| Entity Name: | MEDICA ONE HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Jun 2022 (3 years ago) |
| Document Number: | L22000288755 |
| FEI/EIN Number | 88-3061143 |
| Address: | 10794 Pines Blvd suite 202, PEMBROKE PINES, FL 33026 |
| Mail Address: | 1151 SW 171ST TERRACE, PEMBROKE PINES, FL 33027 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285358606 | 2022-09-29 | 2022-09-29 | 10794 PINES BLVD STE 202, PEMBROKE PINES, FL, 330263920, US | 10794 PINES BLVD STE 202, PEMBROKE PINES, FL, 330263920, US | |||||||||||||||||||||
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| Phone | +1 954-589-5958 |
| Fax | 9545895785 |
Authorized person
| Name | CARLOS J HARO |
| Role | PRIMARY PHYSICIAN |
| Phone | 9545895958 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 276279000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARO, CAROLINA | Agent | 1151 SW 171ST TERRACE, PEMBROKE PINES, FL 33027 |
| Name | Role | Address |
|---|---|---|
| HARO, CAROLINA | Manager | 1151 SW 171ST TERRACE, PEMBROKE PINES, FL 33027 |
| HARO, CARLOS J, DR. | Manager | 1151 SW 171 ST TERRACE, PEMBROKE PINES, FL 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-09 | 10794 Pines Blvd suite 202, PEMBROKE PINES, FL 33026 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-04-06 |
| Florida Limited Liability | 2022-06-27 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
