| Entity Name: | CARMONA MEDICAL CARE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Jan 2018 (7 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 18 Jun 2020 (5 years ago) |
| Document Number: | P18000004096 |
| FEI/EIN Number | 82-4040068 |
| Address: | 2307 BOLADO PARKWAY, CAPE CORAL, FL 33990 |
| Mail Address: | 2307 BOLADO PRKWY, CAPE CORAL, FL 33990 |
| ZIP code: | 33990 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922620749 | 2020-05-14 | 2022-08-31 | 2307 BOLADO PKWY, CAPE CORAL, FL, 339902712, US | 2307 BOLADO PKWY, CAPE CORAL, FL, 339902712, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 786-768-3315 |
| Fax | 2394434516 |
Authorized person
| Name | JUAN A CARMONA |
| Role | PRESIDENT |
| Phone | 7867683315 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 2DYCQ |
| State | FL |
| Issuer | MEDICAID |
| Number | 022660000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARMONA HERRERA, JUAN A | Agent | 2307 BOLADO PRKWY, CAPE CORAL, FL 33990 |
| Name | Role | Address |
|---|---|---|
| CARMONA HERRERA, JUAN A | President | 2307 BOLADO PARKWAY, CAPE CORAL, FL 33990 |
| Name | Role | Address |
|---|---|---|
| MORERA, YANELY | Vice President | 2307 BOLADO PARKWAY, CAPE CORAL, FL 33990 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000054150 | CARMONA MEDICAL CENTER | ACTIVE | 2020-05-15 | 2025-12-31 | No data | 2307 BOLADO PKWY, CAPE CORAL, FL, 33990 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-02 | 2307 BOLADO PARKWAY, CAPE CORAL, FL 33990 | No data |
| AMENDMENT | 2020-06-18 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-18 | 2307 BOLADO PARKWAY, CAPE CORAL, FL 33990 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-18 | 2307 BOLADO PRKWY, CAPE CORAL, FL 33990 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-07-01 |
| Amendment | 2020-06-18 |
| ANNUAL REPORT | 2019-04-01 |
| Domestic Profit | 2018-01-11 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
