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  5. VISAGE DERMATOLOGY LLC

VISAGE DERMATOLOGY LLC - Florida Company Profile

Company Details

Entity Name: VISAGE DERMATOLOGY LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

VISAGE DERMATOLOGY LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 03 Jan 2006 (19 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 27 Sep 2010 (15 years ago)
Document Number: L06000000736
FEI/EIN Number 204041180

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 5253 CENTRAL AVE, SAINT PETERSBURG, FL, 33710, US
Mail Address: 5253 CENTRAL AVE, SAINT PETERSBURG, FL, 33710, US
ZIP code: 33710
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932200045 2006-09-25 2008-07-17 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141, US 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141, US

Contacts
Phone +1 727-388-6982

Authorized person
Name ALEXANDRIA KONGSIRI
Role PHYSICIAN
Phone 7273886982

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME83035
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VISAGE DERMATOLOGY LLC 401(K) PLAN 2019 204041180 2020-09-04 VISAGE DERMATOLOGY LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2020-09-04
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401(K) PLAN 2019 204041180 2020-09-04 VISAGE DERMATOLOGY LLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2020-09-04
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401(K) PLAN 2018 204041180 2019-07-23 VISAGE DERMATOLOGY LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2019-07-23
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401(K) PLAN 2017 204041180 2018-06-05 VISAGE DERMATOLOGY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2018-06-05
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401(K) PLAN 2016 204041180 2017-07-31 VISAGE DERMATOLOGY LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401(K) PLAN 2015 204041180 2016-07-14 VISAGE DERMATOLOGY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-14
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401K PLAN 2014 204041180 2015-06-25 VISAGE DERMATOLOGY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2015-06-25
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-25
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401K PLAN 2013 204041180 2014-05-14 VISAGE DERMATOLOGY LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2014-05-14
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-14
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401K PLAN 2012 204041180 2013-06-03 VISAGE DERMATOLOGY LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Signature of
Role Plan administrator
Date 2013-06-03
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-03
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
VISAGE DERMATOLOGY LLC 401K PLAN 2011 204041180 2012-07-06 VISAGE DERMATOLOGY LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-01
Business code 621399
Sponsor’s telephone number 7273886982
Plan sponsor’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141

Plan administrator’s name and address
Administrator’s EIN 204041180
Plan administrator’s name VISAGE DERMATOLOGY LLC
Plan administrator’s address 5253 CENTRAL AVE, ST PETERSBURG, FL, 337108141
Administrator’s telephone number 7273886982

Signature of
Role Plan administrator
Date 2012-07-06
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-06
Name of individual signing ALEXANDRIA KONGSIRI
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
KONGSIRI ALEXANDRIA S Manager 5253 CENTRAL AVE, SAINT PETERSBURG, FL, 33710
KONGSIRI ALEXANDRIA S Agent 5253 CENTRAL AVE, SAINT PETERSBURG, FL, 33710

Events

Event Type Filed Date Value Description
REINSTATEMENT 2010-09-27 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 - -
REGISTERED AGENT NAME CHANGED 2007-04-25 KONGSIRI, ALEXANDRIA S -
REGISTERED AGENT ADDRESS CHANGED 2007-04-25 5253 CENTRAL AVE, SAINT PETERSBURG, FL 33710 -

Documents

Name Date
ANNUAL REPORT 2024-04-15
ANNUAL REPORT 2023-04-25
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-04-28
ANNUAL REPORT 2020-05-21
ANNUAL REPORT 2019-04-24
ANNUAL REPORT 2018-04-25
ANNUAL REPORT 2017-04-14
ANNUAL REPORT 2016-03-08
ANNUAL REPORT 2015-01-12

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5999997300 2020-04-30 0455 PPP 5253 Central Ave, St Petersburg, FL, 33710
Loan Status Date 2021-09-24
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 221200
Loan Approval Amount (current) 221200
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address St Petersburg, PINELLAS, FL, 33710-0095
Project Congressional District FL-13
Number of Employees 18
NAICS code 621111
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 224042.27
Forgiveness Paid Date 2021-08-17
6347308309 2021-01-26 0455 PPS 5253 Central Ave, St Petersburg, FL, 33710-8141
Loan Status Date 2022-05-07
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 111937.5
Loan Approval Amount (current) 111937.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address St Petersburg, PINELLAS, FL, 33710-8141
Project Congressional District FL-13
Number of Employees 18
NAICS code 621111
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 113179.55
Forgiveness Paid Date 2022-03-31

Companies related by officers

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Florida Limited Liability Co. (2014 - 2022)

Companies related by address

No other companies in our directory share the same address as VISAGE DERMATOLOGY LLC

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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