| Entity Name: | POINCIANA MEDICAL CLINIC INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Sep 2013 (11 years ago) |
| Document Number: | P13000076758 |
| FEI/EIN Number | 46-3714235 |
| Address: | 51 & 53 N DOVERPLUM AVE, KISSIMMEE, FL, 34758 |
| Mail Address: | 51 & 53 N DOVERPLUM AVE, KISSIMMEE, FL, 34758 |
| ZIP code: | 34758 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871923037 | 2013-11-25 | 2014-07-21 | 51 N DOVERPLUM AVE, KISSIMMEE, FL, 347583308, US | 51 N DOVERPLUM AVE, KISSIMMEE, FL, 347583308, US | |||||||||||||||||||||||||
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| Phone | +1 407-572-8862 |
| Fax | 4075728863 |
Authorized person
| Name | IVAN A RIVERA SOLER |
| Role | MD |
| Phone | 4075728862 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ACN241 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001456400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RIVERA IVAN AM.D. | Agent | 51 & 53 N DOVERPLUM AVE, KISSIMMEE, FL, 34758 |
| Name | Role | Address |
|---|---|---|
| RIVERA IVAN AM.D | President | 51 & 53 N DOVERPLUM AVE, KISSIMMEE, FL, 32758 |
| Name | Role | Address |
|---|---|---|
| MERCADO EULADIA RN/BSN | Vice President | P.O. BOX 720788, ORLANDO, FL, 32872 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-05-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-01 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
