| Entity Name: | CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 May 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Mar 2021 (4 years ago) |
| Document Number: | L15000083217 |
| FEI/EIN Number | 47-3981006 |
| Address: | 2907 w sitios st, TAMPA, FL, 33629, US |
| Mail Address: | 2907 w sitios at, TAMPA, FL, 33629, US |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952829137 | 2017-09-07 | 2017-09-07 | 12231 MAIN ST UNIT 1196, SAN ANTONIO, FL, 335767253, US | 100 S ASHLEY DR STE 600, TAMPA, FL, 336025300, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-440-2741 |
| Fax | 8133384490 |
| Phone | +1 813-766-4218 |
Authorized person
| Name | DR. ONELIA RAMIREZ-COOK |
| Role | MANAGER |
| Phone | 8137664218 |
Taxonomy
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | ME112720 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00544800 |
| State | FL |
| Issuer | CAQH |
| Number | 12662244 |
| Issuer | INDIVIDUAL NPI |
| Number | 1669639001 |
| Issuer | INDIVIDUAL TAXONOMY |
| Number | 2084P0800X |
| Issuer | LICENSE NUMBER |
| Number | ME112720 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAMIREZ-COOK ONELIA | Agent | 2907 w sitios at, TAMPA, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| RAMIREZ-COOK ONELIA | President | 2907 w sitios st, Tampa, FL, 33629 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-03-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-02 | 2907 w sitios at, TAMPA, FL 33629 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-02 | 2907 w sitios st, TAMPA, FL 33629 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-02 | 2907 w sitios st, TAMPA, FL 33629 | No data |
| REINSTATEMENT | 2017-09-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-05 | RAMIREZ-COOK, ONELIA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-01-28 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-03 |
| REINSTATEMENT | 2021-03-30 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-02 |
| REINSTATEMENT | 2017-09-05 |
| Florida Limited Liability | 2015-05-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
