| Entity Name: | RIVIERA PLAZA MEDICAL OFFICE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Oct 2013 (11 years ago) |
| Date of dissolution: | 31 Dec 2019 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 31 Dec 2019 (5 years ago) |
| Document Number: | L13000141537 |
| FEI/EIN Number | 46-3916469 |
| Address: | 1702 RIDGEWOOD AVE, SUITE I, HOLLY HILL, FL, 32117, US |
| Mail Address: | 1702 RIDGEWOOD AVE, SUITE I, HOLLY HILL, FL, 32117, US |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013338144 | 2013-12-16 | 2014-04-23 | 208 N HALIFAX AVE, SUITE1, DAYTONA BEACH, FL, 321184159, US | 1702 RIDGEWOOD AVE, SUITE I, HOLLY HILL, FL, 321175416, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 386-677-5415 |
| Fax | 3866771475 |
Authorized person
| Name | DR. GLORIA HELEN MIKULA |
| Role | MEDICAL DIRECTOR |
| Phone | 3866775415 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME47765 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 042193600 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | HS776A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GLORIA MIKULA HMD | Agent | 208 NORTH HALIFAX AVE, DAYTONA BEACH, FL, 32118 |
| Name | Role | Address |
|---|---|---|
| MIKULA GLORIA HMD | Manager | 1702 RIDGEWOOD AVE SUITE I, HOLLY HILL, FL, 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-12-31 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-12-31 |
| ANNUAL REPORT | 2019-03-31 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-03-31 |
| ANNUAL REPORT | 2016-03-14 |
| ANNUAL REPORT | 2015-04-20 |
| ANNUAL REPORT | 2014-04-21 |
| Florida Limited Liability | 2013-10-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
