| Entity Name: | ROSA M CUELLO SUAREZ, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Jan 2005 (20 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P05000012104 |
| FEI/EIN Number | 383715063 |
| Address: | 1840 FOREST HILL BLVD, 100, WEST PALM BEACH, FL, 33406 |
| Mail Address: | 1840 FOREST HILL BLVD, 100, WEST PALM BEACH, FL, 33406 |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457420549 | 2006-11-06 | 2013-04-10 | 1840 FOREST HILL BLVD, SUITE 100, WEST PALM BEACH, FL, 334066063, US | 1840 FOREST HILL BLVD, SUITE 100, WEST PALM BEACH, FL, 334066063, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-964-5161 |
| Fax | 5612323086 |
Authorized person
| Name | DR. ROSA M CUELLO SUAREZ |
| Role | PRESIDENT |
| Phone | 5619645161 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0071562 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 251019700 |
| State | FL |
| Issuer | AETNA WELLCARE |
| Number | 228485 |
| Issuer | HEALTH CARE TAX DISTRICT |
| Number | 2626085 |
| Name | Role | Address |
|---|---|---|
| CUELLO SUAREZ ROSA M | Agent | 1840 FOREST HILL BLVD, WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| CUELLO SUAREZ ROSA | Director | 1840 FOREST HILL BLVD SUITE 100, WEST PALM BEACH, FL, 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-05 | 1840 FOREST HILL BLVD, 100, WEST PALM BEACH, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-05 | 1840 FOREST HILL BLVD, 100, WEST PALM BEACH, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-05 | 1840 FOREST HILL BLVD, 100, WEST PALM BEACH, FL 33406 | No data |
| CANCEL ADM DISS/REV | 2008-02-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-01-15 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
