| Entity Name: | GUILLERMO A. FONSECA M.D., PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Sep 1993 (31 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Jun 2020 (5 years ago) |
| Document Number: | P93000064968 |
| FEI/EIN Number | 650436567 |
| Address: | 14750 SW 26 Street, SUITE 212, MIAMI, FL, 33185, US |
| Mail Address: | 14750 SW 26 Street, Suite 212, MIAMI, FL, 33185, US |
| ZIP code: | 33185 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447796339 | 2017-01-16 | 2017-01-16 | 14750 SW 26TH ST, SUITE 212-214, MIAMI, FL, 331855933, US | 14750 SW 26TH ST, SUITE 212-214, MIAMI, FL, 331855933, US | |||||||||||||||||
|
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| Phone | +1 305-223-3989 |
Authorized person
| Name | DR. GUILLERMO ANTONIO FONSECA |
| Role | PRESIDENT |
| Phone | 3052233989 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0064061 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BACON FONSECA RAQUEL | Agent | 14750 SW 26 STREET, MIAMI, FL, 33185 |
| Name | Role | Address |
|---|---|---|
| FONSECA GUILLERMO A | Director | 14750 SW 26 STREET, MIAMI, FL, 33185 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-06-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-11 | 14750 SW 26 STREET, SUITE 212, MIAMI, FL 33185 | No data |
| REINSTATEMENT | 2017-01-11 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-11 | 14750 SW 26 Street, SUITE 212, MIAMI, FL 33185 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-11 | 14750 SW 26 Street, SUITE 212, MIAMI, FL 33185 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-01-11 | BACON FONSECA, RAQUEL | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2006-10-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-03-14 |
| REINSTATEMENT | 2020-06-30 |
| REINSTATEMENT | 2017-01-11 |
| ANNUAL REPORT | 2013-04-29 |
| ANNUAL REPORT | 2012-04-30 |
| ANNUAL REPORT | 2011-02-20 |
| ANNUAL REPORT | 2010-04-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
