| Entity Name: | JORGE E LOPEZ PEREZ MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Apr 2022 (3 years ago) |
| Document Number: | P22000028486 |
| FEI/EIN Number | 88-1833417 |
| Address: | 8111 NW 53RD ST, 365, MIAMI, FL 33166 |
| Mail Address: | 8111 NW 53RD ST, 365, MIAMI, FL 33166 |
| ZIP code: | 33166 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215672043 | 2022-05-05 | 2022-05-05 | 8255 SW 72ND CT UNIT 429, MIAMI, FL, 331434262, US | 11750 BIRD RD, MIAMI, FL, 331753530, US | |||||||||||||||||||
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| Phone | +1 305-223-3000 |
Authorized person
| Name | JORGE E LOPEZ PEREZ |
| Role | OWNER |
| Phone | 7863857614 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110229100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOPEZ PEREZ, JORGE E | Agent | 8111 NW 53RD ST, 365, MIAMI, FL 33166 |
| Name | Role | Address |
|---|---|---|
| LOPEZ PEREZ, JORGE E | President | 8111 NW 53RD ST, 365 MIAMI, FL 33166 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-05 | 8111 NW 53RD ST, 365, MIAMI, FL 33166 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-05 | 8111 NW 53RD ST, 365, MIAMI, FL 33166 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-05 | 8111 NW 53RD ST, 365, MIAMI, FL 33166 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| AMENDED ANNUAL REPORT | 2023-06-28 |
| ANNUAL REPORT | 2023-04-29 |
| Domestic Profit | 2022-04-01 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
