| Entity Name: | ALI REZA ZARGARAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 27 Jun 1995 (30 years ago) |
| Document Number: | P95000050022 |
| FEI/EIN Number | 650592113 |
| Address: | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062, US |
| Mail Address: | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062, US |
| ZIP code: | 33062 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881996395 | 2010-12-03 | 2010-12-03 | 2701 E ATLANTIC BLVD, POMPANO BEACH, FL, 330624941, US | 2701 E ATLANTIC BLVD, POMPANO BEACH, FL, 330624941, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 954-942-8987 |
| Fax | 9549429545 |
Authorized person
| Name | ALI REZA ZARGARAN |
| Role | DOCTOR |
| Phone | 9549428987 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME66452 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 376166500 |
| State | FL |
| Issuer | MEDICARE ID-TYPE |
| Number | 25762 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PECAN LAWRENCE EESQ. | Agent | 3200 SOUTHEAST FINANCIAL, MIAMI, FL, 33131 |
| Name | Role | Address |
|---|---|---|
| ZARGARAN ALI R | President | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062 |
| Name | Role | Address |
|---|---|---|
| ZARGARAN ALI R | Vice President | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062 |
| Name | Role | Address |
|---|---|---|
| ZARGARAN ALI R | Secretary | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062 |
| Name | Role | Address |
|---|---|---|
| ZARGARAN ALI R | Treasurer | 50 N.E. 26TH AVENUE, POMPANO BEACH, FL, 33062 |
| Name | Role | Address |
|---|---|---|
| WELT KENNETH A | Director | 1776 NORTH PINE ISLAND RD, PLANTATION, FL, 33322 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| AMENDMENT | 2014-12-18 | No data | No data |
| CANCEL ADM DISS/REV | 2006-12-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000922830 | LAPSED | 14-24390 | UNITED STATES BANKRUPTCY COURT | 2014-10-16 | 2019-10-20 | $27,845.61 | ALEXANDER + SOMODEVILLA, PLLC, 1401 BRICKELL AVE., SUITE 420, MIAMI, FL 33131 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
