| Entity Name: | BONITA MEDICAL CARE CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 23 Jul 2014 (11 years ago) |
| Date of dissolution: | 02 Feb 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Feb 2017 (8 years ago) |
| Document Number: | P14000061823 |
| FEI/EIN Number | 47-1427234 |
| Address: | 26455 OLD41 RD, STE 18, BONITA SPRINGS, FL 34135 |
| Mail Address: | 1646 SARAZEN PL, NAPLES, FL 34105 |
| ZIP code: | 34135 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639612484 | 2016-11-28 | 2016-11-28 | 1320 MARIPOSA CIR APT 104, NAPLES, FL, 341057231, US | 26455 OLD 41 RD, SUITE 18, BONITA SPRINGS, FL, 341355124, US | |||||||||||||||||||||||||||
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| Phone | +1 239-273-1971 |
| Phone | +1 239-405-7721 |
| Fax | 2394057692 |
Authorized person
| Name | DR. JACKELINE NUNEZ |
| Role | DOCTOR |
| Phone | 2394057721 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ACN487 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | HV2572 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NUNEZ VALDEZ, JACKELINE | Agent | 1746 SARAZEN PL, NAPLES, FL 34105 |
| Name | Role | Address |
|---|---|---|
| NUNEZ VALDEZ, JACKELINE | President | 1746 SARAZEN PL, NAPLES, FL 34105 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-02-02 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-29 | 26455 OLD41 RD, STE 18, BONITA SPRINGS, FL 34135 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-29 | 1746 SARAZEN PL, NAPLES, FL 34105 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
| Domestic Profit | 2014-07-23 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
