| Entity Name: | GABRIELA PEREZ, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 06 Oct 2022 (2 years ago) |
| Document Number: | P22000076955 |
| FEI/EIN Number | 92-0647464 |
| Address: | 2695 South Le Jeune Road, Suite 200, Miami, FL 33134 |
| Mail Address: | 1805 PONCE DE LEON BLVD.,, SUITE 125, CORAL GABLES, FL 33134 |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376254672 | 2022-12-07 | 2022-12-07 | 1805 PONCE DE LEON BLVD STE 125, CORAL GABLES, FL, 331344473, US | 3650 NW 82ND AVE STE 203, DORAL, FL, 331666662, US | |||||||||||||||||||||
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| Phone | +1 786-554-3700 |
| Phone | +1 786-703-7068 |
Authorized person
| Name | DR. GABRIELA PEREZ |
| Role | OWNER/ PHYSICIAN |
| Phone | 7865543700 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1932630712 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Perez, Gabriela , Dr. | Agent | 1805 PONCE DE LEON BLVD.,, SUITE 125, CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| PEREZ, GABRIELA, Dr. | Chief Executive Officer | 1805 PONCE DE LEON BLVD., SUITE 125, CORAL GABLES, FL 33134 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000009926 | PEREZ NEUROLOGY | ACTIVE | 2024-01-17 | 2029-12-31 | No data | 1805 PONCE DE LEON, SUITE 125, CORAL GABLES, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-06 | 2695 South Le Jeune Road, Suite 200, Miami, FL 33134 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-06 | Perez, Gabriela , Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-06 | 1805 PONCE DE LEON BLVD.,, SUITE 125, CORAL GABLES, FL 33134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-08-10 |
| Domestic Profit | 2022-10-06 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
