Individual provider Active NPI

Joan Fernandez de la Vega

  • General Practice Physician
  • Miami, FL
National Provider Identifier
1083468169
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1742 Issued in FL
Practice address
11510 Quail Roost Dr
Miami, FL 33157-6548
Phone
(305) 256-3056
NPI assigned
Apr 15, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN1742 FL Primary

Addresses

Primary practice location

11510 Quail Roost Dr
Miami, FL 33157-6548

Mailing address

11510 Quail Roost Dr
Miami, FL 33157-6548
Phone (305) 256-3056

Other practice location 1

1600 NE Miami Gardens Dr
Miami, FL 33179-4900
Phone (786) 248-5374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250820002112 FL Practitioner - General Practice 8224537709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6355 NW 36TH St
Suite 1100
Virginia Gardens, FL 33166-7059

8217 SW 72ND Ave
Apt 1002
Miami, FL 33143-7987

8217 SW 72ND Ave Apt
Suite 1002
Miami, FL 33143-7987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pasteur & Wellmax Medical Centers LLC Current Accepting new patients
Pasteur & Wellmax Medical Centers LLC CurrentSince Aug 18, 2025 Accepting new patients
Pasteur & Wellmax Medical Centers LLC CurrentSince Aug 18, 2025 Accepting new patients

Locations

11510 Quail Roost Dr
Miami, FL 33157
Phone (305) 256-3056

1600 NE Miami Gardens Dr
North Miami Beach, FL 33179
Phone (305) 919-1970

1500 S Hiatus Rd
Pembroke Pines, FL 33025
Phone (954) 438-4000

6355 NW 36th St
Ste 1100
Virginia Gardens, FL 33166

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1083468169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11510 QUAIL ROOST DR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331576548",
            "telephone_number": "305-256-3056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11510 QUAIL ROOST DR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331576548",
            "telephone_number": "305-256-3056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 NE Miami Gardens Dr",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331794900",
            "country_code": "US",
            "telephone_number": "786-248-5374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ DE LA VEGA",
        "first_name": "JOAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-15",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.