| Entity Name: | FAMILY TREE MEDICAL GROUP II, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 25 Feb 2022 (3 years ago) |
| Document Number: | P22000017259 |
| FEI/EIN Number | 88-1080158 |
| Address: | 2201 NORTH BLVD WEST, #2, DAVENPORT, FL 33837 |
| Mail Address: | 2201 NORTH BLVD W, SUITE #2, DAVENPORT, FL 33837 |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720727654 | 2022-05-31 | 2022-12-14 | 2201 NORTH BLVD W, DAVENPORT, FL, 338378990, US | 2201 NORTH BLVD W, DAVENPORT, FL, 338378990, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 863-353-1246 |
| Fax | 8634199547 |
Authorized person
| Name | MR. VICTOR M PANTOJA JR. |
| Role | BUISNESS OWNER |
| Phone | 4079702981 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PANTOJA, VICTOR M, JR. | Agent | 2201 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Name | Role | Address |
|---|---|---|
| PANTOJA, VICTOR M, JR. | Chief Executive Officer | 2201 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ, FRANCELIS I, MD | President | 2201 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-22 |
| Domestic Profit | 2022-02-25 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
