| Entity Name: | CRISTINA BALSERA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Jul 2000 (25 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: | P00000069769 |
| FEI/EIN Number | 593659435 |
| Address: | 616 Marmora Ave, Tampa, FL, 33606, US |
| Mail Address: | 616 Marmora Ave, SUITE 208, Tampa, FL, 33606, US |
| ZIP code: | 33606 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831365493 | 2008-05-05 | 2008-05-05 | 510 VONDERBURG DR, SUITE 208, BRANDON, FL, 335115980, US | 510 VONDERBURG DR, SUITE 208, BRANDON, FL, 335115980, US | |||||||||||||||||||||||||
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| Phone | +1 813-571-3777 |
| Fax | 8135713737 |
Authorized person
| Name | DR. CRISTIAN BALSERA |
| Role | OWNER |
| Phone | 8135713777 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| License Number | ME78809 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 259600800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BALSERA CRISTINA M | Agent | 616 Marmora Ave, Tampa, FL, 33606 |
| Name | Role | Address |
|---|---|---|
| BALSERA CRISTINA M | Director | 616 Marmora Ave, Tampa, FL, 33606 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-10 | 616 Marmora Ave, Tampa, FL 33606 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-10 | 616 Marmora Ave, Tampa, FL 33606 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-10 | 616 Marmora Ave, SUITE 208, Tampa, FL 33606 | No data |
| REINSTATEMENT | 2012-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2002-08-07 | BALSERA, CRISTINA MD, PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-02-16 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-04-13 |
| REINSTATEMENT | 2012-10-08 |
| ANNUAL REPORT | 2011-04-14 |
| ANNUAL REPORT | 2010-04-06 |
| ANNUAL REPORT | 2009-03-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
