| Entity Name: | BUENA VISTA MEDICAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Oct 2001 (23 years ago) |
| Document Number: | P01000097904 |
| FEI/EIN Number | 651142158 |
| Address: | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| Mail Address: | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184634818 | 2006-08-08 | 2020-09-30 | 11805 SW 46TH ST, MIAMI, FL, 331754739, US | 11805 SW 46TH ST, MIAMI, FL, 331754739, US | |||||||||||||||||||||||
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| Phone | +1 305-610-2526 |
| Fax | 3052215224 |
Authorized person
| Name | DR. CARLOS A PEREZ |
| Role | OWNER/PHYSICIAN |
| Phone | 3056102526 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GENERAL PRACTICE |
| Number | AG701 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ MARIA C | Agent | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| PEREZ MACHADO CARLOS A | Director | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| PEREZ MARIA C | Director | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| PEREZ MACHADO CARLOS A | President | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| PEREZ MARIA C | Secretary | 11805 SW 46 STREET, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2018-12-05 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
