DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Daza, Carlos Guillermo	DOIID	791137	NAIC NPN	10782193

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	7/7/2022		6/30/2025
Active	Non Resident	Agent	Health	7/7/2022		6/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	04/15/2025	06/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	7/22/2022
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/22/2022
Active	Aetna Life Insurance Company	301140	Agent - Health	7/22/2022
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/24/2014	6/30/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Insurance Company	301104	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/24/2014	6/30/2015
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/24/2014	6/30/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	10/24/2014	6/30/2015
Active	SilverScript Insurance Company	663526	Agent - Health	7/22/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/12/2012	1/30/2014
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/12/2012	1/30/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	10/18/2022	1/31/2023
Denied	Health Plan Intermediaries Holdings	786463	Agent - Life
Inactive	Togetherhealth Insurance LLC	1026438	Agent - Health	11/14/2022	1/24/2023
Denied	Togetherhealth Insurance LLC	1026438	Agent - Life