Provider Demographics
NPI:1558486498
Name:BONEVA, DESSISLAVA V (MD)
Entity Type:Individual
Prefix:
First Name:DESSISLAVA
Middle Name:V
Last Name:BONEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 BIRD RD
Mailing Address - Street 2:SUITE 722
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-559-1883
Mailing Address - Fax:305-553-1887
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 722
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-559-1883
Practice Address - Fax:305-559-1887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDME110680208600000X
FLME 1106802086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery