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  5. COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC

COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC

Company Details

Entity Name: COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 28 Dec 2009 (15 years ago)
Date of dissolution: 26 Oct 2021 (3 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 26 Oct 2021 (3 years ago)
Document Number: L09000122644
FEI/EIN Number 271596249
Address: 2915 Lindale Ave, Orlando, FL, 32814, US
Mail Address: 2915 Lindale Ave, Orlando, FL, 32814, US
ZIP code: 32814
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1487093316 2013-06-25 2013-06-25 201 N LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 327923228, US 201 N LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 327923228, US

Contacts
Phone +1 407-339-7546

Authorized person
Name MRS. YVETTE MEJIA
Role BILLING SUPERVISOR
Phone 4073397546

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME105564
State FL
Is Primary Yes
Taxonomy Code 207ND0101X - MOHS-Micrographic Surgery Physician
License Number ME105564
State FL
Is Primary No
Taxonomy Code 207NS0135X - Procedural Dermatology Physician
License Number ME105564
State FL
Is Primary No
Taxonomy Code 207YS0123X - Facial Plastic Surgery Physician
License Number ME105587
State FL
Is Primary No
Taxonomy Code 207YX0007X - Plastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number ME105587
State FL
Is Primary No
Taxonomy Code 2082S0099X - Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number ME105587
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2021 271596246 2022-10-17 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing ERICA. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2020 271596246 2021-10-15 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2021-10-15
Name of individual signing ERICA. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2019 271596246 2020-07-27 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2020-07-27
Name of individual signing ERICA. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2018 271596249 2019-02-14 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2019-02-14
Name of individual signing JEFFREY A. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2017 271596249 2018-06-03 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2018-06-03
Name of individual signing JEFFREY A. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2016 271596249 2017-08-16 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2017-08-16
Name of individual signing JEFFREY A. MAILLER
Valid signature Filed with authorized/valid electronic signature
COMPREHENSIVE DERMATOLOGY, PLC 401(K) PLAN 2015 271596249 2016-07-07 COMPREHENSIVE DERMATOLOGY AND DERMATOLOGIC SURGERY, PLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621399
Plan sponsor’s address 201 N. LAKEMONT AVE, SUITE 100, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2016-07-07
Name of individual signing JEFFREY A. MAILLER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Mailler Erica ADr. Agent 2915 Lindale Ave, Orlando, FL, 32814

Managing Member

Name Role Address
MAILLER ERICA A Managing Member 2915 Lindale Ave, Orlando, FL, 32814

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G13000063439 COMPREHENSIVE DERMATOLOGY AND FACIAL PLASTIC SURGERY EXPIRED 2013-06-24 2018-12-31 No data 1933 DUNDEE DRIVE, WINTER PARK, FL, 32792
G10000065701 COMPREHENSIVE DERMATOLOGY ACTIVE 2010-07-16 2025-12-31 No data 201 NORTH LAKEMONT AVENUE, SUITE 100, WINTER PARK, FL, 32792

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2021-10-26 No data No data
REGISTERED AGENT ADDRESS CHANGED 2021-02-22 2915 Lindale Ave, Orlando, FL 32814 No data
CHANGE OF PRINCIPAL ADDRESS 2021-02-22 2915 Lindale Ave, Orlando, FL 32814 No data
CHANGE OF MAILING ADDRESS 2021-02-22 2915 Lindale Ave, Orlando, FL 32814 No data
REGISTERED AGENT NAME CHANGED 2016-07-07 Mailler, Erica A, Dr. No data
REINSTATEMENT 2015-12-07 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data
LC AMENDMENT 2013-10-17 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2021-10-26
ANNUAL REPORT 2021-02-22
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-03-04
ANNUAL REPORT 2018-02-28
ANNUAL REPORT 2017-02-12
ANNUAL REPORT 2016-07-07
REINSTATEMENT 2015-12-07
ANNUAL REPORT 2014-02-25
LC Amendment 2013-10-17

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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