| Entity Name: | ANGEL ERNESTO RICO MD PA II, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Jan 2023 (2 years ago) |
| Document Number: | L23000026628 |
| FEI/EIN Number | 92-1906193 |
| Address: | 1275 W 47TH PLACE, 420, HIALEAH, FL, 33012, FL |
| Mail Address: | 1275 W 47TH PLACE, 420, HIALEAH, FL, 33012, FL |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295414787 | 2023-07-13 | 2023-11-09 | 1275 W 47TH PL STE 420, HIALEAH, FL, 330123452, US | 1275 W 47TH PL STE 420, HIALEAH, FL, 330123452, US | |||||||||||||||||||||||||||||||
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| Phone | +1 786-353-2098 |
| Fax | 7863532249 |
| Phone | +1 863-532-0987 |
Authorized person
| Name | ANGEL ERNESTO RICO |
| Role | PRESIDENT |
| Phone | 7863532098 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 278704100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAZO KENIA | Agent | 1275 W 47TH PLACE, HIALEAH, FL, 33012 |
| Name | Role | Address |
|---|---|---|
| LAZO KENIA | Authorized Member | 1275 W 47TH PLACE SUITE 420, HIALEAH, FL, 33018 |
| HERNANDEZ LAZARO | Authorized Member | 2800 SW 68 AVE, MIAMI, FL, 33155 |
| Name | Role | Address |
|---|---|---|
| RICO ANGEL ERNESTO | Member | 3555 WEST 88 STREET, HIALEAH GARDENS, FL, 33018 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| Florida Limited Liability | 2023-01-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
