| Entity Name: | ALEJANDRO ELOY DE LA CRUZ MD, PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Apr 2011 (14 years ago) |
| Document Number: | P11000040032 |
| FEI/EIN Number | 452026001 |
| Address: | 13214 SW 8TH ST, MIAMI, FL, 33184, US |
| Mail Address: | 13214 SW 8TH ST, MIAMI, FL, 33184, US |
| ZIP code: | 33184 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720375306 | 2011-07-05 | 2018-06-20 | 155 SW 136TH AVE, MIAMI, FL, 331841017, US | 13214 SW 8TH ST, MIAMI, FL, 331841176, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 305-831-2789 |
| Fax | 3054404089 |
Authorized person
| Name | DR. ALEJANDRO ELOY DE LA CRUZ |
| Role | PRESIDENT |
| Phone | 3058312789 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | ME 109588 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME 109588 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PTAN |
| Number | FJ643Z |
| State | FL |
| Issuer | MEDICAID |
| Number | 004142600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DE LA CRUZ ALEJNDRO E | Agent | 13214 SW 8TH ST, MIAMI, FL, 33184 |
| Name | Role | Address |
|---|---|---|
| DE LA CRUZ ALEJANDRO E | President | 13214 SW 8TH ST, MIAMI, FL, 33184 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000005738 | CRUZ MEDICAL & RESEARCH CENTER | ACTIVE | 2015-01-15 | 2025-12-31 | No data | 13214 SW 8TH ST, MIAMI, FL, 33184 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2016-03-07 | 13214 SW 8TH ST, MIAMI, FL 33184 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-07 | 13214 SW 8TH ST, MIAMI, FL 33184 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-03 | 13214 SW 8TH ST, MIAMI, FL 33184 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-03-30 | DE LA CRUZ, ALEJNDRO E | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-03-05 |
| ANNUAL REPORT | 2019-03-08 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-03-09 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-03-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
