Search icon

ANA J FANDINO MD PA

Company Details

Entity Name: ANA J FANDINO MD PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Apr 2005 (20 years ago)
Last Event: CANCEL ADM DISS/REV
Event Date Filed: 01 Oct 2006 (18 years ago)
Document Number: P05000054295
FEI/EIN Number 202690928
Address: 10300 SUNSET DRIVE, SUITE 430, MIAMI, FL, 33173, US
Mail Address: 10300 SUNSET DRIVE, SUITE 430, MIAMI, FL, 33173, US
ZIP code: 33173
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1639102155 2006-07-08 2007-08-17 9780 SW 24TH ST, MIAMI, FL, 331657574, US 9780 SW 24TH ST, MIAMI, FL, 331657574, US

Contacts

Phone +1 305-551-5051
Fax 3055518808

Authorized person

Name ANA JULIA FANDINO
Role PRESIDENT
Phone 3055515051

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME91994
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 272739100
State FL

Agent

Name Role Address
FANDINO ANA J Agent 10300 SUNSET DRIVE, MIAMI, FL, 33173

President

Name Role Address
FANDINO ANA J President 10300 SUNSET DR. SUITE 430, MIAMI, FL, 33173

Chief Executive Officer

Name Role Address
Rollon Andy Chief Executive Officer 10300 SUNSET DRIVE, MIAMI, FL, 33173

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2016-02-28 10300 SUNSET DRIVE, SUITE 430, MIAMI, FL 33173 No data
CHANGE OF MAILING ADDRESS 2016-02-28 10300 SUNSET DRIVE, SUITE 430, MIAMI, FL 33173 No data
REGISTERED AGENT ADDRESS CHANGED 2016-02-28 10300 SUNSET DRIVE, SUITE430, MIAMI, FL 33173 No data
CANCEL ADM DISS/REV 2006-10-01 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2006-09-15 No data No data

Documents

Name Date
ANNUAL REPORT 2024-03-05
ANNUAL REPORT 2023-08-17
ANNUAL REPORT 2022-05-01
ANNUAL REPORT 2021-04-29
ANNUAL REPORT 2020-06-08
ANNUAL REPORT 2019-04-03
ANNUAL REPORT 2018-02-12
ANNUAL REPORT 2017-05-01
ANNUAL REPORT 2016-02-28
ANNUAL REPORT 2015-02-27

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5020067709 2020-05-01 0455 PPP 10300 SW 72ND ST STE 430, MIAMI, FL, 33173-3021
Loan Status Date 2021-04-16
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 29508
Loan Approval Amount (current) 29508
Undisbursed Amount 0
Franchise Name -
Lender Location ID 9551
Servicing Lender Name Bank of America, National Association
Servicing Lender Address 100 N Tryon St, Ste 170, CHARLOTTE, NC, 28202-4024
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description New Business or 2 years or less
Project Address MIAMI, MIAMI-DADE, FL, 33173-3021
Project Congressional District FL-27
Number of Employees 4
NAICS code 621111
Borrower Race White
Borrower Ethnicity Hispanic or Latino
Business Type Corporation
Originating Lender ID 9551
Originating Lender Name Bank of America, National Association
Originating Lender Address CHARLOTTE, NC
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 29765.08
Forgiveness Paid Date 2021-03-19

Date of last update: 02 Feb 2025

Sources: Florida Department of State