| Entity Name: | FERNANDO GONZALEZ VERGARA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Jul 2013 (12 years ago) |
| Document Number: | P13000059216 |
| FEI/EIN Number | 46-3198995 |
| Address: | 8050 N. UNIVERSITY DRIVE, TAMARAC, FL, 33321, US |
| Mail Address: | 17476 SW 35 TH Ct, Miramar, FL, 33029, US |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265882906 | 2016-06-14 | 2022-11-10 | 8050 N UNIVERSITY DR, TAMARAC, FL, 333212115, US | 8050 N UNIVERSITY DR, TAMARAC, FL, 333212115, US | |||||||||||||||||||||||
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| Phone | +1 786-553-3391 |
| Fax | 9549987307 |
Authorized person
| Name | MRS. ANA IVETTE GONZALEZ |
| Role | MANAGER |
| Phone | 7865533391 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENCE |
| Number | ME114208 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ VERGARA FERNANDO | Agent | 17476 SW 35 Ct, Miramar, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| Vergara Fernando G | President | 8050 N. UNIVERSITY DRIVE, Tamarac, FL, 33321 |
| Name | Role | Address |
|---|---|---|
| Gonzalez Ana I | Vice President | 8050 N. UNIVERSITY DRIVE, Tamarac, FL, 33321 |
| Name | Role | Address |
|---|---|---|
| Gonzalez Ana I | Secretary | 8050 N. UNIVERSITY DRIVE, Tamarac, FL, 33321 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000027960 | VERGARA MEDICAL & AESTHETIC | ACTIVE | 2024-02-21 | 2029-12-31 | No data | 8050 N. UNIVERSITY DRIVE SUITE 101, TAMARAC, FL, 33321 |
| G16000075984 | INNOVATIVE HEALTH | ACTIVE | 2016-07-29 | 2027-12-31 | No data | 6750 TAFT ST, HOLLYWOOD, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-19 | 8050 N. UNIVERSITY DRIVE, 101, TAMARAC, FL 33321 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-19 | 8050 N. UNIVERSITY DRIVE, 101, TAMARAC, FL 33321 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-06 | 17476 SW 35 Ct, Miramar, FL 33029 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-02-17 |
| ANNUAL REPORT | 2020-06-17 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-02-19 |
| AMENDED ANNUAL REPORT | 2016-08-31 |
| ANNUAL REPORT | 2016-03-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
