| Entity Name: | GUADALUPE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Oct 2003 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 17 May 2024 (9 months ago) |
| Document Number: | P03000121129 |
| FEI/EIN Number | 522413525 |
| Address: | 4469 S CONGRESS AVE, STE 106, LAKE WORTH, FL, 33461, US |
| Mail Address: | 4469 S CONGRESS AVE, STE 106, LAKE WORTH, FL, 33461, US |
| ZIP code: | 33461 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861504342 | 2006-08-31 | 2012-10-05 | 4469 S CONGRESS AVE STE 106, LAKE WORTH, FL, 334614726, US | 4469 S CONGRESS AVE STE 106, LAKE WORTH, FL, 334614726, US | |||||||||||||||||||||
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| Phone | +1 561-642-0768 |
| Fax | 5616420769 |
Authorized person
| Name | MRS. OLGA VIRGINIA ROSAZZA |
| Role | OFFICE MANAGER |
| Phone | 5616420768 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 269435200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GALIANO MARIO | Agent | 6437 HUDSON BAY LANE, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| GALIANO MARIO P | President | 4469 S. CONGRESS AVE.,STE. 106, LAKE WORTH, FL, 33461 |
| Name | Role | Address |
|---|---|---|
| GALIANO MARIO P | Director | 4469 S. CONGRESS AVE.,STE. 106, LAKE WORTH, FL, 33461 |
| JACOBO ELGOZY, D.O. | Director | 7191 TAFT STREET, HOLLYWOOD, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2024-05-17 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-11 | 6437 HUDSON BAY LANE, LAKE WORTH, FL 33467 | No data |
| AMENDMENT | 2008-04-18 | No data | No data |
| AMENDMENT | 2007-08-21 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2007-01-17 | GALIANO, MARIO | No data |
| AMENDMENT | 2005-06-01 | No data | No data |
| AMENDMENT | 2004-01-16 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000411592 | TERMINATED | 1000000160789 | PALM BEACH | 2010-02-22 | 2030-03-17 | $ 3,850.37 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| Name | Date |
|---|---|
| Amendment | 2024-05-17 |
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-01-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
