| Entity Name: | PINECREST FAMILY MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Oct 2006 (18 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P06000137246 |
| FEI/EIN Number | 205813224 |
| Address: | 8353 SW 124 STREET, SUITE 201, MIAMI, FL, 33156, US |
| Mail Address: | 8353 SW 124 STREET, SUITE 201, MIAMI, FL, 33156, US |
| ZIP code: | 33156 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851426019 | 2007-02-21 | 2010-10-13 | 8353 SW 124TH ST, SUITE 201, MIAMI, FL, 331565847, US | 8353 SW 124TH ST, SUITE 201, MIAMI, FL, 331565847, US | |||||||||||||||||||||||||
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| Phone | +1 305-235-4141 |
| Fax | 3052354381 |
Authorized person
| Name | DR. AGUEDA HERNANDEZ |
| Role | PRESIDENT |
| Phone | 3052354141 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME89580 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2637103-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ AGUEDA | Agent | 8353 SW 124 STREET, MIAMI, FL, 33156 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ AGUEDA | President | 8353 SW 124 STREET #201, MIAMI, FL, 33156 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-09 | 8353 SW 124 STREET, 201, MIAMI, FL 33156 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-14 | 8353 SW 124 STREET, SUITE 201, MIAMI, FL 33156 | No data |
| CHANGE OF MAILING ADDRESS | 2007-05-14 | 8353 SW 124 STREET, SUITE 201, MIAMI, FL 33156 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-11 |
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-04-26 |
| ANNUAL REPORT | 2009-07-06 |
| ANNUAL REPORT | 2008-04-09 |
| ANNUAL REPORT | 2007-05-14 |
| Domestic Profit | 2006-10-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
