| Entity Name: | D. DE LA VEGA MD P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Aug 1996 (28 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 23 Apr 2012 (13 years ago) |
| Document Number: | P96000066346 |
| FEI/EIN Number | 650681728 |
| Address: | 11093 NW 138 STREET, SUITE 112, HIALEAH GARDENS, FL, 33018, US |
| Mail Address: | 3200 SW 128TH AVE, MIAMI, FL, 33175 |
| ZIP code: | 33018 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063464527 | 2006-05-16 | 2020-02-19 | 11093 NW 138TH ST UNIT 112, HIALEAH GARDENS, FL, 330181190, US | 11093 NW 138TH ST UNIT 112, HIALEAH GARDENS, FL, 330181190, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 305-552-0303 |
| Fax | 3055540709 |
Authorized person
| Name | DR. DAGOBERTO DE LA VEGA |
| Role | PRESIDENT |
| Phone | 3052989100 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME67856 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 377494501 |
| State | FL |
| Issuer | BCBS PROVIDER# |
| Number | 26980 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DE LA VEGA DAGOBERTO | Agent | 3200 S W 128TH AVE, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| DE LA VEGA DAGOBERTO | Director | 3200 SW 128TH AVE, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| DE LA VEGA DAGOBERTO | President | 3200 SW 128TH AVE, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| DE LA VEGA DAGOBERTO | Secretary | 3200 SW 128TH AVE, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| DE LA VEGA DAGOBERTO | Treasurer | 3200 SW 128TH AVE, MIAMI, FL, 33175 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000015434 | ALL AMERICAN COMPLIANCE GROUP | EXPIRED | 2019-01-29 | 2024-12-31 | No data | 11093 NW 138 STREET, SUITE 112, HIALEAH GARDENS, FL, 33018 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-28 | 11093 NW 138 STREET, SUITE 112, HIALEAH GARDENS, FL 33018 | No data |
| REINSTATEMENT | 2012-04-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REINSTATEMENT | 2010-07-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-05-02 | 3200 S W 128TH AVE, MIAMI, FL 33175 | No data |
| REINSTATEMENT | 2005-05-02 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2005-05-02 | 11093 NW 138 STREET, SUITE 112, HIALEAH GARDENS, FL 33018 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-05-02 | DE LA VEGA, DAGOBERTO | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000023998 | TERMINATED | 1000000872677 | DADE | 2021-01-13 | 2031-01-20 | $ 1,288.41 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828 |
| J19000682714 | TERMINATED | 1000000843659 | DADE | 2019-10-11 | 2029-10-16 | $ 712.54 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828 |
| J19000681526 | TERMINATED | 1000000843256 | MIAMI-DADE | 2019-10-10 | 2029-10-16 | $ 402.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828 |
| J17000615270 | TERMINATED | 1000000760864 | DADE | 2017-10-25 | 2027-11-02 | $ 1,044.88 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-05-08 |
| ANNUAL REPORT | 2019-03-03 |
| ANNUAL REPORT | 2018-03-17 |
| ANNUAL REPORT | 2017-03-16 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-03-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
