| Entity Name: | LUIS G DIAZ-RANGEL, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 May 2000 (25 years ago) |
| Document Number: | P00000049936 |
| FEI/EIN Number | 651011042 |
| Address: | 777 EAST 25 STREET,, STE 118, HIALEAH, FL, 33013, US |
| Mail Address: | 6812 SW 80th St, Miami, FL, 33143, US |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427254689 | 2007-06-25 | 2019-01-23 | 777 E 25TH ST STE 118, HIALEAH, FL, 330133804, US | 777 E 25TH ST STE 118, HIALEAH, FL, 330133804, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-693-1988 |
| Fax | 3056933941 |
Authorized person
| Name | LUIS G DIAZ RANGEL |
| Role | OWNER |
| Phone | 3056931988 |
Taxonomy
| Taxonomy Code | 207RH0003X - Hematology & Oncology Physician |
| License Number | ME0052014 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275393600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RANGEL LUIS M | Agent | 777 EAST 25 STREET STE 118, HIALEAH, FL, 33013 |
| Name | Role | Address |
|---|---|---|
| RANGEL LUIS G | Director | 6812 SW 80th St, Miami, FL, 33143 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-01-28 | 777 EAST 25 STREET,, STE 118, HIALEAH, FL 33013 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-12-03 | 777 EAST 25 STREET STE 118, HIALEAH, FL 33013 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-28 | 777 EAST 25 STREET,, STE 118, HIALEAH, FL 33013 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-17 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-01-21 |
| Reg. Agent Change | 2018-12-03 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-01-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
