| Entity Name: | MARTA R. FERNANDEZ, MD, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 Sep 2003 (21 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P03000104458 |
| FEI/EIN Number | 870712747 |
| Address: | 4726 W FLAGLER STREET, MIAMI, FL, 33134 |
| Mail Address: | 4726 W FLAGLER STREET, MIAMI, FL, 33134 |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780880203 | 2007-06-22 | 2011-10-12 | 2500 DEL PRADO BLVD S, CAPE CORAL, FL, 339045750, US | 2500 DEL PRADO BLVD S, CAPE CORAL, FL, 339045750, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-772-1194 |
| Fax | 2397721196 |
Authorized person
| Name | DR. MARTA R FERNANDEZ |
| Role | PRESIDENT |
| Phone | 3056080524 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME90692 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME90692 |
| State | FL |
| Issuer | MEDICAID PROVIDER |
| Number | 268370900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ MARTA R | Agent | 4726 W FLAGLER STREET, MIAMI, FL, 33134 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ MARTA R | President | 15441 SW 158ST, MIAMI, FL, 33187 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ MARTA R | Director | 15441 SW 158ST, MIAMI, FL, 33187 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2010-05-04 | FERNANDEZ, MARTA R | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-05-27 | 4726 W FLAGLER STREET, MIAMI, FL 33134 | No data |
| CHANGE OF MAILING ADDRESS | 2009-05-27 | 4726 W FLAGLER STREET, MIAMI, FL 33134 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-05-27 | 4726 W FLAGLER STREET, MIAMI, FL 33134 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000562154 | ACTIVE | 1000000171221 | DADE | 2010-04-29 | 2030-05-05 | $ 589.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SOUTH SERVICE CENTER, 8175 NW 12TH ST STE 418, MIAMI FL331261828 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-05-04 |
| ANNUAL REPORT | 2009-05-27 |
| ANNUAL REPORT | 2008-04-14 |
| ANNUAL REPORT | 2007-04-25 |
| ANNUAL REPORT | 2006-02-02 |
| ANNUAL REPORT | 2005-06-29 |
| ANNUAL REPORT | 2004-04-22 |
| Domestic Profit | 2003-09-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
