| Entity Name: | RAFAEL MATOS MEDICAL CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Sep 2024 (5 months ago) |
| Document Number: | P24000058490 |
| FEI/EIN Number | 994967719 |
| Address: | 15511 N FLORIDA AVE, TAMPA, FL, 33613, US |
| Mail Address: | 15511 N FLORIDA AVE, TAMPA, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215755277 | 2024-09-30 | 2024-09-30 | 4604 NETHERWOOD DR, TAMPA, FL, 336241171, US | 15511 N FLORIDA AVE, TAMPA, FL, 336131263, US | |||||||||||||||||
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| Phone | +1 813-735-4820 |
| Phone | +1 813-473-8373 |
| Fax | 8137717022 |
Authorized person
| Name | RAFAEL MATOS |
| Role | PROVIDER |
| Phone | 8134738373 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MATOS RAFAEL | Agent | 15511 N FLORIDA AVE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| MATOS RAFAEL | President | 15511 N FLORIDA AVE, TAMPA, FL, 33613 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-09-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
