| Entity Name: | LAZARO FRAGA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Jul 1990 (35 years ago) |
| Document Number: | L92581 |
| FEI/EIN Number | 650212954 |
| Address: | 4141 SW 6TH STREET, MIAMI, FL, 33134, US |
| Mail Address: | 5590 W 20 ave, Hialeah, FL, 33016, US |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932204179 | 2006-09-13 | 2020-08-22 | PO BOX 351597, MIAMI, FL, 331357597, US | 4141 SW 6TH ST, CORAL GABLES, FL, 331342057, US | |||||||||||||||||||||||
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| Phone | +1 305-443-5063 |
| Fax | 3054431336 |
| Phone | +1 305-443-5031 |
| Fax | 3054420844 |
Authorized person
| Name | NORKI HUERTAS |
| Role | PRESIDENT |
| Phone | 3054435063 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAZARO FRAGA, M. D., P. A. 401(K) PLAN | 2009 | 650212954 | 2010-10-08 | LAZARO FRAGA, M.D., P.A. | 26 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650212954 |
| Plan administrator’s name | LAZARO FRAGA, M.D., P.A. |
| Plan administrator’s address | 4141 S.W. 6TH STREET, MIAMI, FL, 33134 |
| Administrator’s telephone number | 3054422228 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-08 |
| Name of individual signing | JUAN GOMEZ |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BEILLY BRADFORD J | Agent | 1144 SE 3RD AVE, FORT LAUDERDALE, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| CASANOVA RENE | Director | 1144 SE 3RD AVENUE, FORT LAUDERDALE, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| CASANOVA RENE | President | 1144 SE 3RD AVENUE, FORT LAUDERDALE, FL, 33316 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000045885 | PRIMECARE FAMILY CENTERS | EXPIRED | 2019-04-11 | 2024-12-31 | No data | 7765 NW 48 STREET, SUITE 300, DORAL, FL, 33166 |
| G18000044813 | LAZARO FRAGA MD PA | EXPIRED | 2018-04-06 | 2023-12-31 | No data | 4131 SW, 6 ST, CORAL GABLES, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2018-11-16 | No data | No data |
| CANCEL ADM DISS/REV | 2007-10-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| AMENDMENT | 2007-08-30 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
