| Entity Name: | FARID ASSOUAD MD, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Mar 2009 (16 years ago) |
| Document Number: | P09000028556 |
| FEI/EIN Number | 264557501 |
| Address: | 1152 N University Dr, pembroke pines, FL, 33024-5012, US |
| Mail Address: | 19667 Turnberry Way Apt 19GR, aventura, FL, 33180, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144622754 | 2014-09-25 | 2014-09-26 | 18738 SW 47TH ST, MIRAMAR, FL, 330296219, US | 18738 SW 47TH ST, MIRAMAR, FL, 330296219, US | |||||||||||||||||||||||
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| Phone | +1 954-224-5640 |
Authorized person
| Name | DR. FARID ASSOUAD |
| Role | PRESIDENT |
| Phone | 9542245640 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME98413 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 278681800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KASBAR & DELUCIA | Agent | 3880 SHERIDAN STREET, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| ASSOUAD FARID | President | 18738 SW 47TH ST., MIRAMAR, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| ASSOUAD FARID | Director | 18738 SW 47TH ST., MIRAMAR, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-31 | 1152 N University Dr, pembroke pines, FL 33024-5012 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-31 | 1152 N University Dr, pembroke pines, FL 33024-5012 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-03-02 | KASBAR & DELUCIA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-01-12 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
