| Entity Name: | CARLOS F. CORRALES, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 31 Aug 1989 (35 years ago) |
| Document Number: | L13341 |
| FEI/EIN Number | 650153848 |
| Mail Address: | 1001 BRICKELL BAY DR, SUITE 1400, MIAMI, FL, 33131 |
| Address: | 16855 NE 2 AVENUE, SUITE 302-A, NORTH MIAMI BEACH, FL, 33169 |
| ZIP code: | 33169 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225207319 | 2008-02-22 | 2008-02-22 | 16855 NE 2ND AVE, SUITE 302A, NORTH MIAMI BEACH, FL, 331621744, US | 16855 NE 2ND AVE, SUITE 302A, NORTH MIAMI BEACH, FL, 331621744, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-653-8566 |
| Fax | 3056534055 |
Authorized person
| Name | MR. EDWIN GONZALEZ JR. |
| Role | BILLING MANAGER |
| Phone | 9547261808 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | OS0002969 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | OS0002969 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CORRALES CARLOS F | Agent | 21331 NE 23RD AVENUE, N. MIAMI BCH., FL, 33180 |
| Name | Role | Address |
|---|---|---|
| CORRALES CARLOS F | Director | 21331 N.E. 23RD AVE., N.M. BEACH, FL, 33180 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2004-05-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1998-10-16 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
