Healthcare Provider Details

I. General information

NPI: 1104247188
Provider Name (Legal Business Name): BANYAN COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 W FLAGLER ST
CORAL GABLES FL
33134-1601
US

IV. Provider business mailing address

1200 NW 78TH AVE STE 100
DORAL FL
33126-1816
US

V. Phone/Fax

Practice location:
  • Phone: 305-398-6100
  • Fax: 305-398-6099
Mailing address:
  • Phone: 305-398-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MANUEL ANDRES FERNANDEZ
Title or Position: CEO
Credential:
Phone: 561-213-9211