| Entity Name: | LA CASA FAMILY PRACTICE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Dec 2023 (a year ago) |
| Document Number: | L23000538497 |
| FEI/EIN Number | 93-4862925 |
| Address: | 13373 KINGSBURY DR, WELLINGTON, FL, 33414 |
| Mail Address: | 1127 ROYAL PALM BEACH BLVD, PMB 138, ROYAL PALM BEACH, FL, 33411 |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417713942 | 2024-02-22 | 2024-02-23 | 1127 ROYAL PALM BEACH BLVD PMB 138, ROYAL PALM BEACH, FL, 334111641, US | 13373 KINGSBURY DR, WELLINGTON, FL, 334143923, US | |||||||||||||
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| Phone | +1 561-236-7585 |
Authorized person
| Name | MILDREY MARTINEZ |
| Role | OWNER |
| Phone | 5612367585 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MARTINEZ MILDREY | Agent | 1127 ROYAL PALM BEACH BLVD, ROYAL PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ MILDREY | Authorized Member | 13373 KINGSBURY DR, WELLINGTON, FL, 33414 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| Florida Limited Liability | 2023-12-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
