| Entity Name: | ROLANDO ACEVEDO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Oct 1998 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Oct 2018 (6 years ago) |
| Document Number: | P98000089639 |
| FEI/EIN Number | 650872897 |
| Address: | 10796 PINES BLVD., SUITE 106, PEMBROKE PINES, FL, 33026 |
| Mail Address: | 19355 NW 12TH ST, PEMBROKE PINES, FL, 33029 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396800447 | 2006-12-27 | 2009-11-16 | 10796 PINES BLVD, SUITE 106, PEMBROKE PINES, FL, 330263919, US | 10796 PINES BLVD, SUITE 106, PEMBROKE PINES, FL, 330263919, US | |||||||||||||||||||||||||
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| Phone | +1 954-443-5688 |
| Fax | 9544329882 |
Authorized person
| Name | DR. ROLANDO ACEVEDO |
| Role | MEDICAL DOCTOR |
| Phone | 9544435688 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0064850 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 374489201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARUSI DANIEL S | Agent | 517 SW 1ST AVE, FORT LAUDERDALE, FL, 33301 |
| Name | Role | Address |
|---|---|---|
| ACEVEDO ROLANDO M | President | 19355 NW 12TH ST, PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| ACEVEDO ROLANDO M | Secretary | 19355 NW 12TH ST, PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| ACEVEDO ROLANDO M | Treasurer | 19355 NW 12TH ST, PEMBROKE PINES, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| ACEVEDO ROLANDO M | Director | 19355 NW 12TH ST, PEMBROKE PINES, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-11 | 19355 nw 12 street, PEMBROKE PINES, FL 33029 | No data |
| REINSTATEMENT | 2018-10-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-02 | CARUSI, DANIEL SESQ. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-11 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-18 |
| ANNUAL REPORT | 2019-02-09 |
| REINSTATEMENT | 2018-10-02 |
| ANNUAL REPORT | 2017-03-24 |
| ANNUAL REPORT | 2016-01-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
