| Entity Name: | ILLUMINA MEDICAL GROUP SPECIALTY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
ILLUMINA MEDICAL GROUP SPECIALTY, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 22 Dec 2017 (7 years ago) |
| Date of dissolution: | 02 Sep 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Sep 2020 (5 years ago) |
| Document Number: | L17000260851 |
| FEI/EIN Number |
82-3790208
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126 |
| Mail Address: | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126, US |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437667078 | 2018-01-17 | 2018-07-27 | 1914 NW 84TH AVE, DORAL, FL, 331261030, US | 1914 NW 84TH AVE, DORAL, FL, 33126, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-254-8900 |
| Fax | 3052548902 |
Authorized person
| Name | MR. ANGEL ANDRES MONGEOTTI |
| Role | EXECUTIVE DIRECTOR OF FINANCE |
| Phone | 3052548900 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | STATE DOCUMENT NUMBER |
| Number | L17000260851 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ILLUMINA MEDICAL GROUP CONTRACTING, LLC | Secretary | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126 |
| ILLUMINA MEDICAL GROUP CONTRACTING, LLC | Manager | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126 |
| ILLUMINA MEDICAL GROUP CONTRACTING, LLC | Treasurer | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126 |
| Illumina Medical Group Contracting, LLC | Agent | 1914 NORTHWEST 84TH AVENUE, DORAL, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-09-02 | - | - |
| CHANGE OF MAILING ADDRESS | 2018-02-18 | 1914 NORTHWEST 84TH AVENUE, DORAL, FL 33126 | - |
| REGISTERED AGENT NAME CHANGED | 2018-02-18 | Illumina Medical Group Contracting, LLC | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-18 | 1914 NORTHWEST 84TH AVENUE, DORAL, FL 33126 | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-09-02 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-02-18 |
| Florida Limited Liability | 2017-12-22 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
