| Entity Name: | ROMUALDO J. SEGUROLA, JR. M.D.. P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 24 Feb 2003 (22 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 15 Jul 2014 (11 years ago) |
| Document Number: | P03000022064 |
| FEI/EIN Number | 33-1049892 |
| Address: | 100 NW 170 STREET, SUITE 305, NORTH MIAMI BEACH, FL 33169 |
| Mail Address: | 100 NW 170 STREET, SUITE 305, NORTH MIAMI BEACH, FL 33169 |
| ZIP code: | 33169 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477629707 | 2006-11-28 | 2019-09-26 | 3650 NW 82ND AVE, SUITE 208, DORAL, FL, 331666658, US | 3650 NW 82ND AVE, SUITE 208, DORAL, FL, 331666658, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-406-3596 |
| Fax | 3054063599 |
Authorized person
| Name | KAREN ENGEN |
| Role | ADMINISTRATOR |
| Phone | 6126697173 |
Taxonomy
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277084900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARNETT HIBNICK, CYNTHIA | Agent | 1 ALHAMBRA PLAZA, SUITE 1410, CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ-CLARK, PEDRO | Chief Executive Officer | 100 NW 170 STREET, SUITE 305 NORTH MIAMI BEACH, FL 33169 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000128284 | SOUTH FLORIDA HEART AND LUNG INSTITUTE | ACTIVE | 2015-12-18 | 2025-12-31 | No data | 100 NW 170 STREET,, 305, MIAMI, FL, 33169 |
| G09021900148 | SOUTH FLORIDA HEART AND LUNG INSTITUTE | EXPIRED | 2009-01-19 | 2014-12-31 | No data | 3650 NW 82ND AVENUE, DORAL, FL, 33166 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-15 | 100 NW 170 STREET, SUITE 305, NORTH MIAMI BEACH, FL 33169 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-15 | 100 NW 170 STREET, SUITE 305, NORTH MIAMI BEACH, FL 33169 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-15 | BARNETT HIBNICK, CYNTHIA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-15 | 1 ALHAMBRA PLAZA, SUITE 1410, CORAL GABLES, FL 33134 | No data |
| AMENDMENT | 2014-07-15 | No data | No data |
| AMENDMENT | 2014-07-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-01-15 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-01 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
