| Entity Name: | POPULATION HEALTH ALLIANCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Sep 2018 (6 years ago) |
| Document Number: | L18000229235 |
| FEI/EIN Number | 83-2113098 |
| Address: | 14680 SW 8TH ST, SUITE 205, MIAMI, FL, 33184, US |
| Mail Address: | 14680 SW 8TH ST, SUITE 205, MIAMI, FL, 33184, US |
| ZIP code: | 33184 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720555204 | 2018-11-01 | 2022-05-04 | 806 S DOUGLAS RD STE 700, CORAL GABLES, FL, 331342082, US | 8200 SW 117TH AVE STE 314, MIAMI, FL, 331834826, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 786-878-5500 |
| Fax | 7865529696 |
| Phone | +1 305-274-6422 |
Authorized person
| Name | JOSEPH L CARUNCHO |
| Role | MANAGER |
| Phone | 7868785505 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MATZNER GARY C | Agent | 2800 Ponce de Leon Blvd., Coral Gables, FL, 33134 |
| Name | Role | Address |
|---|---|---|
| KUTNER MARK MD | Clas | 10095 SW 88TH ST, MIAMI, FL, 33176 |
| Caruncho Joseph L | Clas | 806 South Douglas Road, CORAL GABLES, FL, 33134 |
| Rodriguez Roger | Clas | 806 South Douglas Road, CORAL GABLES, FL, 33134 |
| Montesino Jenifer MD | Clas | 806 South Douglas Road, CORAL GABLES, FL, 33134 |
| Kharfan Gamil | Clas | 806 South Douglas Road, CORAL GABLES, FL, 33134 |
| Santiago Martin Dr. | Clas | 14680 SW 8TH ST, MIAMI, FL, 33184 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-25 | 14680 SW 8TH ST, SUITE 205, MIAMI, FL 33184 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-25 | 14680 SW 8TH ST, SUITE 205, MIAMI, FL 33184 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-25 | 2800 Ponce de Leon Blvd., SUITE 1100, Coral Gables, FL 33134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-03-25 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-05-01 |
| Florida Limited Liability | 2018-09-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
