| Entity Name: | BARROSO MEDICAL SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Mar 2017 (8 years ago) |
| Document Number: | L17000068564 |
| FEI/EIN Number | 82-1394349 |
| Address: | 4835 E. 4TH AVE, SUITE B, HIALEAH, FL 33013 |
| Mail Address: | 4835 E. 4TH AVE, SUITE B, HIALEAH, FL 33013 |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245756576 | 2017-08-17 | 2020-07-21 | 4835 E 4TH AVE STE B, HIALEAH, FL, 330131814, US | 4835 E 4TH AVE STE B, HIALEAH, FL, 330131814, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-613-7986 |
| Phone | +1 786-899-0119 |
| Fax | 7868990440 |
Authorized person
| Name | IHOSVANI BARROSO |
| Role | PRESIDENT |
| Phone | 7868990119 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME122334 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022004900 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | ME122334 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARROSO, IHOSVANI | Agent | 4835 E 4TH AVE, Suite B, HIALEAH, FL 33013 |
| Name | Role | Address |
|---|---|---|
| Barroso, Ihosvani | Manager | 4835 E 4TH AVE, SUITE B HIALEAH, FL 33013 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000014896 | AB CORE PEDIATRICS LLC | EXPIRED | 2019-01-28 | 2024-12-31 | No data | 4835 E 4TH AVE, SUITE B, HIALEAH, FL, 33013 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-11 | 4835 E 4TH AVE, Suite B, HIALEAH, FL 33013 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-09-01 | 4835 E. 4TH AVE, SUITE B, HIALEAH, FL 33013 | No data |
| CHANGE OF MAILING ADDRESS | 2017-09-01 | 4835 E. 4TH AVE, SUITE B, HIALEAH, FL 33013 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-04-09 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-04-11 |
| Florida Limited Liability | 2017-03-27 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2044017401 | 2020-05-05 | 0455 | PPP | 4835 E 4TH AVE STE B, HIALEAH, FL, 33013-1814 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 18 Feb 2025
Sources: Florida Department of State
