| Entity Name: | BANUELOS FAMILY MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Nov 2012 (12 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L12000139763 |
| FEI/EIN Number | 46-1332156 |
| Address: | 6061 Doctors Park Rd, MILTON, FL, 32570, US |
| Mail Address: | 6061 Doctors Park Rd, Milton, FL, 32570, US |
| ZIP code: | 32570 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124366299 | 2013-01-24 | 2013-01-24 | 6061 DOCTORS PARK, MILTON, FL, 325705073, US | 6061 DOCTORS PARK, MILTON, FL, 325705073, US | |||||||||||||||||||
|
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| Phone | +1 850-983-8500 |
| Fax | 8509830009 |
Authorized person
| Name | DR. ELIAS IGNACIO BANUELOS |
| Role | CEO |
| Phone | 8509838500 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME97139 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BANUELOS ELIAS I | Agent | 6061 Doctors Park Rd, MILTON, FL, 32570 |
| Name | Role | Address |
|---|---|---|
| BANUELOS ELIAS I | Manager | 3929 High Bridge Dr, Pace, FL, 32571 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-02-28 | 6061 Doctors Park Rd, MILTON, FL 32570 | No data |
| CHANGE OF MAILING ADDRESS | 2015-02-28 | 6061 Doctors Park Rd, MILTON, FL 32570 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-28 | 6061 Doctors Park Rd, MILTON, FL 32570 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-23 |
| ANNUAL REPORT | 2016-04-17 |
| ANNUAL REPORT | 2015-02-28 |
| ANNUAL REPORT | 2014-03-06 |
| Florida Limited Liability | 2012-11-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
