| Entity Name: | PATRICE MORENO MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Jan 2016 (9 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L16000005355 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 601 MAIN ST, DUNEDIN, FL, 34698, US |
| Mail Address: | 646 Virginia ST, DUNEDIN, FL, 34698, US |
| ZIP code: | 34698 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932590544 | 2015-02-18 | 2015-02-18 | 601 MAIN ST, DUNEDIN, FL, 346985848, US | 601 MAIN ST, DUNEDIN, FL, 346985848, US | |||||||||||||||||||||
|
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| Phone | +1 727-734-6787 |
| Fax | 7277367458 |
Authorized person
| Name | DR. PATRICE MORENO |
| Role | PHYSICIAN |
| Phone | 7277346787 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 524897 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MORENO PATRICE | Agent | 646 Viriginia ST, DUNEDIN, FL, 34698 |
| Name | Role | Address |
|---|---|---|
| MORENO PATRICE | Manager | 646 Virigina ST, DUNEDIN, FL, 34698 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-17 | 601 MAIN ST, DUNEDIN, FL 34698 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-17 | 646 Viriginia ST, Suite 400, DUNEDIN, FL 34698 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-02-11 |
| ANNUAL REPORT | 2017-01-14 |
| ANNUAL REPORT | 2016-03-17 |
| Florida Limited Liability | 2016-01-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
