| Entity Name: | DIVAKER PEDIATRICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Apr 2013 (12 years ago) |
| Document Number: | L13000053577 |
| FEI/EIN Number | 46-2599411 |
| Address: | 6551 North Orange Blossom Trail, Ste # 229, Mount Dora, FL, 32757, US |
| Mail Address: | 13506 SUMMERPORT VILLAGE PKWY Ste#334, STE.334, WINDERMERE, FL, 34786, US |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518302835 | 2013-04-30 | 2013-04-30 | 6551 N ORANGE BLOSSOM TRL, MOUNT DORA, FL, 327577013, US | 6551 N ORANGE BLOSSOM TRL, MOUNT DORA, FL, 327577013, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 609-614-0980 |
| Fax | 6097847474 |
Authorized person
| Name | DR. REZIA DIVAKER |
| Role | PROVIDER |
| Phone | 6096140980 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DIVAKER PEDIATRICS 401(K) PLAN | 2023 | 462599411 | 2024-06-12 | DIVAKER PEDIATRICS | 4 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-06-12 |
| Name of individual signing | SAMUEL DIVAKER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4075754778 |
| Plan sponsor’s address | 6551 NORTH ORANGE BLOSSOM TR., MOUNT DORA, FL, 32757 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-23 |
| Name of individual signing | SAMUEL DIVAKER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DIVAKER REZIA C | Agent | 6551 North Orange Blossom Trail, Ste # 229, Mount Dora, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| DIVAKER REZIA C | Managing Member | 6551 North Orange Blossom Trail, Ste # 229, Mount Dora, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-08 | 6551 North Orange Blossom Trail, Ste # 229, Suite #229, Mount Dora, FL 32757 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-11 | 6551 North Orange Blossom Trail, Ste # 229, Suite #229, Mount Dora, FL 32757 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-02-23 | 6551 North Orange Blossom Trail, Ste # 229, Suite #229, Mount Dora, FL 32757 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-02-19 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
