| Entity Name: | G&A PROFESSIONAL HEALTH SERVICES, PLLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Jun 2018 (7 years ago) |
| Document Number: | L18000152696 |
| FEI/EIN Number | 83-1013295 |
| Address: | 3682 N. WICKHAM ROAD, SUITE B1 #306, MELBOURNE, FL, 32935, US |
| Mail Address: | 3682 N. WICKHAM ROAD, SUITE B1 #306, MELBOURNE, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417422288 | 2018-10-09 | 2023-03-29 | 3682 N WICKHAM RD STE B1-300, MELBOURNE, FL, 329352325, US | 3682 N WICKHAM RD STE B1-306, MELBOURNE, FL, 329352325, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 305-934-8592 |
Authorized person
| Name | GABRIEL E CUETO |
| Role | OWNER |
| Phone | 3059348592 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | KR887 |
| State | FL |
| Issuer | RRMEDICARE PTAN |
| Number | DY8543 |
| State | FL |
| Issuer | MEDICAID |
| Number | 101946200 |
| State | FL |
| Name | Role |
|---|---|
| THE LAW OFFICES OF MAX A. ADAMS, ESQ., PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| CUETO GABRIEL E | Manager | 3682 N. WICKHAM ROAD, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-23 | 4929 SW 74TH CT, MIAMI, FL 33155 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-03-08 | 3682 N. WICKHAM ROAD, SUITE B1 #306, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2019-03-08 | 3682 N. WICKHAM ROAD, SUITE B1 #306, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-09-19 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-03-08 |
| Florida Limited Liability | 2018-06-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
