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  5. VICENTE LAGO, M.D., P.A.

VICENTE LAGO, M.D., P.A.

Company Details

Entity Name: VICENTE LAGO, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 04 Feb 1980 (45 years ago)
Date of dissolution: 28 Sep 2018 (6 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2018 (6 years ago)
Document Number: 655360
FEI/EIN Number 59-1973672
Mail Address: PO BOX 430735, MIAMI, FL 33243
Address: 351 NW 42 AVENUE, SUITE #305, MIAMI, FL 33126
ZIP code: 33126
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1336442441 2010-12-10 2010-12-10 351 NW 42ND AVE, STE 305, MIAMI, FL, 331265683, US 351 NW 42ND AVE, STE 305, MIAMI, FL, 331265683, US

Contacts
Phone +1 305-541-1041
Fax 3055417762

Authorized person
Name VICENTE LAGO
Role PRESIDENT
Phone 3055411041

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
License Number ME0024854
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 037706600
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2017 591973672 2018-03-21 VICENTE LAGO M.D. P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2016 591973672 2017-03-23 VICENTE LAGO M.D. P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Signature of
Role Plan administrator
Date 2017-03-23
Name of individual signing CARLOS INCERA
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2015 591973672 2016-06-20 VICENTE LAGO M.D. P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Signature of
Role Plan administrator
Date 2016-06-20
Name of individual signing CARLOS INCERA
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2014 591973672 2015-07-07 VICENTE LAGO M.D. P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Signature of
Role Plan administrator
Date 2015-07-07
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2013 591973672 2014-07-07 VICENTE LAGO M.D. P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Signature of
Role Plan administrator
Date 2014-07-07
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2012 591973672 2013-06-14 VICENTE LAGO M.D. P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Signature of
Role Plan administrator
Date 2013-06-14
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2011 591973672 2012-09-10 VICENTE LAGO M.D. P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Plan administrator’s name and address
Administrator’s EIN 591973672
Plan administrator’s name VICENTE LAGO M.D. P.A.
Plan administrator’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126
Administrator’s telephone number 3055411041

Signature of
Role Plan administrator
Date 2012-09-10
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2010 591973672 2011-05-31 VICENTE LAGO M.D. P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Plan administrator’s name and address
Administrator’s EIN 591973672
Plan administrator’s name VICENTE LAGO M.D. P.A.
Plan administrator’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126
Administrator’s telephone number 3055411041

Signature of
Role Plan administrator
Date 2011-05-31
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature
VICENTE LAGO M.D. P.A. PROFIT SHARING PLAN 2009 591973672 2010-05-18 VICENTE LAGO M.D. P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-01-30
Business code 621111
Sponsor’s telephone number 3055411041
Plan sponsor’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126

Plan administrator’s name and address
Administrator’s EIN 591973672
Plan administrator’s name VICENTE LAGO M.D. P.A.
Plan administrator’s address 351 NW LE JEUNE RD STE 305, MIAMI, FL, 33126
Administrator’s telephone number 3055411041

Signature of
Role Plan administrator
Date 2010-05-18
Name of individual signing VICENTE LAGO MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LAGO, VICENTE MD Agent 351 NW 42 AVENUE, #305, MIAMI, FL 33126

President

Name Role Address
LAGO, VICENTE MD PA President 5440 S.W. 59TH AVENUE, MIAMI, FL 33155

Director

Name Role Address
LAGO, VICENTE MD PA Director 5440 S.W. 59TH AVENUE, MIAMI, FL 33155

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data
CHANGE OF PRINCIPAL ADDRESS 2007-05-15 351 NW 42 AVENUE, SUITE #305, MIAMI, FL 33126 No data
REGISTERED AGENT NAME CHANGED 2007-05-15 LAGO, VICENTE MD No data
REGISTERED AGENT ADDRESS CHANGED 2007-05-15 351 NW 42 AVENUE, #305, MIAMI, FL 33126 No data
CHANGE OF MAILING ADDRESS 2007-05-15 351 NW 42 AVENUE, SUITE #305, MIAMI, FL 33126 No data
REINSTATEMENT 1994-12-19 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1994-08-26 No data No data

Documents

Name Date
ANNUAL REPORT 2017-03-20
ANNUAL REPORT 2016-03-16
ANNUAL REPORT 2015-05-06
ANNUAL REPORT 2014-05-15
ANNUAL REPORT 2013-04-23
ANNUAL REPORT 2012-02-07
ANNUAL REPORT 2011-04-14
ANNUAL REPORT 2010-04-27
ANNUAL REPORT 2009-04-28
ANNUAL REPORT 2008-04-21

Related by officers

LAGO, VICENTE MD

CONSEJO CUBANO PARA LA DEMOCRACIA, INC.

Related by address

No related companies by address

Date of last update: 05 Feb 2025

Sources: Florida Department of State

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