| Entity Name: | BELLAVISTA DERMATOLOGY GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 27 Jun 2018 (7 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: | L18000157911 |
| Address: | 1509 CULLAIG COURT, JACKSONVILLE, FL, 32259 |
| Mail Address: | 1509 CULLAIG COURT, JACKSONVILLE, FL, 32259 |
| ZIP code: | 32259 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801379409 | 2018-09-10 | 2018-09-10 | 3636 UNIVERSITY BLVD S, UNIT B2, JACKSONVILLE, FL, 32216, US | 3636 UNIVERSITY BLVD S, UNIT B2, JACKSONVILLE, FL, 32216, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-297-1415 |
Authorized person
| Name | MR. RIGEL MARTINEZ |
| Role | OWNER |
| Phone | 9042971415 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207ND0900X - Dermatopathology Physician |
| Is Primary | No |
| Taxonomy Code | 207NI0002X - Clinical & Laboratory Dermatological Immunology Physician |
| Is Primary | No |
| Taxonomy Code | 207NP0225X - Pediatric Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| PARIKH ANKUR A | Agent | 1509 CULLAIG COURT, JACKSONVILLE, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| PARIKH ANKUR A | Manager | 1509 CULLAIG COURT, JACKSONVILLE, FL, 32259 |
| MAMTORA VIPUL B | Manager | 1360 ROBERTS RD, JACKSONVILLE, FL, 32259 |
| MARTINEZ RIGEL | Manager | 3126 BELDEN CIR#4, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2018-06-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
