| Entity Name: | CASABLANCA DERMATOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Apr 2024 (9 months ago) |
| Document Number: | L24000200047 |
| Address: | 840 E 25 ST, HIALEAH, FL, 33013, UN |
| Mail Address: | 840 E 25 ST, HIALEAH, FL, 33013, UN |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710717335 | 2024-08-07 | 2024-08-07 | 840 E 25TH ST, HIALEAH, FL, 330133402, US | 840 E 25TH ST, HIALEAH, FL, 330133402, US | |||||||||||||
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| Phone | +1 786-452-3109 |
Authorized person
| Name | MS. LUSAYMA SANCHEZ |
| Role | MANAGER |
| Phone | 7864523109 |
Taxonomy
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HAWATMEH FARIS | Agent | 840 E 25 ST, HIALEAH, FL, 33013 |
| Name | Role | Address |
|---|---|---|
| HAWATMEH FARIS | Manager | 840 E 25 ST, HIALEAH, FL, 33013 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
