| Entity Name: | MEDICAL CARE PAIN RELIEF CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Aug 2021 (3 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 18 Nov 2024 (3 months ago) |
| Document Number: | P21000076751 |
| FEI/EIN Number | 872372124 |
| Address: | 13911 N DALE MABRY HWY, SUITE 108, TAMPA, FL, 33618, US |
| Mail Address: | 13911 N DALE MABRY HWY, SUITE 108, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295493914 | 2021-11-30 | 2022-12-02 | 13911 N DALE MABRY HWY STE 108, TAMPA, FL, 336182414, US | 13911 N DALE MABRY HWY STE 108, TAMPA, FL, 336182414, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-964-6395 |
| Fax | 8139646551 |
Authorized person
| Name | YOANA FERNANDEZ |
| Role | OWNER |
| Phone | 8139646395 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
| Taxonomy Code | 2278P1004X - Pulmonary Diagnostics Certified Respiratory Therapist |
| Is Primary | No |
| Taxonomy Code | 2279P1004X - Pulmonary Diagnostics Registered Respiratory Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RRT |
| Number | RT14832 |
| State | FL |
| Issuer | MEDICAID |
| Number | 112893700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EDUARDO FONSECA GONZALEZ | Agent | 13911 N DALE MABRY HWY, TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| EDUARDO FONSECA GONZALEZ | President | 13911 N DALE MABRY HWY #108, TAMPA, FL, 33618 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT AND NAME CHANGE | 2024-11-18 | MEDICAL CARE PAIN RELIEF CORP | No data |
| REGISTERED AGENT NAME CHANGED | 2024-11-18 | EDUARDO FONSECA GONZALEZ | No data |
| Name | Date |
|---|---|
| Amendment and Name Change | 2024-11-18 |
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-03-03 |
| Domestic Profit | 2021-08-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
