| Entity Name: | LUIS A. VELAZQUEZ M.D.P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Jan 1991 (34 years ago) |
| Document Number: | S25645 |
| FEI/EIN Number | 65-0243982 |
| Address: | 8600 SW 92 STREET, 109, MIAMI, FL 33156 |
| Mail Address: | 8600 SW 92 STREET, 109, MIAMI, FL 33156 |
| ZIP code: | 33156 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306161401 | 2010-03-31 | 2010-12-29 | 8600 SW 92ND ST STE 109, MIAMI, FL, 331567377, US | 8600 SW 92ND ST STE 109, MIAMI, FL, 331567377, US | |||||||||||||||||||||||||
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| Phone | +1 305-598-4499 |
| Fax | 3055983426 |
Authorized person
| Name | LUIS VELAZQUEZ |
| Role | PHYSICIAN |
| Phone | 3055984499 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0055886 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 064046800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VELAZQUEZ, LUIS A., M.D. | Agent | 8600 SW 92 STREET, MIAMI, FL 33156 |
| Name | Role | Address |
|---|---|---|
| VELAZQUEZ, LUIS A.,M.D. | President | 8600 SW 92 STREET, #109, MIAMI, FL |
| Name | Role | Address |
|---|---|---|
| VELAZQUEZ, LUIS A.,M.D. | Director | 8600 SW 92 STREET, #109, MIAMI, FL |
| Name | Role | Address |
|---|---|---|
| VELAZQUEZ, LUIS A.,M.D. | Secretary | 8600 SW 92 STREET, #109, MIAMI, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 1996-05-01 | 8600 SW 92 STREET, 109, MIAMI, FL 33156 | No data |
| CHANGE OF MAILING ADDRESS | 1996-05-01 | 8600 SW 92 STREET, 109, MIAMI, FL 33156 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1996-05-01 | 8600 SW 92 STREET, MIAMI, FL 33156 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-29 |
| ANNUAL REPORT | 2024-03-29 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-06-11 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-03-08 |
| ANNUAL REPORT | 2016-03-31 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
