| Entity Name: | JOSE MENDEZ MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 Jun 2012 (13 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 Dec 2013 (11 years ago) |
| Document Number: | P12000051256 |
| FEI/EIN Number | 45-5440293 |
| Address: | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 |
| Mail Address: | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 |
| ZIP code: | 32819 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407100951 | 2012-11-06 | 2020-07-30 | 8615 COMMODITY CIR STE 12, ORLANDO, FL, 328199072, US | 8615 COMMODITY CIR STE 12, ORLANDO, FL, 32819, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 407-476-1212 |
| Fax | 4074761213 |
Authorized person
| Name | DR. JOSE Y MENDEZ |
| Role | PRESIDENT |
| Phone | 4077383030 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| License Number | ME107982 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 005210100 |
| State | FL |
| Issuer | FLORIDA BLUE |
| Number | 14M9E |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MENDEZ, JOSE | Agent | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| MENDEZ, JOSE | President | 9212 COUNTRY BAY CT, Orlando, FL 32819 |
| Name | Role | Address |
|---|---|---|
| MENDEZ, JOSE | Treasurer | 9212 COUNTRY BAY CT, Orlando, FL 32819 |
| Name | Role | Address |
|---|---|---|
| MENDEZ, JOSE | Secretary | 9212 COUNTRY BAY CT, Orlando, FL 32819 |
| Name | Role | Address |
|---|---|---|
| ARAQUE, ASTRID | Vice President | 9212 COUNTRY BAY CT, ORLANDO, FL 32819 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000019793 | ALMA BEHAVIORAL GROUP | ACTIVE | 2013-02-26 | 2028-12-31 | No data | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-28 | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-14 | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-14 | 8615 COMMODITY CIRCLE, SUITE 12, ORLANDO, FL 32819 | No data |
| AMENDMENT | 2013-12-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-02-28 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-02-14 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-04-09 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
