| Entity Name: | MANUEL MELENDEZ MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Aug 2013 (11 years ago) |
| Document Number: | P13000069700 |
| FEI/EIN Number | 46-3504967 |
| Address: | 10250 SW 56TH street suiTe a-102, mIAMI, FL, 33165, US |
| Mail Address: | 10250 SW 56TH street suiTe a-102, mIAMI, FL, 33165, US |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609202050 | 2013-09-17 | 2022-03-22 | 826 MEDINA AVE, CORAL GABLES, FL, 331342418, US | 10250 SW 56TH ST STE A102, MIAMI, FL, 331657064, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 786-477-4431 |
| Fax | 7864774377 |
Authorized person
| Name | DR. MANUEL MELENDEZ |
| Role | PRESIDENT |
| Phone | 7864774431 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME102626 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | (PTAN ) MEDICARE PROVIDER TRANSACTION NUMBER |
| Number | HS308A |
| State | FL |
| Issuer | MEDICAID |
| Number | 001349400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MELENDEZ MANUEL | Agent | 10250 SW 56TH street suiTe a-102, mIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| MELENDEZ MANUEL | President | 10250 SW 56TH street suiTe a-102, mIAMI, FL, 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2017-03-10 | 10250 SW 56TH street suiTe a-102, mIAMI, FL 33165 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-10 | 10250 SW 56TH street suiTe a-102, mIAMI, FL 33165 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-01 | 10250 SW 56TH street suiTe a-102, mIAMI, FL 33165 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-10 |
| ANNUAL REPORT | 2016-04-01 |
| ANNUAL REPORT | 2015-03-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
