| Entity Name: | MED LAKE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Jun 2015 (10 years ago) |
| Date of dissolution: | 18 Jan 2016 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 18 Jan 2016 (9 years ago) |
| Document Number: | L15000108980 |
| Address: | 16371 NW 67TH AVENUE, MIAMI LAKES, FL, 33014, US |
| Mail Address: | 16371 NW 67TH AVENUE, MIAMI LAKES, FL, 33014, US |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518340124 | 2015-06-30 | 2015-10-13 | 16371 NW 67TH AVE, MIAMI LAKES, FL, 330146044, US | 16371 NW 67TH AVE, MIAMI LAKES, FL, 330146044, US | |||||||||||||||||||||
|
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| Phone | +1 786-332-4991 |
| Fax | 7864096203 |
| Fax | 7864092037 |
Authorized person
| Name | MRS. MAYRA LOURDES ZENO |
| Role | MEDICAL DIRECTOR |
| Phone | 7863324991 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | HCC11818 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BOU MARIA G | Agent | 16371 NW 67 AVENUE, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| BOU MARIA G | Managing Member | 16371 NW 67TH AVENUE, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| ZENO MAYRA L | Manager | 16371 NW 67TH AVENUE, MIAMI LAKES, FL, 33014 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000067578 | G & I MEDICAL RESEARCH | EXPIRED | 2015-06-29 | 2020-12-31 | No data | 16371 NW 67 AVENUE, MIAMI LAKES, FL, 33014 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-18 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-18 |
| Florida Limited Liability | 2015-06-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
