| Entity Name: | ANGEL F. SAN ROMAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 22 Jul 1991 (34 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 24 Sep 1996 (28 years ago) |
| Document Number: | S75265 |
| FEI/EIN Number | 65-0204726 |
| Address: | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL 33146 |
| Mail Address: | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL 33146 |
| ZIP code: | 33146 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972993921 | 2015-01-29 | 2016-08-23 | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL, 331462436, US | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL, 331462436, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-663-2845 |
| Fax | 3056639361 |
Authorized person
| Name | DR. ANGEL F SAN ROMAN |
| Role | PRESIDENT |
| Phone | 3056632845 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME0055882 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 063497200 |
| State | FL |
| Name | Role |
|---|---|
| FLORIDA ANNUAL REPORT SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| SAN ROMAN, ANGEL F | President | 5965 PONCE DE LEON BLVD, STE. 2, CORAL GABLES, FL 33146 |
| Name | Role | Address |
|---|---|---|
| SAN ROMAN, ANGEL F | Director | 5965 PONCE DE LEON BLVD, STE. 2, CORAL GABLES, FL 33146 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-04 | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL 33146 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-04 | 5965 PONCE DE LEON BLVD, SUITE 2, CORAL GABLES, FL 33146 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1999-04-30 | 2300 CORAL WAY, SUITE 200, MIAMI, FL 33145 | No data |
| REGISTERED AGENT NAME CHANGED | 1999-04-30 | FLORIDA ANNUAL REPORT SERVICES INC. | No data |
| REINSTATEMENT | 1996-09-24 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| ARTICLES OF CORRECTION | 1991-09-05 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-03-18 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-02-08 |
| ANNUAL REPORT | 2017-02-01 |
| ANNUAL REPORT | 2016-03-17 |
| ANNUAL REPORT | 2015-03-10 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
