| Entity Name: | MEDICAL CORAL WAY CENTER, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Apr 2002 (23 years ago) |
| Document Number: | P02000041040 |
| FEI/EIN Number | 030427642 |
| Address: | 1401 S. MILITARY TRL, SUITE C, WEST PALM BEACH, FL, 33415 |
| Mail Address: | 1401 S. MILITARY TRL, SUITE C, WEST PALM BEACH, FL, 33415 |
| ZIP code: | 33415 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396780185 | 2006-06-17 | 2009-10-01 | 1401 S MILITARY TRL, SUITE C, WEST PALM BEACH, FL, 334155720, US | 1401 S MILITARY TRL, SUITE C-1, WEST PALM BEACH, FL, 334155720, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 561-429-3122 |
| Fax | 5614293124 |
Authorized person
| Name | MRS. MARIELA CRUZ |
| Role | PRESIDENT |
| Phone | 5614293122 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | HEALTH CARE CLINIC LICENS |
| Number | HCC4058 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CRUZ MARIELA | Agent | 1401 S . MILITARY TRL, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ MARIELA | Director | 1401 S MILITARY TRL SUITE C, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ MARIELA | Secretary | 1401 S MILITARY TRL SUITE C, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ MARIELA | President | 1401 S MILITARY TRL SUITE C, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ MARIELA | Treasurer | 1401 S MILITARY TRL SUITE C, WEST PALM BEACH, FL, 33415 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000012290 | CAGIGAS MEDICAL CENTER NO. 2 | EXPIRED | 2018-01-23 | 2023-12-31 | No data | 2311 N 10TH AVE STE 14, LAKE WORTH, FL, 33461 |
| G12000045439 | CAGIGAS MEDICAL CENTER | ACTIVE | 2012-05-16 | 2027-12-31 | No data | 1401 S MILITARY TRAIL STE C, SUITE C, WEST PALM BEACH, FL, 33415 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2009-01-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J15000057477 | TERMINATED | 1000000648099 | PALM BEACH | 2014-12-03 | 2025-01-08 | $ 3,976.16 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
