| Entity Name: | JUAN O. BRAVO, MD PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Jan 2005 (20 years ago) |
| Document Number: | L05000002993 |
| FEI/EIN Number | 20-2136165 |
| Address: | 1932 CORAL HEIGHTS CT, OAKLAND, FL 33008 |
| Mail Address: | 1932 Coral Heights Court, Oakland Park, FL 33308 |
| ZIP code: | 33008 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336258243 | 2006-08-30 | 2023-03-29 | 170 FITZGERALD RD STE 1, LAKELAND, FL, 338132633, US | 3000 CORAL HILLS DR, CORAL SPRINGS, FL, 330654108, US | |||||||||||||||||||||||||||||
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| Phone | +1 863-777-2736 |
| Fax | 8637772724 |
| Phone | +1 863-398-8362 |
| Fax | 8137547565 |
Authorized person
| Name | JUAN O BRAVO |
| Role | CEO |
| Phone | 8633988362 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2083P0011X - Undersea and Hyperbaric Medicine (Preventive Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271611900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRAVO, JUAN O | Agent | 1932 Coral Heights Ct, Oakland Park, FL 33308 |
| Name | Role | Address |
|---|---|---|
| Bravo, Juan Oscar | Managing Member | 1932 Coral Heights Court, Oakland Park, FL 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-02-19 | 1932 CORAL HEIGHTS CT, OAKLAND, FL 33008 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-28 | 1932 CORAL HEIGHTS CT, OAKLAND, FL 33008 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-24 | 1932 Coral Heights Ct, Oakland Park, FL 33308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-19 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-03-24 |
| ANNUAL REPORT | 2018-01-03 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-02-22 |
Date of last update: 04 Jan 2025
Sources: Florida Department of State
