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General NPI Number Information
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NPI Number | 1265766224
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Entity Type | Organization
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Legal Business Name | BORIKEN FAMILY HEALTH AND WELLNESS CENTER PL
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1806 N FLAMINGO RD SUITE 440
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1026
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Country | US
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Telephone | 954-620-0026
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Fax | 954-620-0047
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Provider Business Mailing Address
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Address Line | 1806 N FLAMINGO RD SUITE 440
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1026
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Country | US
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Telephone | 954-620-0026
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Fax | 954-620-0047
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MANUEL FERNANDEZ
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Credential | MD
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Telephone | 305-331-1916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME85860
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME86754
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License Number State | FL
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