| Entity Name: | RAMON GUTIERREZ, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 31 Oct 1991 (33 years ago) |
| Document Number: | S91054 |
| FEI/EIN Number | 593098991 |
| Address: | 18400 NW 75 PLACE, HIALEAH, FL, 33015, US |
| Mail Address: | 18400 NW 75 PLACE SUITE 106, HIALEAH, FL, 33015, US |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689031866 | 2016-01-19 | 2016-01-19 | 3900 NW 79TH AVE STE 500, DORAL, FL, 331666549, US | 3900 NW 79TH AVE STE 500, DORAL, FL, 331666549, US | |||||||||||||||||||||||||
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| Phone | +1 786-717-6868 |
| Fax | 7867176867 |
Authorized person
| Name | DR. RAMON M GUTIERREZ |
| Role | PRESIDENT |
| Phone | 3056060582 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME 031422 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 064965100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ, RAMON | Agent | 18400 NW 75 PLACE SUITE 106, HIALEAH, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ RAMON | President | 18400 NW 75 PLACE, HIALEAH, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ ALEXANDER | Vice President | 18400 NW 75 PLACE SUITE 106, HIALEAH, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| MIJANGOS LORENA B | Secretary | 18400 NW 75 PLACE, HIALEAH, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| MIJANGOS LORENA B | Treasurer | 18400 NW 75 PLACE, HIALEAH, FL, 33015 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000051859 | CLINICA SUR MEDICAL CENTER | EXPIRED | 2017-05-10 | 2022-12-31 | No data | 18400 NW 75 PLACE SUITE 106, HIALEAH, FL, 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| AMENDMENT | 2016-11-18 | No data | No data |
| AMENDMENT | 2015-06-22 | No data | No data |
| AMENDMENT | 2015-04-29 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
