| Entity Name: | CRP PHYSICIAN SERVICES, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Feb 2012 (13 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P12000017764 |
| FEI/EIN Number | 45-4781004 |
| Mail Address: | P.O. BOX 14-4176, CORAL GABLES, FL, 33114, US |
| Address: | 2069 SW 195 AVENUE, MIRAMAR, FL, 33029 |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992129001 | 2014-02-10 | 2014-02-10 | 7400 NW 7TH ST, B111, MIAMI, FL, 331262942, US | 7400 NW 7TH ST, B111, MIAMI, FL, 331262942, US | |||||||||||||
|
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| Phone | +1 786-426-9716 |
Authorized person
| Name | MR. NILO M SIERRA |
| Role | VICE PRESIDENT |
| Phone | 7864269716 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WILSON KARREN E | Agent | 3849 BUCKINGHAMSHIRE DRIVE, LAND O LAKES, FL, 34638 |
| Name | Role | Address |
|---|---|---|
| SIERRA NILO | Vice President | 2069 SW 195 AVENUE, MIRAMAR, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-30 | 2069 SW 195 AVENUE, MIRAMAR, FL 33029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-29 |
| Domestic Profit | 2012-02-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
