| Entity Name: | CASABLANCA MEDICAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Nov 2022 (2 years ago) |
| Document Number: | L22000470090 |
| FEI/EIN Number | 92-0994572 |
| Address: | 840 E 25th St, Hialeah, FL, 33013, US |
| Mail Address: | 2940 SW 128th Ave, MIAMI, FL, 33175, US |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114609419 | 2023-08-04 | 2024-10-18 | 840 E 25TH ST, HIALEAH, FL, 330133402, US | 840 E 25TH ST, HIALEAH, FL, 330133402, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 305-783-7664 |
Authorized person
| Name | MRS. LUSAYMA SANCHEZ |
| Role | BILLING DIRECTOR |
| Phone | 7864523109 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HAWATMEH FARIS | Agent | 2940 SW 128th Ave, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| HAWATMEH FARIS Dr. | RA | 2940 SW 128th Ave, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-30 | 840 E 25th St, Hialeah, FL 33013 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-30 | 840 E 25th St, Hialeah, FL 33013 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-30 | 2940 SW 128th Ave, MIAMI, FL 33175 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-31 | HAWATMEH, FARIS | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-30 |
| ANNUAL REPORT | 2023-01-31 |
| Florida Limited Liability | 2022-11-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
