIN RD STE 100Live Oak, TX 78233-3204

Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000

Phone(210) 654-0030

Fax(855) 278-4550

Organization SubpartNo

Authorized OfficialJessica BonettiAssociate Director · (786) 507-8556

Enumeration DateOctober 30, 2014

Last NPPES UpdateJune 21, 20244 updates tracked since enumeration

NPPES CertifiedJune 21, 2024

✔ NPI 1770988990 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedGeneral PracticeTaxonomy 208D00000X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

12602 TOEPPERWEIN RD STE 100, Live Oak, TX 78233

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Secondary Practice Location 1

Location 112602 Toepperwein Rd Ste 100Live Oak, TX 78233-3204 · Phone (210) 654-0030 · Fax (855) 278-4550

Other Identifiers 1

Medicaid350315301TX

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D1029017

Conviva Medical Center Management Of Texas, PA Dba Conviva Care Center · San Antonio, TX

Active · expires Aug 8, 2026

CLIA Number45D1029017

Laboratory TypePhysician Office

Certificate Effective DateAugust 9, 2024

Certificate Expiration DateAugust 8, 2026

Laboratory DirectorFahd Alnori M. Almohid

Laboratory Phone(210) 654-0030

Laboratory LocationConviva Medical Center Management Of Texas, PA Dba Conviva Care Center12602 Toepperwein Road, Ste 100, San Antonio, TX 78233

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROXANNE RODRIGUEZ P.A.-C

Physician Assistant