| Entity Name: | RAFAEL A. PALMEROLA, MD, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Jul 2000 (25 years ago) |
| Document Number: | P00000065402 |
| FEI/EIN Number | 651024456 |
| Address: | 1575 SW 87 AVE, MIAMI, FL, 33174 |
| Mail Address: | 7875 Sw 66 St, MIAMI, FL, 33143, US |
| ZIP code: | 33174 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790715688 | 2006-07-04 | 2019-08-27 | 7875 SW 66TH ST, SOUTH MIAMI, FL, 331432712, US | 7875 SW 66TH ST, SOUTH MIAMI, FL, 331432712, US | |||||||||||||||||||||||||||||
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| Phone | +1 786-326-8608 |
Authorized person
| Name | EILEEN SUAREZ |
| Role | BILLING MANAGER |
| Phone | 7868439059 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME67254 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 377249700 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | AK108 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLEITES SERGIO ACPA | Agent | 1575 SW 87 AVE, MIAMI, FL, 33174 |
| Name | Role | Address |
|---|---|---|
| PALMEROLA RAFAEL A | President | 1575 SW 87 AVENUE, MIAMI, FL, 33174 |
| Name | Role | Address |
|---|---|---|
| PALMEROLA RAFAEL A | Director | 1575 SW 87 AVENUE, MIAMI, FL, 33174 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-03-18 | 1575 SW 87 AVE, MIAMI, FL 33174 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-03-21 | FLEITES, SERGIO A, CPA | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-05-09 | 1575 SW 87 AVE, MIAMI, FL 33174 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-03-22 | 1575 SW 87 AVE, MIAMI, FL 33174 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-03-18 |
| ANNUAL REPORT | 2021-02-15 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-02-20 |
| ANNUAL REPORT | 2017-03-20 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
