| Entity Name: | INTI FERNANDEZ M.D. AT MIA, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Apr 2021 (4 years ago) |
| Document Number: | P21000033420 |
| FEI/EIN Number | 86-3354265 |
| Address: | 2100 NW 42ND AVE, MIAMI, FL, 33126 |
| Mail Address: | PO BOX 347768, CORAL GABLES, FL, 33234 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245805340 | 2021-05-21 | 2021-05-21 | 2100 NW 42ND AVE, MIAMI, FL, 33126, US | 2100 NW 42ND AVE, MIAMI, FL, 33126, US | |||||||||||||||||||||||||
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| Phone | +1 305-903-7587 |
Authorized person
| Name | INTI FERNANDEZ |
| Role | PRESIDENT |
| Phone | 3059037587 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1831235043 |
| State | FL |
| Issuer | IND NPI |
| Number | 1659471101 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ INTI | Agent | 4001 SW 4 ST, MIAMI, FL, 33134 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ INTI | President | 2100 NW 42ND AVE, MIAMI, FL, 33126 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-28 |
| Domestic Profit | 2021-04-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
