| Entity Name: | MANUEL D GONZALEZ MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Mar 2010 (15 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 19 Oct 2022 (2 years ago) |
| Document Number: | P10000022919 |
| FEI/EIN Number | 352378587 |
| Address: | 2141 NW 7 Street, MIAMI, FL, 33125, US |
| Mail Address: | 2141 NW 7th Street, Miami, FL, 33125, US |
| ZIP code: | 33125 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528729480 | 2022-01-04 | 2022-01-04 | 2141 NW 7TH ST, MIAMI, FL, 331253483, US | 2141 NW 7TH ST, MIAMI, FL, 331253483, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 786-688-0105 |
| Fax | 7867560707 |
Authorized person
| Name | MANUEL D. GONZALEZ |
| Role | AUTHORIZED OFFICIAL |
| Phone | 7864645120 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1249800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ MANUEL D | Agent | 1795 SW 16 Street, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ MANUEL D | President | 1795 SW 16 Street, MIAMI, FL, 33145 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000025922 | VIDAMAX MEDICAL CENTER | ACTIVE | 2024-02-16 | 2029-12-31 | No data | 1127 NW 22 AVE, MIAMI, FL, 33125 |
| G20000081083 | CENTURY MEDICAL GROUP | ACTIVE | 2020-07-10 | 2025-12-31 | No data | 721 NW 21 CT, SUIT 100, MIAMI, FL, 33125 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-10-19 | 2141 NW 7 Street, MIAMI, FL 33125 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-19 | GONZALEZ, MANUEL D | No data |
| REINSTATEMENT | 2022-10-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-16 | 2141 NW 7 Street, MIAMI, FL 33125 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-26 | 1795 SW 16 Street, MIAMI, FL 33145 | No data |
| REINSTATEMENT | 2014-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-23 |
| REINSTATEMENT | 2022-10-19 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-01-21 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
