| Entity Name: | ANGEL CARRASCO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Oct 2008 (16 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P08000091277 |
| FEI/EIN Number | 263505255 |
| Address: | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL, 33034 |
| Mail Address: | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL, 33034 |
| ZIP code: | 33034 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487847604 | 2007-08-21 | 2009-07-30 | 7200 NW 7TH ST, SUITE 206, MIAMI, FL, 33126, US | 7200 NW 7TH ST, SUITE 206, MIAMI, FL, 33126, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-266-0222 |
| Fax | 3052660848 |
Authorized person
| Name | DR. ANGEL CARRASCO |
| Role | PRESIDENT |
| Phone | 3052660222 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0005X - Neurodevelopmental Disabilities Physician |
| Is Primary | No |
| Taxonomy Code | 2251N0400X - Neurology Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 225XN1300X - Neurorehabilitation Occupational Therapist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265050900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARRASCO ANGEL | Agent | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL, 33034 |
| Name | Role | Address |
|---|---|---|
| CARRASCO ANGEL | President | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL, 33034 |
| Name | Role | Address |
|---|---|---|
| CARRASCO ANGEL | Director | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL, 33034 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000063652 | NEURO-QUISQUEYA | EXPIRED | 2013-06-24 | 2018-12-31 | No data | 1380 N KROME AVE., SUITE 104, FLORIDA CITY, FL, 33034 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-24 | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL 33034 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-24 | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL 33034 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-24 | 1380 N KROME AVE. SUITE 104, FLORIDA CITY, FL 33034 | No data |
| REINSTATEMENT | 2011-01-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CANCEL ADM DISS/REV | 2009-10-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-04-24 |
| REINSTATEMENT | 2011-01-28 |
| REINSTATEMENT | 2009-10-13 |
| FEI CHANGE | 2009-07-29 |
| Domestic Profit | 2008-10-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
