| Entity Name: | CARRASQUERO PEDIATRICS & ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Jun 2012 (13 years ago) |
| Last Event: | LC AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 14 Aug 2014 (10 years ago) |
| Document Number: | L12000079048 |
| FEI/EIN Number | 45-5491284 |
| Address: | 407 Wekiva Springs Road, Longwood, FL, 32779, US |
| Mail Address: | 407 Wekiva Springs Road, Longwood, FL, 32779, US |
| ZIP code: | 32779 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134478605 | 2012-08-30 | 2012-08-30 | 407 WEKIVA SPRINGS ROAD, SUITE 110, LONGWOOD, FL, 32779, US | 407 WEKIVA SPRINGS ROAD, SUITE 110, LONGWOOD, FL, 32779, US | |||||||||||||||||||||||||
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| Phone | +1 407-790-7998 |
| Fax | 4079518821 |
Authorized person
| Name | DR. LUISA CARRASQUERO |
| Role | MD |
| Phone | 4077907998 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME99334 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279635000 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENT SERVICES CO. | Agent |
| Name | Role | Address |
|---|---|---|
| CARRASQUERO LUISA | Managing Member | 2740 Sabal Alexander Circle, Longwood, FL, 32779 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000104518 | WEKIVA SPRINGS PEDIATRICS | ACTIVE | 2019-09-24 | 2029-12-31 | No data | 407 WEKIVA SPRINGS ROAD, SUITE 123, LONGWOOD, FL, 32779 |
| G12000071965 | WEKIVA SPRINGS PEDIATRICS | EXPIRED | 2012-07-18 | 2017-12-31 | No data | 1777 FIREHOUSE LANE #208, ORLANDO, FL, 32814 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-09 | 407 Wekiva Springs Road, Suite 123, Longwood, FL 32779 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-09 | 407 Wekiva Springs Road, Suite 123, Longwood, FL 32779 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-06 | 3211 Vineland Rd, Suite 174, Kissimmee, FL 34746 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-04-17 | REGISTERED AGENT SERVICES CO. | No data |
| LC AMENDED AND RESTATED ARTICLES | 2014-08-14 | No data | No data |
| LC AMENDMENT | 2012-07-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-09 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-04-17 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-03-09 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
