| Entity Name: | MD HEALTHCARE BOCA RATON LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Mar 2021 (4 years ago) |
| Document Number: | L21000128938 |
| FEI/EIN Number | 86-2963015 |
| Mail Address: | 304 INDIAN TRACE, SUITE 636, WESTON, FL, 33326, US |
| Address: | 7050 W PALMETTO PARK ROAD SUITE 30, BOCA RATON, FL, 33433, US |
| ZIP code: | 33433 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144979949 | 2022-03-21 | 2022-12-06 | 304 INDIAN TRACE, SUITE 636, WESTON, FL, 33326, US | 7050 W. PALMETTO PARK ROAD, SUITE 30, BOCA RATON, FL, 33433, US | |||||||||||||||||||||||||||
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| Phone | +1 786-553-9745 |
| Phone | +1 954-425-9154 |
| Fax | 8669811882 |
Authorized person
| Name | DR. RENATO SEGURA |
| Role | MEDICAL DIRECTOR/PRESIDENT |
| Phone | 7863014164 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024422400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Westerburger Derwin | Agent | 7050 W PALMETTO PARK ROAD SUITE 30, BOCA RATON, FL, 33433 |
| Name | Role | Address |
|---|---|---|
| Westerburger Derwin | mana | 7050 W PALMETTO PARK ROAD SUITE 30, BOCA RATON, FL, 33433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-10-24 | Westerburger, Derwin | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-10-24 | 7050 W PALMETTO PARK ROAD SUITE 30, BOCA RATON, FL 33433 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-07-12 | 7050 W PALMETTO PARK ROAD SUITE 30, BOCA RATON, FL 33433 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-26 |
| ANNUAL REPORT | 2024-04-30 |
| AMENDED ANNUAL REPORT | 2023-10-24 |
| AMENDED ANNUAL REPORT | 2023-08-28 |
| ANNUAL REPORT | 2023-04-29 |
| AMENDED ANNUAL REPORT | 2022-07-26 |
| AMENDED ANNUAL REPORT | 2022-07-25 |
| ANNUAL REPORT | 2022-02-09 |
| Florida Limited Liability | 2021-03-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
