| Entity Name: | MARIA O. LOPEZ, M.D., LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jul 2016 (9 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 18 Jul 2016 (9 years ago) |
| Document Number: | L16000138314 |
| FEI/EIN Number | 65-0723106 |
| Address: | 1447 Medical Park Blvd., WELLINGTON, FL, 33414, US |
| Mail Address: | 1447 Medical Park Blvd., WELLINGTON, FL, 33414, US |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982624466 | 2006-07-20 | 2018-06-08 | 10111 FOREST HILL BLVD RM 268, WELLINGTON, FL, 334146142, US | 10111 FOREST HILL BLVD RM 268, WELLINGTON, FL, 33414, US | |||||||||||||||||||||||||
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| Phone | +1 561-753-7571 |
| Fax | 5617537266 |
Authorized person
| Name | DR. MARIA O LOPEZ |
| Role | PRESIDENT |
| Phone | 5617537571 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0062293 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 259541900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOPEZ MARIA O | Agent | 2205 SOUNDINGS COURT, WEST PALM BEACH, FL, 33413 |
| Name | Role | Address |
|---|---|---|
| LOPEZ MARIA | Manager | 1447 Medical Park Blvd., WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-08 | 1447 Medical Park Blvd., Suite 208, WELLINGTON, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-08 | 1447 Medical Park Blvd., Suite 208, WELLINGTON, FL 33414 | No data |
| CONVERSION | 2016-07-18 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P96000102416. CONVERSION NUMBER 700000162837 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-08 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-02-06 |
| Florida Limited Liability | 2016-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
