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 |
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 | |||||||||||||||||||||||||
|
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 |
Name | Role | Address |
---|---|---|
FANDINO ANA J | Agent | 10300 SUNSET DRIVE, MIAMI, FL, 33173 |
Name | Role | Address |
---|---|---|
FANDINO ANA J | President | 10300 SUNSET DR. SUITE 430, MIAMI, FL, 33173 |
Name | Role | Address |
---|---|---|
Rollon Andy | Chief Executive Officer | 10300 SUNSET DRIVE, MIAMI, FL, 33173 |
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 |
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 |
Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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5020067709 | 2020-05-01 | 0455 | PPP | 10300 SW 72ND ST STE 430, MIAMI, FL, 33173-3021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State