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PEDIATRICA HEALTH OF FLORIDA, LLC

Company Details

Entity Name: PEDIATRICA HEALTH OF FLORIDA, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 09 Aug 2024 (6 months ago)
Last Event: LC AMENDMENT
Event Date Filed: 20 Nov 2024 (2 months ago)
Document Number: L24000344971
FEI/EIN Number 86-1141885
Address: 75 VALENCIA AVE STE 709, CORAL GABLES, FL 33134
Mail Address: 75 VALENCIA AVE STE 709, CORAL GABLES, FL 33134
ZIP code: 33134
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316385164 2013-06-13 2024-09-12 75 VALENCIA AVE STE 709, CORAL GABLES, FL, 331346132, US 4788 HODGES BLVD, SUITE B-108, JACKSONVILLE, FL, 322247222, US

Contacts

Phone +1 904-223-9100
Fax 9042239282

Authorized person

Name DR. PRASANTHI REDDY
Role OWNER/ DOCTOR
Phone 9042239100

Taxonomy

Taxonomy Code 2080A0000X - Pediatric Adolescent Medicine Physician
License Number ME91195
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 118989200
State FL

Agent

Name Role
CAPITOL CORPORATE SERVICES, INC. Agent

Manager

Name Role Address
PALENZUELA, ROBERTO L Manager 75 VALENCIA AVE STE 709, CORAL GABLES, FL 33134

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000142711 PEDIATRICA OF PORT ST. LUCIE ACTIVE 2024-11-22 2029-12-31 No data 380 SW PRIMA VISTA BLVD, PORT ST LUCIE, FL, 34983
G24000142710 PEDIATRICA OF ST. AUGUSTINE SOUTH ACTIVE 2024-11-22 2029-12-31 No data 2676 US-1, ST. AUGUSTINE, FL, 32086
G24000125045 PEDIATRICA OF JULINGTON ACTIVE 2024-10-08 2029-12-31 No data 4125 RACE TRACK ROAD, UNIT 104, ST. JOHNS, FL, 32259
G24000125046 PEDIATRICA OF GAINESVILLE ACTIVE 2024-10-08 2029-12-31 No data 2005 SW 75TH ST, SUITE 10, GAINESVILLE, FL, 32607
G24000124647 PEDIATRICA OF SOUTH DAYTONA ACTIVE 2024-10-08 2029-12-31 No data 909 BIG TREE RD, SOUTH DAYTONA, FL, 32119
G24000124619 PEDIATRICA OF DELRAY BEACH ACTIVE 2024-10-07 2029-12-31 No data 4800 E. LINTON BLVD, STE E-315, DELRAY BEACH, FL, 33445
G24000114082 PEDIATRICA OF PHILIPS ACTIVE 2024-09-12 2029-12-31 No data 14797 PHILIPS HWY, SUITE #108, JACKSONVILLE, FL, 32256
G24000114081 PEDIATRICA OF SOUTHSIDE ACTIVE 2024-09-12 2029-12-31 No data 4788 HODGES BLVD, SUITE B-108, JACKSONVILLE, FL, 32224
G24000114083 PEDIATRICA OF NOCATEE ACTIVE 2024-09-12 2029-12-31 No data 101 MARKETSIDE DRIVE, UNIT 405, PONTE VEDRA, FL, 32081
G24000114084 PEDIATRICA OF DAYTONA BEACH ACTIVE 2024-09-12 2029-12-31 No data 515 HEALTH BLVD, DAYTONA BEACH, FL, 32114

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-11-20 No data No data
REGISTERED AGENT NAME CHANGED 2024-11-20 CAPITOL CORPORATE SERVICES, INC. No data
REGISTERED AGENT ADDRESS CHANGED 2024-11-20 515 E PARK AVE 2nd FL, TALLAHASSEE, FL 32301 No data
CHANGE OF MAILING ADDRESS 2024-08-29 75 VALENCIA AVE STE 709, CORAL GABLES, FL 33134 No data
LC AMENDMENT 2024-08-29 No data No data
CHANGE OF PRINCIPAL ADDRESS 2024-08-29 75 VALENCIA AVE STE 709, CORAL GABLES, FL 33134 No data
CONVERSION 2024-08-09 No data CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P05000092612. CONVERSION NUMBER 100000257231

Documents

Name Date
LC Amendment 2024-11-20
LC Amendment 2024-08-29
Florida Limited Liability 2024-08-09

Date of last update: 07 Jan 2025

Sources: Florida Department of State