Provider Demographics
NPI:1265766224
Name:BORIKEN FAMILY HEALTH AND WELLNESS CENTER PL
Entity type:Organization
Organization Name:BORIKEN FAMILY HEALTH AND WELLNESS CENTER PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-331-1916
Mailing Address - Street 1:1806 N FLAMINGO RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1026
Mailing Address - Country:US
Mailing Address - Phone:954-620-0026
Mailing Address - Fax:954-620-0047
Practice Address - Street 1:1806 N FLAMINGO RD
Practice Address - Street 2:SUITE 440
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1026
Practice Address - Country:US
Practice Address - Phone:954-620-0026
Practice Address - Fax:954-620-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85860207P00000X
FLME86754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty