| Entity Name: | PORTILLA MEDICAL GROUP,LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PORTILLA MEDICAL GROUP,LLC. is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 17 Jun 2013 (12 years ago) |
| Date of dissolution: | 23 Sep 2016 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (9 years ago) |
| Document Number: | L13000086586 |
| FEI/EIN Number |
46-2984867
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 330 SW 27TH AVE, 302, MIAMI, FL, 33135, US |
| Mail Address: | 330 SW 27TH AVE, 302, MIAMI, FL, 33135, US |
| ZIP code: | 33135 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124467717 | 2013-06-18 | 2014-09-11 | 330 SW 27TH AVE, STE 302, MIAMI, FL, 331352961, US | 330 SW 27TH AVE, STE 302, MIAMI, FL, 331352961, US | |||||||||||||||||||||||||||
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| Phone | +1 305-631-1220 |
| Fax | 3056311251 |
Authorized person
| Name | DR. MARIANELA DE LA PORTILLA |
| Role | PRESIDENT/MEDICAL DIRECTOR |
| Phone | 3056311220 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010921800 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | HU244A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| De la Portilla Marianela | Auth | 330 SW 27TH AVE, MIAMI, FL, 33135 |
| DE LA PORTILLA ARIEL | Manager | 330 SW 27TH AVE, MIAMI, FL, 33135 |
| DE LA PORTILLA MANUEL | Manager | 330 SW 27TH AVE, MIAMI, FL, 33135 |
| DE LA PORTILLA MARIANELA | Agent | 330 SW 27 AVE, MIAMI, FL, 33135 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000077108 | PORTILLA MEDICAL GROUP & RESEARCH | EXPIRED | 2015-07-24 | 2020-12-31 | - | 330 SW 27TH AVE, SUITE 302, MIAMI, FL, 33135 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | - | - |
| LC AMENDMENT | 2016-05-16 | - | - |
| REGISTERED AGENT NAME CHANGED | 2016-05-16 | DE LA PORTILLA, MARIANELA | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-12-14 | 330 SW 27 AVE, 302, MIAMI, FL 33135 | - |
| Name | Date |
|---|---|
| LC Amendment | 2016-05-16 |
| AMENDED ANNUAL REPORT | 2015-12-22 |
| AMENDED ANNUAL REPORT | 2015-12-16 |
| AMENDED ANNUAL REPORT | 2015-12-14 |
| ANNUAL REPORT | 2015-04-27 |
| ANNUAL REPORT | 2014-02-25 |
| Florida Limited Liability | 2013-06-17 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
