| Entity Name: | CRISTOBAL R. ROSARIO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Feb 1996 (29 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Jan 2007 (18 years ago) |
| Document Number: | P96000013227 |
| FEI/EIN Number | 593360414 |
| Address: | 3830 TAMPA RD., #500, PALM HARBOR, FL, 34684, US |
| Mail Address: | 3830 TAMPA RD., #500, PALM HARBOR, FL, 34684, US |
| ZIP code: | 34684 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124252838 | 2009-05-08 | 2009-05-08 | 3890 TAMPA ROAD, SUITE 307, PALM HARBOR, FL, 346843677, US | 3890 TAMPA ROAD, SUITE 307, PALM HARBOR, FL, 346843677, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-786-6155 |
| Fax | 7277819899 |
Authorized person
| Name | CRISTOBAL R ROSARIO |
| Role | M.D. |
| Phone | 7277866155 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0068810 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264028700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 378616100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROSARIO CRISTOBAL R | Agent | 3830 TAMPA RD., #500, PALM HARBOR, FL, 34684 |
| Name | Role | Address |
|---|---|---|
| ROSARIO CRISTOBAL R | Director | 3830 TAMPA RD., #500, PALM HARBOR, FL, 34684 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000109839 | GULF COAST INTERNISTS | ACTIVE | 2024-09-04 | 2029-12-31 | No data | 3830 TAMPA RD, SUITE 500, PALM HARBOR, FL, 34684 |
| G15000077514 | GULF COAST INTERNISTS | EXPIRED | 2015-07-27 | 2020-12-31 | No data | 3890 TAMPA RD, SUITE 307, PALM HARBOR, FL, 34684 |
| G11000071296 | HEALTH & AGE MANAGEMENT CENTER | EXPIRED | 2011-07-15 | 2016-12-31 | No data | 3890 TAMPA RD, SUITE 307, PALM HARBOR, FL, 34684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-19 | 3830 TAMPA RD., #500, PALM HARBOR, FL 34684 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-19 | 3830 TAMPA RD., #500, PALM HARBOR, FL 34684 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-19 | 3830 TAMPA RD., #500, PALM HARBOR, FL 34684 | No data |
| REINSTATEMENT | 2007-01-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2007-01-05 | ROSARIO, CRISTOBAL R | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-21 |
| ANNUAL REPORT | 2020-03-23 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-19 |
| ANNUAL REPORT | 2015-03-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
