| Entity Name: | PROFESSIONAL MEDICAL PRACTICE INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 25 Aug 2015 (9 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P15000070251 |
| FEI/EIN Number | 47-4893594 |
| Address: | 7221 SW 24 ST #202-A, MIAMI, FL 33155 |
| Mail Address: | 7221 SW 24 ST #202-A, MIAMI, FL 33155 |
| ZIP code: | 33155 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447618442 | 2016-02-04 | 2023-01-26 | 7221 SW 24 STREET, SUITE #202A, MIAMI, FL, 33155, US | 11246 SW 137TH AVE STE 202A, MIAMI, FL, 331864201, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 786-294-0811 |
| Fax | 7863625244 |
| Phone | +1 786-631-5999 |
Authorized person
| Name | MR. YANET RODRIGUEZ |
| Role | PRESIDENT |
| Phone | 3058211613 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | HCC10584 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | HCC10584 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261QA0600X |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ, YORDANY | Agent | 7221 SW 24 ST #202-A, MIAMI, FL 33155 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ, YORDANY | President | 7221 SW 24 ST #202-A, MIAMI, FL 33155 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-08-10 | GONZALEZ, YORDANY | No data |
| AMENDMENT | 2020-06-16 | No data | No data |
| AMENDMENT | 2020-03-06 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-04 | 7221 SW 24 ST #202-A, MIAMI, FL 33155 | No data |
| AMENDMENT | 2019-10-04 | No data | No data |
| AMENDMENT | 2019-09-26 | No data | No data |
| AMENDMENT | 2019-04-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-05 | 7221 SW 24 ST #202-A, MIAMI, FL 33155 | No data |
| AMENDMENT | 2018-11-05 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2020-08-10 |
| Amendment | 2020-06-16 |
| ANNUAL REPORT | 2020-05-13 |
| Amendment | 2020-03-06 |
| Amendment | 2019-10-04 |
| Amendment | 2019-09-26 |
| ANNUAL REPORT | 2019-05-09 |
| Amendment | 2019-04-25 |
| Amendment | 2018-11-05 |
| AMENDED ANNUAL REPORT | 2018-10-19 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
