GONZALO J IRAVEDRA PA
Osteopathic Medicine at Pines Blvd, Hollywood, FL

License number
Florida ME32736
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: GONZALO J IRAVEDRA MD
Title: PRESIDENT
Phone: (954) 499-7878
Address
Address
18503 Pines Blvd SUITE 303, Hollywood, FL 33029
National Provider ID: 1215941596
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DR. GONZALO J. IRAVEDRA, PA

Hollywood, FL

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Feb 23, 2001
Inactive since:
Sep 24, 2010
Addresses:
601 N Flamingo Rd SUITE 315-A, Hollywood, FL 33028 (Physical)
15841 Pne Blvd #395, Hollywood, FL 33027 (Mailing)
State ID:
P01000019983
Business type:
Florida Profit Corporation
Director:
Gonzalo Jdr Iravedra Director, inactive, 15841 Pne Blvd #395, Hollywood, FL 33027 (Physical)
Agent:
Gonzalo Iravedra,15841 Pne Blvd, Hollywood, FL 33027 (Physical)
EIN:
65-1106091

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