| Entity Name: | JUAN C. BAYOLO, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Aug 2015 (9 years ago) |
| Date of dissolution: | 23 May 2016 (9 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 May 2016 (9 years ago) |
| Document Number: | L15000134716 |
| Address: | 3430 WEST LAMBRIGHT ST., STE. 101, TAMPA, FL, 33614 |
| Mail Address: | 3430 WEST LAMBRIGHT ST., STE. 101, TAMPA, FL, 33614 |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386999589 | 2012-07-13 | 2015-09-15 | 3430 W LAMBRIGHT ST, SUITE 101, TAMPA, FL, 336144750, US | 3430 W LAMBRIGHT ST, SUITE 101, TAMPA, FL, 336144750, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-605-0662 |
| Fax | 8136050663 |
Authorized person
| Name | DR. JUAN CARLOS BAYOLO |
| Role | PROPIETARY |
| Phone | 8136050662 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ACN247 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 278268500 |
| State | FL |
| Issuer | NPI |
| Number | 1801848478 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAMOS JOSE S | Agent | 2344 CRESTOVER LANE, WESLEY CHAPEL, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| BAYOLO JUAN C | Manager | 3640 PEPPERVINE PLACE, WESLEY CHAPEL, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2016-05-23 | No data | No data |
| CONVERSION | 2015-08-05 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P12000034753. CONVERSION NUMBER 300000153593 |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2016-05-23 |
| Florida Limited Liability | 2015-08-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
