| Entity Name: | SAN JOSE CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Oct 2003 (21 years ago) |
| Document Number: | P03000109069 |
| FEI/EIN Number | 593768885 |
| Address: | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Mail Address: | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| ZIP code: | 32217 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083846349 | 2009-08-19 | 2009-08-19 | 504 BASSWOOD CT, JACKSONVILLE, FL, 322594436, US | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 322172037, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 904-256-3330 |
| Fax | 9042563332 |
Authorized person
| Name | DR. ANTOINE KASSIS |
| Role | MEDICAL DIRECTOR |
| Phone | 9042563330 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME75962 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 263567400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KASSIS ANTOINE | Agent | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KASSIS ANTOINE M | President | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KASSIS ANTOINE M | Secretary | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KASSIS ANTOINE M | Treasurer | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KASSIS ANTOINE M | Director | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL, 32217 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-03-20 | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL 32217 | No data |
| CHANGE OF MAILING ADDRESS | 2009-03-20 | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL 32217 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-03-20 | 2449 UNIVERSITY BLVD W, JACKSONVILLE, FL 32217 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-12-15 | KASSIS, ANTOINE | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
