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  5. DR. RAPHAEL LOPEZ, LLC

DR. RAPHAEL LOPEZ, LLC

Company Details

Entity Name: DR. RAPHAEL LOPEZ, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 19 Mar 2008 (17 years ago)
Date of dissolution: 23 Sep 2022 (2 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2022 (2 years ago)
Document Number: L08000028553
FEI/EIN Number 830508504
Address: 295 Patterson Rd., SUITE B, Haines city, FL, 33844, US
Mail Address: 295 Patterson Rd., SUITE B, Haines city, FL, 33844, US
ZIP code: 33844
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1942472949 2008-03-31 2008-03-31 1212 ROYCROFT AVE, CELEBRATION, FL, 347474016, US 131 WEBB DR, SUITE C, DAVENPORT, FL, 338373921, US

Contacts
Phone +1 321-939-4268

Authorized person
Name DR. RAPHAEL LUIS LOPEZ
Role OWNER/PRESIDENT
Phone 3219394268

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME85048
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DR RAPHAEL LOPEZ LLC 401K PLAN 2020 830508504 2021-08-17 DR RAPHAEL LOPEZ LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 295 PATTERSON RD., SUITE B, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2021-08-17
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-17
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2019 830508504 2020-07-24 DR RAPHAEL LOPEZ LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 295 PATTERSON RD., SUITE B, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2020-07-24
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-24
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2018 830508504 2019-05-03 DR RAPHAEL LOPEZ LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 295 PATTERSON RD., SUITE B, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2019-05-03
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-03
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2017 830508504 2018-11-02 DR RAPHAEL LOPEZ LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 295 PATTERSON RD., SUITE B, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2018-11-02
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-11-02
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2016 830508504 2017-06-07 DR RAPHAEL LOPEZ LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 131 WEBB DR, SUITE C, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2015 830508504 2016-06-10 DR RAPHAEL LOPEZ LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 131 WEBB DR, SUITE C, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2016-06-10
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2014 830508504 2015-05-07 DR RAPHAEL LOPEZ LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 131 WEBB DR, SUITE C, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2015-05-07
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2013 830508504 2014-07-16 DR RAPHAEL LOPEZ LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 131 WEBB DR, SUITE C, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2014-07-16
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-16
Name of individual signing RAPHAEL L LOPEZ
Valid signature Filed with authorized/valid electronic signature
DR RAPHAEL LOPEZ LLC 401K PLAN 2012 830508504 2013-10-03 DR RAPHAEL LOPEZ LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8639683321
Plan sponsor’s address 131 WEBB DR, SUITE C, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2013-10-03
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-03
Name of individual signing RAPHAEL LOPEZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Lopez Raphael Agent 295 Patterson Rd., Haines city, FL, 33844

Managing Member

Name Role Address
LOPEZ RAPHAEL Managing Member 295 Patterson Rd., Haines city, FL, 33844

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G19000026369 CYPRUSS MEDICAL CENTER EXPIRED 2019-02-25 2024-12-31 No data 295 PATTERSON ROAD, SUITE B, HAINES CITY, FL, 33844
G08135900286 CYPRESS MEDICAL CENTER EXPIRED 2008-05-14 2013-12-31 No data 131 WEBB DR., SUITE C, DAVENPORT, FL, 33837

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 No data No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-23 295 Patterson Rd., SUITE B, Haines city, FL 33844 No data
CHANGE OF PRINCIPAL ADDRESS 2018-04-23 295 Patterson Rd., SUITE B, Haines city, FL 33844 No data
CHANGE OF MAILING ADDRESS 2018-04-23 295 Patterson Rd., SUITE B, Haines city, FL 33844 No data
REGISTERED AGENT NAME CHANGED 2015-01-20 Lopez, Raphael No data
REINSTATEMENT 2015-01-20 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
REINSTATEMENT 2012-01-04 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2011-09-23 No data No data

Documents

Name Date
ANNUAL REPORT 2021-04-26
ANNUAL REPORT 2020-01-30
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-04-23
ANNUAL REPORT 2017-04-12
ANNUAL REPORT 2016-02-23
REINSTATEMENT 2015-01-20
ANNUAL REPORT 2013-02-13
REINSTATEMENT 2012-01-04
ANNUAL REPORT 2010-01-12

Related by officers

LOPEZ RAPHAEL

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Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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