Healthcare Provider Details

I. General information

NPI: 1598886426
Provider Name (Legal Business Name): WILFRED P FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 NE 1ST ST STE 2
POMPANO BEACH FL
33062-4934
US

IV. Provider business mailing address

9720 SW 90TH AVE
MIAMI FL
33176-2950
US

V. Phone/Fax

Practice location:
  • Phone: 954-247-9324
  • Fax: 844-840-8030
Mailing address:
  • Phone: 305-742-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME50322
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME50322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: