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BLUE DIAMOND MEDICAL CENTER ,CORP. - Florida Company Profile

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Company Details

Entity Name: BLUE DIAMOND MEDICAL CENTER ,CORP.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 23 Feb 2022 (3 years ago)
Document Number: P22000015740
FEI/EIN Number 881013407
Address: 16430 nw 59 th avenue, miami, FL, 33014, UN
Mail Address: 16430 nw 59 th avenue, miami, FL, 33014, UN
ZIP code: 33014
City: Hialeah
County: Miami-Dade
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CARVAJAL MARCOS President 2401 DUNHILL AVE, MIRAMAR, FL, 33025
CARVAJAL MARCOS Agent 2401 DUNHILL AVE, MIRAMAR, FL, 33025

National Provider Identifier

NPI Number:
1245967587
Certification Date:
2023-04-15

Authorized Person:

Name:
MARCOS JOSE CARVAJAL
Role:
APRN-FNP
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
3054567559

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-04-21 16430 nw 59 th avenue, suite #202, miami, FL 33014 UN -
CHANGE OF MAILING ADDRESS 2022-04-21 16430 nw 59 th avenue, suite #202, miami, FL 33014 UN -

Documents

Name Date
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-04-28
Domestic Profit 2022-02-23

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Date of last update: 01 Aug 2025

Sources: Florida Department of State