| Entity Name: | MICHELLE CARRILLO-MASSA, MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 29 Dec 2014 (10 years ago) |
| Date of dissolution: | 25 Nov 2015 (9 years ago) |
| Last Event: | VOLUNTRY DISSOLUTION |
| Event Date Filed: | 25 Nov 2015 (9 years ago) |
| Document Number: | L14000195928 |
| Address: | 920 W INDIANTOWN RD., 107B, JUPITER, FL 33458 |
| Mail Address: | 5200 N FLAGLER DR, 2401, WEST PALM BEACH, FL 33407 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861880353 | 2015-01-06 | 2015-01-06 | 920 W INDIANTOWN RD, JUPITER, FL, 334586847, US | 920 W INDIANTOWN RD, JUPITER, FL, 334586847, US | |||||||||||||||||
|
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| Phone | +1 561-385-7591 |
Authorized person
| Name | MICHELLE CARRILLO-MASSA |
| Role | OWNER |
| Phone | 5613857591 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME115891 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CERTIFIED MEDICAL CREDENTIALING, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| CARRILLO, MICHELLE | Manager | 920 W INDIANTOWN RD SUITE 107B, JUPITER, FL 33458 |
| Name | Role | Address |
|---|---|---|
| MEDORE, MICHEL | Authorized Person | 5200 N FLAGLER DR SUITE 2401, WEST PALM BEACH, FL 33407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2015-11-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| CORLCVLDSI | 2015-11-25 |
| Florida Limited Liability | 2014-12-29 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
