| Entity Name: | ANTONIO G. REVILLA JR., M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 Jul 1975 (50 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | 479904 |
| FEI/EIN Number | 59-1616573 |
| Address: | 1880 EAST COMMERCIAL BLVD., SUITE 3, FT LAUDERDALE, FL 33308 |
| Mail Address: | 1880 EAST COMMERCIAL BLVD., SUITE 3, FT LAUDERDALE, FL 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548532088 | 2012-01-30 | 2012-02-17 | 1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL, 333083747, US | 1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL, 333083747, US | |||||||||||||||||||||||||||
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| Phone | +1 954-772-0949 |
| Fax | 9547720957 |
Authorized person
| Name | DR. ANTONIO G. REVILLA JR. |
| Role | PRESIDENT |
| Phone | 9547720949 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | ME0021737 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| License Number | ME0021737 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| REVILLA, ANTONIO G JR MD | Agent | 1880 EAST COMMERCIAL BLVD STE 3, FT. LAUDERDALE, FL 33308 |
| Name | Role | Address |
|---|---|---|
| REVILLA, ANTONIO G JR | President | 1880 E COMMERCIAL BLVD STE 3, FORT LAUDERDALE, FL 33308 |
| Name | Role | Address |
|---|---|---|
| REVILLA, ANTONIO G JR | Director | 1880 E COMMERCIAL BLVD STE 3, FORT LAUDERDALE, FL 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-02 | 1880 EAST COMMERCIAL BLVD., SUITE 3, FT LAUDERDALE, FL 33308 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-02 | 1880 EAST COMMERCIAL BLVD., SUITE 3, FT LAUDERDALE, FL 33308 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-02-02 | 1880 EAST COMMERCIAL BLVD STE 3, FT. LAUDERDALE, FL 33308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-02 |
| ANNUAL REPORT | 2010-02-02 |
| ANNUAL REPORT | 2009-02-24 |
| ANNUAL REPORT | 2008-01-23 |
| ANNUAL REPORT | 2007-01-16 |
| ANNUAL REPORT | 2006-03-31 |
| ANNUAL REPORT | 2005-03-28 |
| ANNUAL REPORT | 2004-04-29 |
| ANNUAL REPORT | 2003-03-21 |
| ANNUAL REPORT | 2002-03-25 |
Date of last update: 06 Feb 2025
Sources: Florida Department of State
