| Entity Name: | YANELY PINEIRO PUEBLA, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Aug 2014 (11 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 26 Jun 2017 (8 years ago) |
| Document Number: | P14000066962 |
| FEI/EIN Number | 47-1577796 |
| Address: | 12311 TAFT STREET, PEMBROKE PINES, FL, 33026, US |
| Mail Address: | 12311 TAFT STREET, PEMBROKE PINES, FL, 33026, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306366992 | 2017-06-23 | 2017-12-05 | 12311 TAFT ST STE 1, PEMBROKE PINES, FL, 330264384, US | 12311 TAFT ST, PEMBROKE PINES, FL, 330264384, US | |||||||||||||||||||||||||||
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| Phone | +1 954-487-1516 |
| Fax | 9544871519 |
| Phone | +1 305-720-1191 |
Authorized person
| Name | DR. YANELY PINEIRO PUEBLA |
| Role | PRESIDENT |
| Phone | 3057201191 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME119291 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016072800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PINEIRO PUEBLA YANELY | Agent | 8462 NW 166 TERRACE, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| PINEIRO PUEBLA YANELY | President | 12311 TAFT STREET, PEMBROKE PINES, FL, 33026 |
| Name | Role | Address |
|---|---|---|
| Duarte Martinez Reynold | Chief Executive Officer | 12311 TAFT STREET, PEMBROKE PINES, FL, 33026 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000059439 | PRIORITY FAMILY HEALTH | EXPIRED | 2017-05-30 | 2022-12-31 | No data | 8462 NW 166TH TERRACE, MIAMI LAKES, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-11-22 | 12311 TAFT STREET, PEMBROKE PINES, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2017-11-22 | 12311 TAFT STREET, PEMBROKE PINES, FL 33026 | No data |
| AMENDMENT | 2017-06-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-06-26 | 8462 NW 166 TERRACE, MIAMI LAKES, FL 33016 | No data |
| AMENDMENT | 2017-05-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-04-18 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-04-05 |
| Amendment | 2017-06-26 |
| Amendment | 2017-05-26 |
| ANNUAL REPORT | 2017-04-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
