| Entity Name: | TOTAL MRI & DIAGNOSTIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Nov 2018 (6 years ago) |
| Document Number: | P18000094151 |
| FEI/EIN Number | 83-2570724 |
| Address: | 4440 SHERIDAN STREET STE B, HOLLYWOOD, FL 33021 |
| Mail Address: | 4440 SHERIDAN STREET STE B, HOLLYWOOD, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265040604 | 2020-07-22 | 2021-08-09 | 4440 SHERIDAN ST, STE B, HOLLYWOOD, FL, 330213535, US | 4440 SHERIDAN ST, STE B, HOLLYWOOD, FL, 330213535, US | |||||||||||||||||||||
|
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| Phone | +1 786-756-3038 |
Authorized person
| Name | GABRIEL G. FLOREZ, M.D. |
| Role | PRESIDENT |
| Phone | 7867563038 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA LICENSE |
| Number | PENDING |
| Name | Role | Address |
|---|---|---|
| FLOREZ, GABRIEL | Agent | 4440 SHERIDAN STREET STE B, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| FLOREZ, GABRIEL | President | 4440 SHERIDAN STREET STE B, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| FLOREZ, GABRIEL | Secretary | 4440 SHERIDAN STREET STE B, HOLLYWOOD, FL 33021 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000062249 | SUNSHINE BABY ULTRASOUND | ACTIVE | 2022-05-18 | 2027-12-31 | No data | 4440 SHERIDAN STREET, STE B, HOLLYWOOD, FL, 33021 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-04-23 |
| AMENDED ANNUAL REPORT | 2021-06-01 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-04-30 |
| Domestic Profit | 2018-11-16 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
