| Entity Name: | IVAN D. RODRIGUEZ, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Apr 2000 (25 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Nov 2001 (23 years ago) |
| Document Number: | P00000042148 |
| FEI/EIN Number | 651002758 |
| Address: | 6350 LAKE JUNE RD, MIAMI LAKES, FL, 33014 |
| Mail Address: | 6350 LAKE JUNE RD, MIAMI LAKES, FL, 33014 |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376625780 | 2006-10-19 | 2007-12-03 | 7777 NW 167TH TER, MIAMI LAKES, FL, 330168452, US | 7100 W 20TH AVE, SUITE 504, HIALEAH, FL, 330161897, US | |||||||||||||||||||||||||||
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| Phone | +1 305-824-0706 |
| Fax | 3058244699 |
| Phone | +1 305-827-3330 |
Authorized person
| Name | IVAN D RODRIGUEZ |
| Role | PRESIDENT |
| Phone | 3058240706 |
Taxonomy
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| License Number | OS7908 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 267179400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Rodriguez Ivan DIvan D. | Agent | 6350 LAKE JUNE RD, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ IVAN D | Director | 6350 LAKE JUNE RD., MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| Rodriguez Janet | Manager | 6350 LAKE JUNE RD, MIAMI LAKES, FL, 33014 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-03-05 | Rodriguez, Ivan D., Ivan D. Rodriguez | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-01 | 6350 LAKE JUNE RD, MIAMI LAKES, FL 33014 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-01 | 6350 LAKE JUNE RD, MIAMI LAKES, FL 33014 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-02-01 | 6350 LAKE JUNE RD, MIAMI LAKES, FL 33014 | No data |
| REINSTATEMENT | 2001-11-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-09-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-03-13 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-29 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-03-14 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
