| Entity Name: | FERNANDEZ FAMILY MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Apr 2013 (12 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P13000029737 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 901-A SW 87 AVE, MIAMI, FL, 33174 |
| Mail Address: | 901-A SW 87 AVE, MIAMI, FL, 33174 |
| ZIP code: | 33174 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205271046 | 2013-05-07 | 2013-05-07 | 901 SW 87TH AVE, SUITE # A, MIAMI, FL, 331743206, US | 901 SW 87TH AVE, SUITE # A, MIAMI, FL, 331743206, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-512-0080 |
| Fax | 3055120082 |
Authorized person
| Name | INTI FERNANDEZ |
| Role | PRESIDENT |
| Phone | 3059037587 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME97323 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007660200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ INTI | Agent | 901-A SW 87 AVE, MIAMI, FL, 33174 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ INTI | President | 901-A SW 87 AVE, MIAMI, FL, 33174 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2015-04-10 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-10 | FERNANDEZ, INTI | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-29 |
| REINSTATEMENT | 2015-04-10 |
| Domestic Profit | 2013-04-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
