| Entity Name: | CLINICA GUADALUPE, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Oct 2017 (7 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P17000087460 |
| FEI/EIN Number | 82-4929098 |
| Address: | 5475 Golden Gate Parkway, Naples, FL, 34116, US |
| Mail Address: | 5475 Golden Gate Parkway, Naples, FL, 34116, US |
| ZIP code: | 34116 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700376993 | 2018-05-14 | 2018-05-14 | 19050 SW 194TH AVE, MIAMI, FL, 331871945, US | 5475 GOLDEN GATE PKWY STE 5W, NAPLES, FL, 341167529, US | |||||||||||||||||||||||||
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| Phone | +1 786-344-8916 |
| Phone | +1 239-315-4821 |
| Fax | 2393154824 |
Authorized person
| Name | MRS. BELKIS A ALVAREZ |
| Role | ADMINISTRATOR |
| Phone | 7863448916 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | HCC12895 |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALBA JOSE MSR. | Agent | 5475 Golden Gate Parkway, Naples, FL, 34116 |
| Name | Role | Address |
|---|---|---|
| ALBA JOSE MSR | President | 5475 Golden Gate Parkway, Naples, FL, 34116 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000039705 | GOLDENGATE PHARMACY | EXPIRED | 2018-03-26 | 2023-12-31 | No data | 5475 GOLDEN GATE PARKWAY, SUITE 5W, NAPLES, FL, 33187 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-26 | 5475 Golden Gate Parkway, Suite 5W, Naples, FL 34116 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-26 | 5475 Golden Gate Parkway, Suite 5W, Naples, FL 34116 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-26 | 5475 Golden Gate Parkway, Suite 5W, Naples, FL 34116 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-26 |
| Domestic Profit | 2017-10-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
