| Entity Name: | FLORIDA MEDICAL HEALTH AND WELLNESS CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 May 2013 (12 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: | P13000040926 |
| FEI/EIN Number | 46-2733231 |
| Address: | 2151 E COMMERCIAL BLVD, SUITE 202, FORT LAUDERDALE, FL, 33308 |
| Mail Address: | 2151 E COMMERCIAL BLVD, SUITE 202, FORT LAUDERDALE, FL, 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619313699 | 2013-05-16 | 2014-01-30 | 2151 E COMMERCIAL BLVD, SUITE 202, FORT LAUDERDALE, FL, 333083807, US | 2151 E COMMERCIAL BLVD, SUITE 202, FORT LAUDERDALE, FL, 333083807, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-431-8022 |
| Fax | 9544318078 |
Authorized person
| Name | DR. VICTORIA MACATANGAY GAUS |
| Role | PRESIDENT |
| Phone | 9544318022 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME97569 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010243600 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | HM460A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GAUS VICTORIA | Agent | 2096 SW 163 AVENUE, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| GAUS VICTORIA | President | 2096 SW 163 AVENUE, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| RIZALINA OLEGARIO | Treasurer | 17454 NW 10TH ST., PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| RIZALINA OLEGARIO | Secretary | 17454 NW 10TH ST., PEMBROKE PINES, FL, 33029 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000064971 | FLORIDA NEUROPATHY CENTER | EXPIRED | 2013-06-27 | 2018-12-31 | No data | 2151 E COMMERCIAL BLVD,SUITE 202, FT.LAUDERDALE, FL, 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| NAME CHANGE AMENDMENT | 2013-05-13 | FLORIDA MEDICAL HEALTH AND WELLNESS CENTER INC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-04-24 |
| Domestic Profit | 2013-05-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
