| Entity Name: | PATRICIA BRAVO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Aug 2002 (22 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Nov 2002 (22 years ago) |
| Document Number: | P02000085659 |
| FEI/EIN Number | 522370687 |
| Address: | 1440 79 ST CSWY, NORTH BAY VILLAGE, FL, 33141, US |
| Mail Address: | 1440 79st Cswy, North Bay Village, FL, 33141, US |
| ZIP code: | 33141 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235463654 | 2009-10-01 | 2012-06-10 | 1440 79TH STREET CSWY, SUITE #1400, NORTH BAY VILLAGE, FL, 331414188, US | 1440 79TH STREET CSWY, SUITE #1400, NORTH BAY VILLAGE, FL, 331414188, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 305-763-8573 |
| Fax | 3057638574 |
Authorized person
| Name | DR. PATRICIA BRAVO |
| Role | DIRECTOR |
| Phone | 3057638573 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME 91464 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1235463654 |
| State | FL |
| Issuer | MEDICAID |
| Number | 267682600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRAVO PATRICIA | Agent | 1440 79 ST CSWY, NORTH BAY VILLAGE, FL, 33141 |
| Name | Role | Address |
|---|---|---|
| Bravo Patricia Dr. | pres | 1440 79 ST CSWY, NORTH BAY VILLAGE, FL, 33141 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000114085 | BRAVO RESEARCH | ACTIVE | 2021-09-03 | 2026-12-31 | No data | 1440 79 ST CAUSEWAY SUITE #1400, NORTH BAY VILLAGE, FL, 33141 |
| G11000008099 | BRAVO HEALTH CARE CENTER | ACTIVE | 2011-01-19 | 2026-12-31 | No data | 1440 J.F. KENNEDY CAUSEWAY, SUITE 1400, NORTH BAY VILLAGE, FL, 33141 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-22 | 1440 79 ST CSWY, Suite #1400, NORTH BAY VILLAGE, FL 33141 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-17 | 1440 79 ST CSWY, Suite #1400, NORTH BAY VILLAGE, FL 33141 | No data |
| CHANGE OF MAILING ADDRESS | 2014-02-06 | 1440 79 ST CSWY, Suite #1400, NORTH BAY VILLAGE, FL 33141 | No data |
| AMENDMENT | 2002-11-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-07 |
| ANNUAL REPORT | 2023-05-05 |
| ANNUAL REPORT | 2022-04-17 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-05-09 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-02-21 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-04-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
