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  5. SUSANA GONZALEZ, M.D., P.A.

SUSANA GONZALEZ, M.D., P.A.

Company Details

Entity Name: SUSANA GONZALEZ, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 May 2005 (20 years ago)
Document Number: P05000064231
FEI/EIN Number 342046080
Address: 11891 Island Ave, Matlacha, FL, 33993, US
Mail Address: 11891 Island Ave, Matlacha, FL, 33993, US
ZIP code: 33993
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1396151809 2014-07-03 2016-05-03 1225 ALTON ROAD, MIAMI BEACH, FL, 33139, US 1225 ALTON ROAD, MIAMI BEACH, FL, 33139, US

Contacts
Phone +1 305-532-8355
Fax 3055329675

Authorized person
Name MRS. ESTHER ENCINOSA
Role DIRECTOR
Phone 3055328355

Taxonomy
Taxonomy Code 207RG0300X - Geriatric Medicine (Internal Medicine) Physician
License Number ME0052209
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 048427000
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUSANA GONZALEZ, M.D. 401(K) PLAN 2023 342046080 2024-06-12 SUSANA GONZALEZ, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 11891 ISLAND AVE, MATLACHA, FL, 33993

Signature of
Role Plan administrator
Date 2024-06-12
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2022 342046080 2023-07-18 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 11891 ISLAND AVE, MATLACHA, FL, 33993

Signature of
Role Plan administrator
Date 2023-07-18
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2021 342046080 2022-06-27 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 11891 ISLAND AVE, MATLACHA, FL, 33993

Signature of
Role Plan administrator
Date 2022-06-27
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2020 342046080 2021-05-10 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 7230 W TROON CIRCLE, MIAMI LAKES, FL, 33014

Signature of
Role Plan administrator
Date 2021-05-10
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2019 342046080 2020-04-10 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 7230 W TROON CIRCLE, MIAMI LAKES, FL, 33014

Signature of
Role Plan administrator
Date 2020-04-10
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2018 342046080 2019-06-03 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 7230 W TROON CIRCLE, MIAMI LAKES, FL, 33014

Signature of
Role Plan administrator
Date 2019-06-03
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2017 342046080 2018-06-21 SUSANA GONZALEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3059047976
Plan sponsor’s address 7230 W TROON CIR., MIAMI LAKES, FL, 33014

Signature of
Role Plan administrator
Date 2018-06-21
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2016 342046080 2017-07-05 SUSANA GONZALEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3057776828
Plan sponsor’s address 4308 ALTON ROAD #620, MIAMI BEACH, FL, 33140

Signature of
Role Plan administrator
Date 2017-07-05
Name of individual signing SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature
SUSANA GONZALEZ, M.D. 401(K) PLAN 2015 342046080 2016-07-25 SUSANA GONZALEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3057776828
Plan sponsor’s address 4308 ALTON ROAD #620, MIAMI BEACH, FL, 33140
SUSANA GONZALEZ, M.D. 401(K) PLAN 2014 342046080 2015-06-09 SUSANA GONZALEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 621111
Sponsor’s telephone number 3057776828
Plan sponsor’s address 4308 ALTON ROAD #620, MIAMI BEACH, FL, 33140

Signature of
Role Plan administrator
Date 2015-06-09
Name of individual signing DR. SUSANA GONZALEZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GONZALEZ SUSANA M Agent 11891 Island Ave, Matlacha, FL, 33993

President

Name Role Address
GONZALEZ SUSANA MSusana President 11891 Island Ave, Matlacha, FL, 33993

Director

Name Role Address
GONZALEZ SUSANA MSusana Director 11891 Island Ave, Matlacha, FL, 33993

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-01-29 11891 Island Ave, Matlacha, FL 33993 No data
CHANGE OF MAILING ADDRESS 2022-01-29 11891 Island Ave, Matlacha, FL 33993 No data
REGISTERED AGENT ADDRESS CHANGED 2022-01-29 11891 Island Ave, Matlacha, FL 33993 No data

Documents

Name Date
ANNUAL REPORT 2024-03-04
ANNUAL REPORT 2023-01-28
ANNUAL REPORT 2022-01-29
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-18
ANNUAL REPORT 2018-01-11
ANNUAL REPORT 2017-01-07
ANNUAL REPORT 2016-01-14
ANNUAL REPORT 2015-04-30

Related by officers

GONZALEZ SUSANA M

NAG UNLIMITED INC. RG BIZ REAL ESTATE INVESTMENT, LLC MINT 3906, LLC QUIJANO GROUP INC. POLINOMICS, LLC SUSANA MARIA GONZALEZ ROMERO, PA JBL CONSTRUCTION INC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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