| Entity Name: | FRAGA PEDIATRICS & ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Sep 1997 (27 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 16 Nov 2018 (6 years ago) |
| Document Number: | P97000078792 |
| FEI/EIN Number | 65-0779316 |
| Mail Address: | 5590 W 20 Ave, Suite 300, Hialeah, FL 33016 |
| Address: | 5590 W 20 Ave, SUITE # 100, HIALEAH, FL 33016 |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891890059 | 2006-09-13 | 2017-12-26 | 7765 NW 48TH ST STE 300, DORAL, FL, 331665404, US | 5590 W 20TH AVE STE 100, HIALEAH, FL, 330167061, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-442-1740 |
| Phone | +1 305-828-3997 |
| Fax | 3058284696 |
Authorized person
| Name | RENE CASANOVA |
| Role | PRESIDENT |
| Phone | 3054421740 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000711900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 279232000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BEILLY, BRADFORD JESQ | Agent | 1144 SE 3RD AVE, FORT LAUDERDALE, FL 33316 |
| Name | Role | Address |
|---|---|---|
| CASANOVA, RENE | Director | 1144 SE 3RD AVENUE, FORT LAUDERDALE, FL 33316 |
| Name | Role | Address |
|---|---|---|
| CASANOVA, RENE | President | 1144 SE 3RD AVENUE, FORT LAUDERDALE, FL 33316 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000045890 | PRIMECARE FAMILY CENTERS | EXPIRED | 2019-04-11 | 2024-12-31 | No data | 7765 NW 48 STREET, SUITE 300, DORAL, FL, 33166 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-20 | 5590 W 20 Ave, SUITE # 100, HIALEAH, FL 33016 | No data |
| AMENDMENT | 2018-11-16 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-02-10 | 5590 W 20 Ave, SUITE # 100, HIALEAH, FL 33016 | No data |
| CANCEL ADM DISS/REV | 2007-10-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| AMENDMENT | 2007-08-30 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-08-30 | 1144 SE 3RD AVE, FORT LAUDERDALE, FL 33316 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-08-30 | BEILLY, BRADFORD JESQ | No data |
| NAME CHANGE AMENDMENT | 1999-02-15 | FRAGA PEDIATRICS & ASSOCIATES, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-20 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-06-17 |
| ANNUAL REPORT | 2019-04-09 |
| Amendment | 2018-11-16 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
