| Entity Name: | ANTONIO CUBANO, M.D.,P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Aug 2012 (13 years ago) |
| Document Number: | P12000068072 |
| FEI/EIN Number | 46-0713072 |
| Address: | 352 Englenook Dr, Debary, FL, 32713, US |
| Mail Address: | 1756 Bridgewater Dr, Heathrow, FL, 32746, US |
| ZIP code: | 32713 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649644162 | 2015-11-20 | 2023-11-13 | 352 ENGLENOOK DR, DEBARY, FL, 327131803, US | 352 ENGLENOOK DR, DEBARY, FL, 327131803, US | |||||||||||||||
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| Phone | +1 407-732-7266 |
| Fax | 4077327310 |
Authorized person
| Name | DR. ANTONIO MIGUEL CUBANO |
| Role | DIRECTOR |
| Phone | 4077327266 |
Taxonomy
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CUBANO ANTONIO M | Agent | 1756 Bridgewater Dr, Heathrow, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| CUBANO ANTONIO MDr. | President | 1756 Bridgewater Dr, Heathrow, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000015620 | LAKE MARY BEHAVIORAL AND INFUSION CENTER | ACTIVE | 2020-02-03 | 2025-12-31 | No data | 352 ENGLENOOK DR, DEBARY, FL, 32713 |
| G18000066990 | BODY MIND AND SOUL | EXPIRED | 2018-06-11 | 2023-12-31 | No data | 725 PRIMERA BLVD SUITE 140, LAKE MARY, FL, 32746 |
| G17000104164 | KETAMINE OF CENTRAL FLORIDA | ACTIVE | 2017-09-19 | 2027-12-31 | No data | 725 PRIMERA BLVD, SUITE 140, LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-12 | 352 Englenook Dr, Debary, FL 32713 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-12 | 352 Englenook Dr, Debary, FL 32713 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-02 | 1756 Bridgewater Dr, Heathrow, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-12 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-02 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-03-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
