| Entity Name: | CRUZ AZUL OF WPB, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Jul 2011 (14 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P11000068235 |
| Address: | 6294 18TH ST S #1015, WEST PALM BEACH, FL, 33415 |
| Mail Address: | 6294 18TH ST S #1015, WEST PALM BEACH, FL, 33415 |
| ZIP code: | 33415 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811278245 | 2011-08-30 | 2011-08-30 | 6294 18TH ST S, WEST PALM BCH, FL, 334155419, US | 6294 18TH ST S, WEST PALM BCH, FL, 334155419, US | |||||||||||||||||||||||
|
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| Phone | +1 561-201-4016 |
Authorized person
| Name | DACHA CRUZ |
| Role | PRESIDENT |
| Phone | 5612014016 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | LE91892 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | COMERCIAL INSURANCES PPO HMO |
| Number | 1891785994 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CRUZ DACHA | Agent | 6294 18TH ST S #1015, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ DACHA | President | 6294 18TH ST S #1015, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| CRUZ DACHA | Director | 6294 18TH ST S #1015, WEST PALM BEACH, FL, 33415 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2011-07-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
