| Entity Name: | KIDSVILLE PEDIATRICS II, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Apr 2001 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 01 Aug 2011 (14 years ago) |
| Document Number: | P01000041303 |
| FEI/EIN Number | 593717691 |
| Mail Address: | PO BOX 452223, KISSIMMEE, FL, 34745 |
| Address: | 1050 WEST CARROLL STREET, KISSIMMEE, FL, 34741 |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144292756 | 2006-02-07 | 2019-08-13 | 1050 W CARROLL ST, KISSIMMEE, FL, 347411268, US | 1050 W CARROLL ST, KISSIMMEE, FL, 347411268, US | |||||||||||||||||||||||||
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| Phone | +1 407-518-0078 |
| Fax | 4075180094 |
Authorized person
| Name | MR. VICTOR M. PANTOJA JR. |
| Role | ADMINISTRATOR |
| Phone | 4075180078 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME-0074421 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 274049400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PANTOJA VICTOR MJr. | Agent | 1050 WEST CARROLL STREET, KISSIMMEE, FL, 34741 |
| Name | Role | Address |
|---|---|---|
| Gonzalez Francelis IMD | Chief Executive Officer | PO BOX 452223, Kissimmee, FL, 34745 |
| Name | Role | Address |
|---|---|---|
| PANTOJA VICTOR MJr. | President | PO BOX 452223, KISSIMMEE, FL, 34745 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000000668 | DR. G | ACTIVE | 2023-01-03 | 2028-12-31 | No data | PO BOX 452223, KISSIMMEE, FL, 34745 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-10 | 1050 WEST CARROLL STREET, KISSIMMEE, FL 34741 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-03-03 | PANTOJA, VICTOR M, Jr. | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-11 | 1050 WEST CARROLL STREET, KISSIMMEE, FL 34741 | No data |
| AMENDMENT | 2011-08-01 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-03-09 | 1050 WEST CARROLL STREET, KISSIMMEE, FL 34741 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-04 |
| ANNUAL REPORT | 2015-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
