| Entity Name: | CERON PEDIATRICS AND INTEGRATIVE MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Mar 2018 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Oct 2019 (5 years ago) |
| Document Number: | L18000070151 |
| FEI/EIN Number | 824907373 |
| Address: | 1539 PARENTAL HOME ROAD, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 1539 PARENTAL HOME ROAD, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477043180 | 2018-05-17 | 2019-04-12 | 13758 CLUB COVE DR, JACKSONVILLE, FL, 322255430, US | 1539 PARENTAL HOME RD, JACKSONVILLE, FL, 322163009, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-891-9498 |
| Fax | 9044250821 |
| Phone | +1 904-338-0434 |
Authorized person
| Name | LOURDES CAROLINA CERON CANAS |
| Role | OWNER |
| Phone | 9048919498 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019982900 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PROGRESSIVE PEDIATRICS LLC 401(K) PROFIT SHARING PLAN & TRUST | 2018 | 260132243 | 2019-10-09 | CERON PEDIATRICS AND INTEGRATIVE MEDICINE PLLC | 5 | |||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2019-10-09 |
| Name of individual signing | LOURDES CERON-CANAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-10-09 |
| Name of individual signing | LOURDES CERON-CANAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2008-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9043380434 |
| Plan sponsor’s DBA name | SAME |
| Plan sponsor’s address | JACKSONVILLE, 1539 PARENTAL HOME RD, JACKSONVILLE, FL, 322163009 |
Signature of
| Role | Plan administrator |
| Date | 2019-08-30 |
| Name of individual signing | LOURDES CERON-CANAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-08-30 |
| Name of individual signing | LOURDES CERON-CANAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| lcarolina ceron canas | Agent | 1539 Parental Home Road, Jacksonville, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| CERON-CANAS LOURDES C | Manager | 1539 PARENTAL HOME ROAD, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-17 | 1539 Parental Home Road, Jacksonville, FL 32216 | No data |
| REINSTATEMENT | 2019-10-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-01 | lcarolina ceron canas | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-29 | 1539 PARENTAL HOME ROAD, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-29 | 1539 PARENTAL HOME ROAD, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-14 |
| AMENDED ANNUAL REPORT | 2019-10-17 |
| REINSTATEMENT | 2019-10-01 |
| Florida Limited Liability | 2018-03-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
