| Entity Name: | MOSAICO MENTAL HEALTH CENTER, CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Nov 2016 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Oct 2022 (2 years ago) |
| Document Number: | P16000092688 |
| FEI/EIN Number | 81-4489564 |
| Address: | 7726 WINEGARD RD, 2ND FLOOR STE 9, ORLANDO, FL, 32809, US |
| Mail Address: | 3016 ST AUGUSTINE DR, ORLANDO, FL, 32825, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114575636 | 2019-08-28 | 2022-02-17 | 7726 WINEGARD RD, 2ND FLOOR STE 9, ORLANDO, FL, 328097147, US | 7726 WINEGARD RD, 2ND FLOOR STE 9, ORLANDO, FL, 328097147, US | |||||||||||||||||||||
|
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| Phone | +1 407-930-0050 |
| Fax | 4077514804 |
Authorized person
| Name | IRIS SOTO |
| Role | ADMIN |
| Phone | 4079300050 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106075100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Soto Iris | Agent | 3016 ST AUGUSTINE DR, ORLANDO, FL, 32825 |
| Name | Role | Address |
|---|---|---|
| RUIZ SANTIAGO GUSTAVO V | President | 3016 ST AUGUSTINE DR, ORLANDO, FL, 32825 |
| Name | Role | Address |
|---|---|---|
| SOTO IRIS D | Vice President | 3016 ST AUGUSTINE DR, ORLANDO, FL, 32825 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-03-13 | 7726 WINEGARD RD, 2ND FLOOR STE 9, ORLANDO, FL 32809 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-13 | 3016 ST AUGUSTINE DR, ORLANDO, FL 32825 | No data |
| REINSTATEMENT | 2022-10-13 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-10-13 | 7726 WINEGARD RD, 2ND FLOOR STE 9, ORLANDO, FL 32809 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-19 | Soto, Iris | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-04-11 |
| REINSTATEMENT | 2022-10-13 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-03-23 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-12 |
| Domestic Profit | 2016-11-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
