| Entity Name: | AGUSTIN MARTINEZ M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Apr 2001 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 06 Oct 2005 (19 years ago) |
| Document Number: | P01000041181 |
| FEI/EIN Number | 651095564 |
| Address: | 250 EAST 49TH STREET, HIALEAH, FL, 33013, US |
| Mail Address: | 1324 SW 143RD AVENUE, MIAMI, FL, 33184 |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992892558 | 2006-10-06 | 2014-04-16 | 1324 SW 143RD AVE, MIAMI, FL, 331843223, US | 250 E 49TH ST, HIALEAH, FL, 330131855, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 305-822-6885 |
| Fax | 3058259965 |
Authorized person
| Name | AGUSTIN MARTINEZ |
| Role | PHYSICIAN |
| Phone | 3058226885 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME82266 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261107400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTINEZ AGUSTIN M | Agent | 250 EAST 49TH STREET, HIALEAH, FL, 33013 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ AGUSTIN M | Director | 1324 SW 143RD AVE, MIAMI, FL, 33184 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ AGUSTIN M | President | 1324 SW 143RD AVE, MIAMI, FL, 33184 |
| Name | Role | Address |
|---|---|---|
| Martinez Iriada | Secretary | 250 EAST 49TH STREET, HIALEAH, FL, 33013 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2011-02-17 | 250 EAST 49TH STREET, HIALEAH, FL 33013 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-01-25 | MARTINEZ, AGUSTIN MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-01-25 | 250 EAST 49TH STREET, HIALEAH, FL 33013 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-17 | 250 EAST 49TH STREET, HIALEAH, FL 33013 | No data |
| AMENDMENT | 2005-10-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-02-11 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-02 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-01-24 |
| ANNUAL REPORT | 2016-02-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
