| Entity Name: | CASTILLO'S MD SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Mar 2015 (10 years ago) |
| Document Number: | L15000055856 |
| FEI/EIN Number | 47-4615223 |
| Address: | 9760 Horn Lane, ESTERO, FL 33928 |
| Mail Address: | 9760 Horn Lane, ESTERO, FL 33928 |
| ZIP code: | 33928 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922455104 | 2016-05-18 | 2016-05-23 | 13500 TROIA DR, ESTERO, FL, 339287304, US | 1530 LEE BLVD, SUITTE 1600, LEHIGH ACRES, FL, 339364893, US | |||||||||||||||||||||||||||
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| Phone | +1 239-369-2749 |
| Fax | 2393699158 |
Authorized person
| Name | MS. JESSIE CEPEDA |
| Role | OFFICE MANAGER |
| Phone | 2392403005 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1910600 |
| State | FL |
| Issuer | MEDICARE |
| Number | CX526Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CASTILLO, EDGARDO | Agent | 9760 Horn Lane, ESTERO, FL 33928 |
| Name | Role | Address |
|---|---|---|
| CASTILLO, EDGARDO, MD | Managing Member | 9760 Horn Lane, ESTERO, FL 33928 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-14 | 9760 Horn Lane, ESTERO, FL 33928 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-14 | 9760 Horn Lane, ESTERO, FL 33928 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-14 | 9760 Horn Lane, ESTERO, FL 33928 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-09 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-02-06 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-03-12 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-03-09 |
| ANNUAL REPORT | 2016-02-24 |
| Florida Limited Liability | 2015-03-30 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
