| Entity Name: | FANA MEDICAL GROUP - PORT RICHEY, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 13 Nov 2012 (12 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L12000143244 |
| FEI/EIN Number | 61-1701767 |
| Mail Address: | 9183 Waterash Lane N, Pinellas Park, FL 33782 |
| Address: | 5798 38TH AVENUE NORTH, ST. PETERSBURG, FL 33710 |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356689111 | 2013-01-29 | 2013-01-29 | 5537 GULF DR, NEW PORT RICHEY, FL, 346524021, US | 7505 ROTTINGHAM RD, PORT RICHEY, FL, 346682648, US | |||||||||||||||||||
|
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| Phone | +1 727-849-2600 |
| Fax | 7278477703 |
Authorized person
| Name | DR. MIGUEL A FANA JR. |
| Role | PRESIDENT |
| Phone | 8133827898 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME80639 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GASSMAN, ALAN S | Agent | 1245 COURT STREET, SUITE 102, CLEARWATER, FL 33756 |
| Name | Role | Address |
|---|---|---|
| FANA, MIGUEL | Manager | 5798 38TH AVENUE NORTH, ST. PETERSBURG, FL 33710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-24 | 5798 38TH AVENUE NORTH, ST. PETERSBURG, FL 33710 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-03-24 |
| ANNUAL REPORT | 2014-04-10 |
| ANNUAL REPORT | 2013-02-06 |
| Florida Limited Liability | 2012-11-13 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
