| Entity Name: | MIAMI LAKES MEDICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 Apr 1995 (30 years ago) |
| Document Number: | P95000027994 |
| FEI/EIN Number | 65-0572755 |
| Address: | 6175 NW 167TH ST.,, SUITE G-25, MIAMI, FL 33015 |
| Mail Address: | 6175 NW 167TH ST.,, SUITE G-25, MIAMI, FL 33015 |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073667465 | 2007-01-22 | 2014-01-03 | 6175 NW 167TH ST, SUITE G-25, HIALEAH, FL, 330154339, US | 6175 NW 167TH ST, SUITE G-25, HIALEAH, FL, 330154339, US | |||||||||||||||||||||||||
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| Phone | +1 305-558-8838 |
| Fax | 3055588011 |
Authorized person
| Name | MR. JESUS ROJAS |
| Role | OWNER |
| Phone | 3055588838 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 319 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 951286100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Rojas, Jesus, Jr. | Agent | 6175 NW 167TH ST, SUITE G-25, MIAMI, FL 33015 |
| Name | Role | Address |
|---|---|---|
| ROJAS, JESUS | President | 6175 NW 167TH ST.,, SUITE G-25 MIAMI, FL 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-08 | 6175 NW 167TH ST, SUITE G-25, MIAMI, FL 33015 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-07 | 6175 NW 167TH ST.,, SUITE G-25, MIAMI, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-07 | 6175 NW 167TH ST.,, SUITE G-25, MIAMI, FL 33015 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-03-11 | Rojas, Jesus, Jr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-10 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-03-17 |
| ANNUAL REPORT | 2018-02-03 |
| ANNUAL REPORT | 2017-01-03 |
| ANNUAL REPORT | 2016-02-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
