| Entity Name: | WELLCARE CLINICAL SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Nov 2019 (5 years ago) |
| Document Number: | L19000276855 |
| FEI/EIN Number | 84-3822408 |
| Address: | 4835 Hollywood Blvd, HOLLYWOOD, FL, 33021, US |
| Mail Address: | 4835 Hollywood Blvd, HOLLYWOOD, FL, 33021, US |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225651136 | 2020-05-26 | 2020-07-07 | 4701 PIERCE ST, HOLLYWOOD, FL, 330215807, US | 4835 HOLLYWOOD BLVD, HOLLYWOOD, FL, 330216548, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 713-703-5255 |
| Phone | +1 954-908-9550 |
Authorized person
| Name | DR. AURORA LUNA |
| Role | PHYSICIAN/OWNER |
| Phone | 7137035255 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 202C00000X - Independent Medical Examiner Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 246RP1900X - Phlebotomy Technician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Luna Aurora | Agent | 4835 Hollywood Blvd, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| LUNA AURORA | Authorized Member | 4835 Hollywood Blvd, HOLLYWOOD, FL, 33021 |
| FERNANDEZ WIFREDO | Authorized Member | 4835 Hollywood Blvd, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-16 | 4835 Hollywood Blvd, Suite 4, HOLLYWOOD, FL 33021 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-27 | 4835 Hollywood Blvd, Suite 4, HOLLYWOOD, FL 33021 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-27 | Luna, Aurora | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-27 | 4835 Hollywood Blvd, HOLLYWOOD, FL 33021 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-05-16 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-01-15 |
| Florida Limited Liability | 2019-11-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
