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  5. MANUEL H. HERNANDEZ, M.D., P.A.

MANUEL H. HERNANDEZ, M.D., P.A.

Company Details

Entity Name: MANUEL H. HERNANDEZ, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 18 Jun 1998 (27 years ago)
Document Number: P98000054651
FEI/EIN Number 58-2401792
Address: 4235 KINGS HWY., STE 101, PORT CHARLOTTE, FL 33980
Mail Address: 4235 KINGS HWY., STE 101, PORT CHARLOTTE, FL 33980
ZIP code: 33980
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316064231 2007-03-24 2023-10-06 4235 KINGS HWY UNIT 101, PUNTA GORDA, FL, 339808421, US 4235 KINGS HWY, SUITE 101, PUNTA GORDA, FL, 339808415, US

Contacts
Phone +1 941-764-7773
Fax 9417647681

Authorized person
Name MANUEL HERNANDEZ
Role PRESIDENT
Phone 9417647773

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number 0076069
State FL
Is Primary Yes
Taxonomy Code 207ND0101X - MOHS-Micrographic Surgery Physician
License Number 0076069
State FL
Is Primary No
Taxonomy Code 207ND0900X - Dermatopathology Physician
License Number 0076069
State FL
Is Primary No
Taxonomy Code 207NP0225X - Pediatric Dermatology Physician
License Number 0076069
State FL
Is Primary No
Taxonomy Code 207NS0135X - Procedural Dermatology Physician
License Number 0076069
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 582401792 2023-09-15 MANUEL H. HERNANDEZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 339808421

Signature of
Role Plan administrator
Date 2023-09-15
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 582401792 2023-09-15 MANUEL H. HERNANDEZ, M.D., P.A. 6
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 339808421

Signature of
Role Plan administrator
Date 2023-09-15
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 582401792 2023-09-15 MANUEL H. HERNANDEZ, M.D., P.A. 6
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 339808421

Signature of
Role Plan administrator
Date 2023-09-15
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2021 582401792 2022-10-13 MANUEL H. HERNANDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 339808421

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2020 582401792 2021-10-06 MANUEL H. HERNANDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 339808421

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2019 582401792 2020-07-06 MANUEL H. HERNANDEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 33980

Signature of
Role Plan administrator
Date 2020-07-06
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2018 582401792 2019-10-07 MANUEL H. HERNANDEZ, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 33980

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2017 582401792 2018-07-18 MANUEL H. HERNANDEZ, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 33980

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2016 582401792 2017-07-18 MANUEL H. HERNANDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 33980

Signature of
Role Plan administrator
Date 2017-07-18
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature
MANUEL H. HERNANDEZ, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2015 582401792 2016-09-13 MANUEL H. HERNANDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 9417647773
Plan sponsor’s address 4235 KINGS HIGHWAY, SUITE 101, PORT CHARLOTTE, FL, 33980

Signature of
Role Plan administrator
Date 2016-09-13
Name of individual signing KAREM CANCIO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
FMR CORP. Agent

President

Name Role Address
HERNANDEZ, MANUEL H President 4235 KINGS HWY., STE 101, PORT CHARLOTTE, FL 33980

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2011-02-28 4235 KINGS HWY., STE 101, PORT CHARLOTTE, FL 33980 No data
CHANGE OF PRINCIPAL ADDRESS 2010-06-22 4235 KINGS HWY., STE 101, PORT CHARLOTTE, FL 33980 No data
REGISTERED AGENT ADDRESS CHANGED 2008-01-22 C/O FORMOSO-MURIAS, P.A., 401 SW 27THAVE, MIAMI, FL 33135 No data

Documents

Name Date
ANNUAL REPORT 2025-01-07
ANNUAL REPORT 2024-02-09
ANNUAL REPORT 2023-02-17
ANNUAL REPORT 2022-03-05
ANNUAL REPORT 2021-02-15
ANNUAL REPORT 2020-02-12
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-02-07
ANNUAL REPORT 2017-02-17
ANNUAL REPORT 2016-02-04

Related by officers

HERNANDEZ, MANUEL H

SETUP SWFL LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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