Healthcare Provider Details

I. General information

NPI: 1265766224
Provider Name (Legal Business Name): BORIKEN FAMILY HEALTH AND WELLNESS CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 PEMBROKE RD STE 208
MIRAMAR FL
33027-2544
US

IV. Provider business mailing address

12600 PEMBROKE RD STE 208
MIRAMAR FL
33027-2544
US

V. Phone/Fax

Practice location:
  • Phone: 954-620-0026
  • Fax: 954-620-0047
Mailing address:
  • Phone: 954-620-0026
  • Fax: 954-620-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME85860
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME86754
License Number StateFL

VIII. Authorized Official

Name: MANUEL FERNANDEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-331-1916