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  5. NOEL DE JESUS FERNANDEZ MD PA

NOEL DE JESUS FERNANDEZ MD PA

Company Details

Entity Name: NOEL DE JESUS FERNANDEZ MD PA
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 30 Oct 2013 (11 years ago)
Document Number: P13000088923
FEI/EIN Number 46-3993243
Address: 1975 W 76th St, Hialeah, FL 33014
Mail Address: 1975 W 76th St, Hialeah, FL 33014
ZIP code: 33014
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649948209 2021-08-31 2021-08-31 1975 W 76TH ST, HIALEAH, FL, 330143269, US 6738 W SUNRISE BLVD STE 102, PLANTATION, FL, 333136070, US

Contacts
Phone +1 786-703-1535
Fax 3053972725
Phone +1 954-530-5835
Fax 9543376216

Authorized person
Name IRIS MARTINEZ
Role COO
Phone 7867031535

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 017678803
State FL

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300FELXO3Z7B57T36 P13000088923 US-FL GENERAL ACTIVE No data

Addresses
Legal C/O FERNANDEZ, NOEL, 16571 SW 49 COURT, MIRAMAR, US-FL, US, 33027
Headquarters 16571 NW 49th Court, Miramar, US-FL, US, 33027

Registration details
Registration Date 2019-08-29
Last Update 2023-08-04
Status LAPSED
Next Renewal 2020-08-27
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As P13000088923

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NOEL DE JESUS FERNANDEZ MD PA DEFINED BENEFIT PLAN 2023 463993243 2024-10-11 NOEL DE JESUS FERNANDEZ MD PA 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2024-10-11
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2023 463993243 2024-10-04 NOEL DE JESUS FERNANDEZ MD PA 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2024-10-04
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2022 463993243 2023-06-28 NOEL DE JESUS FERNANDEZ MD PA 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2023-06-28
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA DEFINED BENEFIT PLAN 2022 463993243 2023-09-28 NOEL DE JESUS FERNANDEZ MD PA 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2023-09-28
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA DEFINED BENEFIT PLAN 2021 463993243 2022-10-11 NOEL DE JESUS FERNANDEZ MD PA 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2021 463993243 2022-09-19 NOEL DE JESUS FERNANDEZ MD PA 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2022-09-19
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA DEFINED BENEFIT PLAN 2020 463993243 2021-10-14 NOEL DE JESUS FERNANDEZ MD PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2020 463993243 2021-07-30 NOEL DE JESUS FERNANDEZ MD PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2021-07-30
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2019 463993243 2020-09-25 NOEL DE JESUS FERNANDEZ MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 1975 W. 76TH ST., HIALEAH, FL, 33014

Signature of
Role Plan administrator
Date 2020-09-25
Name of individual signing IRIS MARTINEZ
Valid signature Filed with authorized/valid electronic signature
NOEL DE JESUS FERNANDEZ MD PA 401(K) PROFIT SHARING PLAN 2018 463993243 2019-10-10 NOEL DE JESUS FERNANDEZ MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7867031536
Plan sponsor’s address 235 WEST 49TH STREET, HIALEAH, FL, 33012

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing NOEL DE JESUS FERNANDEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-10
Name of individual signing NOEL DE JESUS FERNANDEZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FERNANDEZ, NOEL Agent 1975 W 76th St, Hialeah, FL 33014

President

Name Role Address
Fernandez, Noel De Jesus President 1975 W 76th St, Hialeah, FL 33014

Secretary

Name Role Address
MARTINEZ, Iris Secretary 1975 W 76th St, Hialeah, FL 33014

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-03-22 1975 W 76th St, Hialeah, FL 33014 No data
CHANGE OF MAILING ADDRESS 2022-03-22 1975 W 76th St, Hialeah, FL 33014 No data
REGISTERED AGENT ADDRESS CHANGED 2022-03-22 1975 W 76th St, Hialeah, FL 33014 No data

Documents

Name Date
ANNUAL REPORT 2024-03-26
ANNUAL REPORT 2023-03-03
ANNUAL REPORT 2022-03-22
ANNUAL REPORT 2021-03-01
ANNUAL REPORT 2020-07-20
ANNUAL REPORT 2019-04-10
ANNUAL REPORT 2018-04-03
ANNUAL REPORT 2017-04-30
ANNUAL REPORT 2016-04-13
ANNUAL REPORT 2015-04-30

Related by officers

FERNANDEZ, NOEL

REPUBLIC LIFESTYLE LLC NF PLATINUM INC SERVICES & EXPRESS SOLUTIONS CORP DJ 312 TRANSPORT CORP LA FAMILLE MEDICAL GROUP LLC NUESTRA FAMILIA MEDICAL CENTER 3, LLC NUESTRA FAMILIA MEDICAL CENTER OF TAMPA, LLC MJ VENDING LLC SMOKE CLUB LLC RF DISTRIBUTION, LLC

Fernandez, Noel De Jesus

NUESTRA FAMILIA MEDICAL CENTER LLC NUESTRA FAMILIA MEDICAL CENTER 2, LLC NUESTRA FAMILIA DENTAL MANAGEMENT, LLC ADURIS MEDICAL RESEARCH, LLC

Related by address

1975 W 76th St, Hialeah, FL 33014

FERNANDEZ MEDICAL TRANSPORTATION, LLC NDJ REAL ESTATE, LLC

1975 W 76th St, Hialeah, FL 33014

FERNANDEZ MEDICAL TRANSPORTATION, LLC NDJ REAL ESTATE, LLC

Date of last update: 22 Jan 2025

Sources: Florida Department of State

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