| Entity Name: | PARADIGM MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 May 2011 (14 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 Mar 2012 (13 years ago) |
| Document Number: | L11000058329 |
| FEI/EIN Number | 45-3261400 |
| Address: | 2240 NW 87 Ave, MIAMI, FL, 33172, US |
| Mail Address: | 16015 SW 102 LANE, MIAMI, FL, 33196, US |
| ZIP code: | 33172 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285916015 | 2011-09-19 | 2023-07-20 | 16015 SW 102ND LN, MIAMI, FL, 331966173, US | 2240 NW 87TH AVE, DORAL, FL, 331722414, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 786-655-0095 |
| Fax | 7868705651 |
Authorized person
| Name | DR. JULIO CESAR REYES-GAVILAN |
| Role | OWNER |
| Phone | 7862467289 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME121514 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004296400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| REYES - GAVILAN JULIO M | Agent | 16015 SW 102 LANE, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| De los Reyes Mirtha | Manager | 16015 sw 102 lane, MIAMI, FL, 33196 |
| Reyes-Gavilan Julio C | Manager | 16015 sw 102 lane, MIAMI, FL, 33196 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000079791 | JULIO C.REYES-GAVILAN M.D | ACTIVE | 2023-07-06 | 2028-12-31 | No data | 16015 SW 102 LANE, MIAMI, FL, 33196 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-12-03 | 2240 NW 87 Ave, MIAMI, FL 33172 | No data |
| CHANGE OF MAILING ADDRESS | 2021-12-03 | 2240 NW 87 Ave, MIAMI, FL 33172 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-12-03 | 16015 SW 102 LANE, MIAMI, FL 33196 | No data |
| LC AMENDMENT | 2012-03-30 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-22 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-03-03 |
| AMENDED ANNUAL REPORT | 2021-12-03 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-03-04 |
| AMENDED ANNUAL REPORT | 2019-07-31 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-01-21 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
