| Entity Name: | NEPHROLOGY SPECIALISTS OF FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jun 2017 (8 years ago) |
| Document Number: | L17000121137 |
| FEI/EIN Number | 82-1746333 |
| Mail Address: | PO BOX 652256, MIAMI, FL, 33265, US |
| Address: | 12905 SW 42ND ST., SUITE #213, MIAMI, FL, 33175, US |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477083269 | 2017-06-14 | 2022-07-21 | PO BOX 652256, MIAMI, FL, 332652256, US | 747 PONCE DE LEON BLVD STE 605, CORAL GABLES, FL, 331342074, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 305-407-9900 |
| Fax | 8889812863 |
Authorized person
| Name | DR. JOSE M CARDONA-GUZMAN |
| Role | OWNER |
| Phone | 3054079900 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | GI3222Z |
| State | FL |
| Issuer | MEDICAID |
| Number | 005961600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARDONA-GUZMAN JOSE M | Agent | 12905 SW 42ND ST., MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| CARDONA JOSE M | Manager | 12905 SW 42ND ST., MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-30 | 12905 SW 42ND ST., SUITE #213, MIAMI, FL 33175 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-04-30 |
| Florida Limited Liability | 2017-06-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
