| Entity Name: | JUAN M GUTIERREZ, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 11 Mar 1998 (27 years ago) |
| Date of dissolution: | 24 Sep 1999 (25 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 1999 (25 years ago) |
| Document Number: | P98000022981 |
| Address: | 11406 SW 35TH LANE, MIAMI, FL 33165 |
| Mail Address: | 11406 SW 35TH LANE, MIAMI, FL 33165 |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417363185 | 2014-07-02 | 2015-08-06 | 11880 SW 40TH ST, SUITE 404, MIAMI, FL, 331753584, US | 11880 SW 40TH ST, SUITE 404, MIAMI, FL, 331753584, US | |||||||||||||||||||||||||
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| Phone | +1 305-227-6618 |
| Fax | 3052276668 |
Authorized person
| Name | DR. JUAN M GUTIERREZ |
| Role | PHYSICIAN |
| Phone | 3052276618 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME40749 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 068939400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ, JUAN M | Agent | 11406 SW 35TH LANE, MIAMI, FL 33165 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ, JUAN MMD | Director | 11406 S.W. 35TH LANE, MIAMI, F; 33165 |
| GUTIERREZ, MARIA A | Director | 11406 S.W. 35TH LANE, MIAMI, F; 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 1998-03-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
