| Entity Name: | PROFORM MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Feb 2017 (8 years ago) |
| Document Number: | L17000035072 |
| FEI/EIN Number | 82-0631730 |
| Mail Address: | 9195 SW 72 ST. #100, MIAMI, FL 33173 |
| Address: | 4960 SW 72 AVE, suite 408, MIAMI, FL 33155 |
| ZIP code: | 33155 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093373409 | 2019-05-31 | 2019-05-31 | 8525 SW 92ND ST STE D17, MIAMI, FL, 331567378, US | 8525 SW 92ND ST STE D17, MIAMI, FL, 331567378, US | |||||||||||||||
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| Phone | +1 786-517-4577 |
| Fax | 7863647330 |
Authorized person
| Name | DR. DANIEL RODRIGO MARIN |
| Role | PRESIDENT |
| Phone | 7865174577 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MARIN, DANIEL | Agent | 8525 SW 92 STREET, D-17, MIAMI, FL 33156 |
| Name | Role | Address |
|---|---|---|
| MARIN, DANIEL | Authorized Member | 8525 SW 92 STREET, D-17 MIAMI, FL 33156 |
| MARIN, CRISTINA | Authorized Member | 8525 SW 92 STREET, D-17 MIAMI, FL 33156 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-22 | 4960 SW 72 AVE, suite 408, MIAMI, FL 33155 | No data |
| CHANGE OF MAILING ADDRESS | 2022-12-22 | 4960 SW 72 AVE, suite 408, MIAMI, FL 33155 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-16 | 8525 SW 92 STREET, D-17, MIAMI, FL 33156 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-06 |
| Florida Limited Liability | 2017-02-13 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
