| Entity Name: | RENE CASANOVA MEDICAL OFFICE INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Jan 2005 (20 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 06 Nov 2012 (12 years ago) |
| Document Number: | P05000001563 |
| FEI/EIN Number | 202106700 |
| Address: | 1881 North University Drive, 103, Coral Springs, FL, 33071, US |
| Mail Address: | 1881 N University Drive, 103, Coral Springs, FL, 33175, US |
| ZIP code: | 33071 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629481809 | 2014-06-05 | 2023-10-18 | 1881 N UNIVERSITY DR STE 103, CORAL SPRINGS, FL, 330718923, US | 1881 N UNIVERSITY DR STE 103, CORAL SPRINGS, FL, 330718923, US | |||||||||||||||||||||||
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| Phone | +1 954-516-0070 |
Authorized person
| Name | DR. RENE CASANOVA |
| Role | MEDICAL DIRECTOR |
| Phone | 9542025137 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME78770 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264910101 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CASANOVA RENE | Agent | 2924 SW 92 CT., MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| CASANOVA RENE | Director | 2924 SW 92 CT., MIAMI, FL, 33165 |
| Zayas Luis F | Director | 1881 N University Drive, Coral Springs, FL, 33071 |
| Name | Role | Address |
|---|---|---|
| CASANOVA RENE | President | 2924 SW 92 CT., MIAMI, FL, 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-06-26 | 1881 North University Drive, 103, Coral Springs, FL 33071 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-11 | 1881 North University Drive, 103, Coral Springs, FL 33071 | No data |
| AMENDMENT | 2012-11-06 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-25 | 2924 SW 92 CT., MIAMI, FL 33165 | No data |
| AMENDMENT | 2007-11-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-16 |
| AMENDED ANNUAL REPORT | 2023-06-26 |
| ANNUAL REPORT | 2023-02-11 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-01-26 |
| AMENDED ANNUAL REPORT | 2020-05-18 |
| ANNUAL REPORT | 2020-03-09 |
| AMENDED ANNUAL REPORT | 2019-11-13 |
| ANNUAL REPORT | 2019-06-14 |
| ANNUAL REPORT | 2018-04-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
