| Entity Name: | ISMAEL RODRIGUEZ M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Oct 2003 (21 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Dec 2018 (6 years ago) |
| Document Number: | P03000115637 |
| FEI/EIN Number | 571190215 |
| Address: | 2140 KINGSLEY AVE, ORANGE PARK, FL, 32073, US |
| Mail Address: | 11005 bittersweet ct, Ellicot City, MD, 21042, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609066778 | 2007-07-25 | 2008-05-06 | PO BOX 1779, ORANGE PARK, FL, 320671779, US | 2001 KINGSLEY AVE, ORANGE PARK, FL, 320735148, US | |||||||||||||||||||||||||
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| Phone | +1 904-276-6977 |
| Phone | +1 904-276-8500 |
Authorized person
| Name | ISMAEL RODRIGUEZ |
| Role | PRESIDENT |
| Phone | 9042766977 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| License Number | ME72759 |
| State | PR |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 270550800 |
| State | FL |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ISMAEL | President | 11005 bittersweet ct, Ellicot City, MD, 21042 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ISMAEL | Secretary | 11005 bittersweet ct, Ellicot City, MD, 21042 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ISMAEL | Treasurer | 11005 bittersweet ct, Ellicot City, MD, 21042 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ISMAEL | Director | 11005 bittersweet ct, Ellicot City, MD, 21042 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-08 | 2140 KINGSLEY AVE, ORANGE PARK, FL 32073 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-08 | 2140 KINGSLEY AVE, ORANGE PARK, FL 32073 | No data |
| REINSTATEMENT | 2018-12-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-12-05 | SPIEGEL & UTRERA, P.A. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-04 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-02-17 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-13 |
| REINSTATEMENT | 2018-12-05 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-21 |
| ANNUAL REPORT | 2014-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
