| Entity Name: | CAPOTE'S INTERNAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 29 Mar 2012 (13 years ago) |
| Date of dissolution: | 10 Dec 2013 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 Dec 2013 (11 years ago) |
| Document Number: | L12000043559 |
| FEI/EIN Number | 36-4731350 |
| Address: | 937 SW 122 AVENUE, MIAMI, FL 33184 |
| Mail Address: | 937 SW 122 AVENUE, MIAMI, FL 33184 |
| ZIP code: | 33184 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396029419 | 2011-10-07 | 2012-09-04 | 937 SW 122ND AVE, MIAMI, FL, 331842406, US | 937 SW 122ND AVE, MIAMI, FL, 331842406, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-260-0706 |
Authorized person
| Name | PAVEL CAPOTE |
| Role | MANAGER |
| Phone | 8132600706 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME104299 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | B/C BS |
| Number | 146A8 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001388500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CAPOTE, PAVEL | Agent | 937 SW 122 AVENUE, MIAMI, FL 33184 |
| Name | Role | Address |
|---|---|---|
| CAPOTE, PAVEL | Manager | 937 SW 122 AVENUE, MIAMI, FL 33184 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000096342 | CI MEDICAL CENTER | EXPIRED | 2012-10-02 | 2017-12-31 | No data | 937 SW 122 AVENUE, MIAMI, FL, 33184 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2013-12-10 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-07 |
| Florida Limited Liability | 2012-03-29 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
