| Entity Name: | BRISEIDA CASTA, MD, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Jun 2007 (18 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 26 Sep 2011 (13 years ago) |
| Document Number: | P07000067168 |
| FEI/EIN Number | 260329122 |
| Address: | 2731 EXECUTIVE PARK DRIVE, SUITE 3, WESTON, FL, 33331, US |
| Mail Address: | 2731 EXECUTIVE PARK DRIVE, SUITE 3, WESTON, FL, 33331, US |
| ZIP code: | 33331 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447657051 | 2014-11-25 | 2014-11-25 | 2731 EXECUTIVE PARK DR, SUITE #3, WESTON, FL, 333313657, US | 2731 EXECUTIVE PARK DR, SUITE #3, WESTON, FL, 333313657, US | |||||||||||||||||||||||||
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| Phone | +1 954-389-1064 |
| Fax | 9543893541 |
Authorized person
| Name | DR. BRISEIDA CASTA |
| Role | OWNER |
| Phone | 9543891064 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME74512 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255595600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALEXIS SANTOS | Agent | 621 SW 113TH. TERR, PEMBROKE PINES, FL, 33025 |
| Name | Role | Address |
|---|---|---|
| CASTA BRISEIDA | President | 2731 EXECUTIVE PARK DRIVE SUITE 3, WESTON, FL, 33337 |
| Name | Role | Address |
|---|---|---|
| CASTA BRISEIDA | Vice President | 2731 EXECUTIVE PARK DRIVE, WESTON, FL, 33331 |
| Name | Role | Address |
|---|---|---|
| CASTA BRISEIDA | Secretary | 2731 EXECUTIVE PARK DRIVE SUITE 3, WESTON, FL, 33337 |
| Name | Role | Address |
|---|---|---|
| CASTA BRISEIDA | Treasurer | 2731 EXECUTIVE PARK DRIVE, WESTON, FL, 33331 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2011-09-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-09-26 | ALEXIS, SANTOS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-09-26 | 621 SW 113TH. TERR, PEMBROKE PINES, FL 33025 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-06-21 | 2731 EXECUTIVE PARK DRIVE, SUITE 3, WESTON, FL 33331 | No data |
| CHANGE OF MAILING ADDRESS | 2007-06-21 | 2731 EXECUTIVE PARK DRIVE, SUITE 3, WESTON, FL 33331 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-05-31 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-05-02 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
