| Entity Name: | SAWGRASS HOSPITALIST, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jun 2012 (13 years ago) |
| Document Number: | P12000052349 |
| FEI/EIN Number | 45-5544298 |
| Address: | 4160 DERBY DR, DAVIE, FL, 33330, US |
| Mail Address: | 4160 Derby Dr, Davie, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447595194 | 2012-12-06 | 2012-12-06 | 3093 NW 126TH AVE, SUNRISE, FL, 333236342, US | 3501 JOHNSON ST, HOLLYWOOD, FL, 330215421, US | |||||||||||||||||
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| Phone | +1 610-331-0782 |
| Fax | 9549646084 |
| Phone | +1 954-987-2000 |
Authorized person
| Name | RAFAEL SEGUNDO BRICENO |
| Role | PRESIDENT |
| Phone | 6103310782 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRICENO RAFAEL SM.D. | Agent | 4160 Derby Dr, Davie, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| BRICENO RAFAEL SM.D. | President | 4160 DERBY DR, DAVIE, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-27 | 4160 Derby Dr, Davie, FL 33330 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-06-14 | 4160 DERBY DR, DAVIE, FL 33330 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-17 | 4160 DERBY DR, DAVIE, FL 33330 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-02-28 | BRICENO, RAFAEL S, M.D. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-02-02 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-02-13 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-03-03 |
| ANNUAL REPORT | 2015-03-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7313917304 | 2020-04-30 | 0455 | PPP | 3093 NW 126TH AVE, SUNRISE, FL, 33323 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Feb 2025
Sources: Florida Department of State
