| Entity Name: | HEALTH MEDICAL ULTRA LIMITED LIABILITY COMPANY |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Dec 2019 (5 years ago) |
| Document Number: | L20000002194 |
| FEI/EIN Number | 844619561 |
| Mail Address: | 108 SUNRISE HILL LN, AUBURNDALE, FL, 33823-8499, US |
| Address: | 1760 Havendale Blvd NW, Winter Haven, FL, 33881, US |
| ZIP code: | 33881 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942829536 | 2020-04-13 | 2020-09-18 | 1760 HAVENDALE BLVD NW, WINTER HAVEN, FL, 338811224, US | 1760 HAVENDALE BLVD NW, WINTER HAVEN, FL, 338811224, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 863-662-3007 |
| Fax | 8638754681 |
Authorized person
| Name | MARIA I DIEZ |
| Role | CREDENTIALING MANAGER |
| Phone | 7863995995 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100166000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CAPARROS GONZALEZ JUAN LUIS MD | Agent | 1760 Havendale Blvd NW, Winter Haven, FL, 33881 |
| Name | Role | Address |
|---|---|---|
| CAPARROS GONZALEZ JUAN LUIS | Manager | 1760 Havendale Blvd NW, Winter Haven, FL, 33881 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-18 | 1760 Havendale Blvd NW, Winter Haven, FL 33881 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-31 | 1760 Havendale Blvd NW, Winter Haven, FL 33881 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-17 | 1760 Havendale Blvd NW, Winter Haven, FL 33881 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-18 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-01-31 |
| Florida Limited Liability | 2019-12-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
