| Entity Name: | BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 28 Sep 1987 (37 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | M59818 |
| FEI/EIN Number | 59-2848225 |
| Address: | 4980 W. 10TH AVE., STE. 102, HIALEAH, FL 33012 |
| Mail Address: | 4980 W. 10TH AVE., STE. 102, HIALEAH, FL 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225192263 | 2006-12-21 | 2020-08-22 | 4980 W 10TH AVE, SUITE 102, HIALEAH, FL, 330123437, US | 4980 W 10TH AVE, SUITE 102, HIALEAH, FL, 330123437, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-558-4140 |
| Fax | 3055589698 |
Authorized person
| Name | MR. CARLOS EXPOSITO |
| Role | PRESIDENT |
| Phone | 3055584140 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | HCC4409 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 257947 |
| State | FL |
| Issuer | WELLCARE STAYWELL |
| Number | 170998 |
| State | FL |
| Issuer | BCBS |
| Number | 77793 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 216622 |
| State | FL |
| Issuer | ALL OTHERS |
| Number | 77793 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Garcia, Margarita | Agent | 4980 W. 10TH AVE., SUITE 102, HIALEAH, FL 33012 |
| Name | Role | Address |
|---|---|---|
| GARCIA, MARGARITA | President | 4980 W. 10TH AVE. STE. 102, HIALEAH, FL 33012 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-06-20 | Garcia, Margarita | No data |
| AMENDMENT | 2014-08-19 | No data | No data |
| AMENDMENT | 2014-07-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1997-02-12 | 4980 W. 10TH AVE., SUITE 102, HIALEAH, FL 33012 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1995-05-01 | 4980 W. 10TH AVE., STE. 102, HIALEAH, FL 33012 | No data |
| CHANGE OF MAILING ADDRESS | 1995-05-01 | 4980 W. 10TH AVE., STE. 102, HIALEAH, FL 33012 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-27 |
| AMENDED ANNUAL REPORT | 2016-06-20 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-27 |
| Amendment | 2014-08-19 |
| Amendment | 2014-07-28 |
| Off/Dir Resignation | 2014-07-28 |
| ANNUAL REPORT | 2014-04-13 |
| ANNUAL REPORT | 2013-03-29 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
