| Entity Name: | CARLOS DELGADO MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Mar 1999 (26 years ago) |
| Document Number: | P99000030632 |
| FEI/EIN Number | 650912648 |
| Address: | 1957 W 60 ST, HIALEAH, FL, 33012 |
| Mail Address: | 1957 W 60 ST, HIALEAH, FL, 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376772558 | 2009-07-08 | 2022-03-31 | 1957 W 60TH ST, HIALEAH, FL, 330127504, US | 1957 W 60TH ST, HIALEAH, FL, 330127504, US | |||||||||||||||||||||||||
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| Phone | +1 305-825-8170 |
| Fax | 3058258177 |
Authorized person
| Name | CARLOS LORENZO DELGADO |
| Role | OWNER |
| Phone | 3058258170 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME65801 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110488100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DELGADO CARLOS L | Agent | 18181 SW 22 STREET, MIRAMAR, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| DELGADO CARLOS L | President | 18181 SW 22 STREET, MIRAMAR, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| DELGADO CARLOS L | Director | 18181 SW 22 STREET, MIRAMAR, FL, 33029 |
| DELGADO NANCY V | Director | 18181 SW 22 STREET, MIRAMAR, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| DELGADO NANCY V | Treasurer | 18181 SW 22 STREET, MIRAMAR, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2012-01-07 | DELGADO, CARLOS L | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-29 | 1957 W 60 ST, HIALEAH, FL 33012 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-29 | 1957 W 60 ST, HIALEAH, FL 33012 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
