| Entity Name: | M & M PEDIATRICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Jan 2001 (24 years ago) |
| Document Number: | P01000010220 |
| FEI/EIN Number | 651063833 |
| Address: | 18503 PINES BLVD., SUITE 212, PEMBROKE PINES, FL, 33029 |
| Mail Address: | 18503 PINES BLVD., SUITE 212, PEMBROKE PINES, FL, 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336519693 | 2015-09-30 | 2015-09-30 | 18503 PINES BLVD STE 212, PEMBROKE PINES, FL, 330291405, US | 18503 PINES BLVD STE 212, PEMBROKE PINES, FL, 330291405, US | |||||||||||||||||||||||||
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| Phone | +1 954-392-0266 |
| Fax | 9543920267 |
Authorized person
| Name | DR. MARTHA MAYORGA VASQUEZ |
| Role | DOCTOR/OWNER |
| Phone | 9543920266 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME66599 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 258309700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MAYORGA VASQUEZ MARTHA | Agent | 18503 PINES BLVD., PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| MAYORGA VASQUEZ MARTHA L | Director | 18503 PINES BLVD., PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| MAYORGA VASQUEZ MARTHA L | Manager | 18503 PINES BLVD., PEMBROKE PINES, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2007-04-18 | MAYORGA VASQUEZ, MARTHA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-04-18 | 18503 PINES BLVD., SUITE 212, PEMBROKE PINES, FL 33029 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-28 | 18503 PINES BLVD., SUITE 212, PEMBROKE PINES, FL 33029 | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-28 | 18503 PINES BLVD., SUITE 212, PEMBROKE PINES, FL 33029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-10 |
| ANNUAL REPORT | 2020-06-03 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-03-13 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-03-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
