| Entity Name: | ANDRELICA INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Oct 2008 (16 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Mar 2011 (14 years ago) |
| Document Number: | P08000097372 |
| FEI/EIN Number | 26-3635115 |
| Address: | 10616 S FEDERAL HWY, PORT ST LUCIE, FL 34952 |
| Mail Address: | 1926 SW TAURUS LANE, PORT ST LUCIE, FL 34984 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649558701 | 2011-07-23 | 2011-07-23 | 10616 S FEDERAL HWY, PORT SAINT LUCIE, FL, 349526401, US | 10616 S FEDERAL HWY, PORT SAINT LUCIE, FL, 349526401, US | |||||||||||||||||||||||||
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| Phone | +1 772-237-4719 |
| Fax | 7722374738 |
Authorized person
| Name | DR. ORLY PENA-SANCHEZ |
| Role | OWNER |
| Phone | 7722374719 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ACN232 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000174900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PENA SANCHEZ, ORLY | Agent | 1926 SW TAURUS LANE, PORT ST LUCIE, FL 34984 |
| Name | Role | Address |
|---|---|---|
| PENA SANCHEZ, ORLY | President | 1926 SW TAURUS LANE, PORT ST LUCIE, FL 34984 |
| Name | Role | Address |
|---|---|---|
| VASQUEZ BOJATO, DUVIS M | Secretary | 1926 SW TAURUS LANE, PORT ST LUCIE, FL 34984 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-10 | 10616 S FEDERAL HWY, PORT ST LUCIE, FL 34952 | No data |
| REINSTATEMENT | 2011-03-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-06 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-01-15 |
| ANNUAL REPORT | 2018-01-05 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-15 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9824807405 | 2020-05-21 | 0455 | PPP | 10616 S FEDERAL HWY, PORT SAINT LUCIE, FL, 34952-6401 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 24 Feb 2025
Sources: Florida Department of State
