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  5. LOPEZ PAIN MANAGEMENT, LLC

LOPEZ PAIN MANAGEMENT, LLC

Company Details

Entity Name: LOPEZ PAIN MANAGEMENT, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 05 Dec 2013 (11 years ago)
Date of dissolution: 27 Sep 2024 (4 months ago)
Last Event: REINSTATEMENT
Event Date Filed: 13 Jan 2025 (22 days ago)
Document Number: L13000168592
FEI/EIN Number 46-4251159
Address: 4863 PALM COAST PARKWAY NW, UNIT 2, PALM COAST, FL, 32137, US
Mail Address: 4863 PALM COAST PARKWAY, UNIT 2, PALM COAST, FL, 32137, US
ZIP code: 32137
County: Flagler
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1902655731 2024-05-14 2024-05-14 5601 CAPTAINS LN, WILMINGTON, NC, 284093619, US 5367 SPRING HILL DR, SPRING HILL, FL, 346064540, US

Contacts
Phone +1 910-256-0075
Fax 8772965238
Phone +1 352-600-6780
Fax 3526006765

Authorized person
Name CHRISTINE RIVENBARK
Role ADMINISTRATOR
Phone 9102560075

Taxonomy
Taxonomy Code 208VP0000X - Pain Medicine Physician
Is Primary No
Taxonomy Code 208VP0014X - Interventional Pain Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SEASIDE SPINE & PAIN CASH BALANCE PLAN 2023 464251159 2024-10-15 LOPEZ PAIN MANAGEMENT, LLC 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing MANUEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing MANUEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
SEASIDE SPINE & PAIN 401(K) PLAN 2023 464251159 2024-10-15 LOPEZ PAIN MANAGEMENT, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing MANUEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing MANUEL LOPEZ
Valid signature Filed with authorized/valid electronic signature
SEASIDE SPINE & PAIN CASH BALANCE PLAN 2022 464251159 2023-10-12 LOPEZ PAIN MANAGEMENT, LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-12
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
SEASIDE SPINE & PAIN 401(K) PLAN 2022 464251159 2023-10-12 LOPEZ PAIN MANAGEMENT, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-12
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
SEASIDE SPINE & PAIN 401(K) PLAN 2021 464251159 2022-10-13 LOPEZ PAIN MANAGEMENT, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
SEASIDE SPINE & PAIN CASH BALANCE PLAN 2021 464251159 2022-10-13 LOPEZ PAIN MANAGEMENT, LLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 3862227746
Plan sponsor’s address 4863 PALM COURT PARKWAY, NW, UNIT 2, PALM COAST, FL, 32137

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing MANUEL LOPEZ DIEZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LOPEZ MANUEL E Agent 4863 Palm Coast Parlway NW, Palm Coast, FL, 32137

Manager

Name Role Address
LOPEZ MANUEL Manager 4863 PALM COAST PARKWAY NW, PALM COAST, FL, 32137

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000069620 TRIUNE PAIN AND SPINE SPECIALISTS ACTIVE 2024-06-04 2029-12-31 No data 4863 PALM COAST PARKWAY NW, SUITE 2, PALM COAST, FL, 32137
G23000045541 APEX PAIN MEDICINE ACTIVE 2023-04-10 2028-12-31 No data 4863 PALM COAST PARKWAY NW, SUITE 2, PALM COAST, FL, 32137
G21000170097 SUNSHINE SPINE & PAIN SPECIALISTS ACTIVE 2021-12-22 2026-12-31 No data 4863 PALM COAST PARKWAY NW, SUITE 2, PALM COAST, FL, 32137
G18000037951 SEASIDE SPINE & PAIN CENTER EXPIRED 2018-03-21 2023-12-31 No data 4863 PALM COAST PARKWAY, UNIT 2, PALM COAST, FL, 32137

Events

Event Type Filed Date Value Description
REINSTATEMENT 2025-01-13 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2024-09-27 No data No data
REGISTERED AGENT ADDRESS CHANGED 2021-01-29 4863 Palm Coast Parlway NW, unit 2, Palm Coast, FL 32137 No data
REGISTERED AGENT NAME CHANGED 2019-10-14 LOPEZ, MANUEL E No data
REINSTATEMENT 2019-10-14 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
CHANGE OF MAILING ADDRESS 2018-06-26 4863 PALM COAST PARKWAY NW, UNIT 2, PALM COAST, FL 32137 No data
CHANGE OF PRINCIPAL ADDRESS 2018-06-26 4863 PALM COAST PARKWAY NW, UNIT 2, PALM COAST, FL 32137 No data

Documents

Name Date
REINSTATEMENT 2025-01-13
ANNUAL REPORT 2023-07-12
ANNUAL REPORT 2022-02-08
ANNUAL REPORT 2021-01-29
ANNUAL REPORT 2020-03-16
REINSTATEMENT 2019-10-14
ANNUAL REPORT 2018-06-26
ANNUAL REPORT 2017-04-27
ANNUAL REPORT 2016-04-14
ANNUAL REPORT 2015-04-29

Related by officers

LOPEZ MANUEL

ALL IMMIGRATION SERVICES, CORP M & M MANAGEMENT PROPERTIES, INC. CMC HEALTHCARE MANAGEMENT LLC P&L TOBACCO DISTRIBUTOR LLC VALLEY PRODUCE CORP. NORMANDY INVESTORS CORPORATION FRENTE NACIONAL PRESIDIO POLITICO INC. PEGASUS WORLDWIDE CORPORATION INSIDE PRO SPORTS, LLC CUCHITA CORPORATION

LOPEZ MANUEL E

SAN JUDAS PHARMACY INC. MED CLINIC INC. EXTREME DRY CLEAN, LLC MLT EXPRESS LLC REIGN INVESTMENTS LLC ALL BAY SERVICES PROS CORPORATION M LOPEZ ART INC OCCMED SOLUTIONS, LLC PHYSICIAN PARTNER SERVICES, LLC JENMANCO MANAGEMENT LLC

Related by address

4863 PALM COAST PARKWAY NW, UNIT 2, PALM COAST, FL, 32137, US

SEASIDE SPINE & PAIN CENTER, P.A.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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