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REVIVIFY DERMATOLOGY, LLC

REVIVIFY DERMATOLOGY, LLC - Florida Company Profile

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Company Details

Entity Name:	REVIVIFY DERMATOLOGY, LLC
Jurisdiction:	FLORIDA
Filing Type:	Florida Limited Liability Co.
Status:	Inactive
Date Filed:	21 Oct 2019 (6 years ago)
Date of dissolution:	24 Sep 2021 (4 years ago)
Last Event:	ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed:	24 Sep 2021 (4 years ago)
Document Number:	L19000252534
FEI/EIN Number	84-2474824
Address:	21301 POWERLINE ROAD, BOCA RATON, FL, 33433, US
Mail Address:	21301 POWERLINE ROAD, BOCA RATON, FL, 33433, US
ZIP code:	33433
City:	Boca Raton
County:	Palm Beach
Place of Formation:	FLORIDA

Key Officers & Management

Role
Manager
Agent
Manager

National Provider Identifier

NPI Number:

1699319988

Certification Date:

2020-08-19

Link:

View on NPI website

Authorized Person:

Name:

DENISE M. GUEVARA

Role:

MEDICAL DIRECTOR

Phone:

5618778675

Taxonomy:

Selected Taxonomy:

207N00000X - Dermatology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 561-877-8675

Fax:

5616721365

Form 5500 Series

Employer Identification Number (EIN):

842474824

Plan Year:

2024

Number Of Participants:

0

Sponsors Telephone Number:

9547297917

File:

Plan Year:

2023

Number Of Participants:

0

Sponsors Telephone Number:

9547297917

File:

Plan Year:

2022

Number Of Participants:

0

Sponsors Telephone Number:

9547297917

File:

Plan Year:

2021

Number Of Participants:

5

Sponsors Telephone Number:

9547297917

File:

Plan Year:

2020

Number Of Participants:

0

Sponsors Telephone Number:

9547297917

File:

Fictitious Names

Registration Number	Fictitious Name	Status	Filed Date	Expiration Date	Cancellation Date	Mailing Address
G20000088131	REVIVIFY DERMATOLOGY	ACTIVE	2020-07-24	2025-12-31	-	21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL, 33433

Events

Event Type	Filed Date	Value	Description
ADMIN DISSOLUTION FOR ANNUAL REPORT	2021-09-24	-	-
CHANGE OF PRINCIPAL ADDRESS	2020-03-25	21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL 33433	-
CHANGE OF MAILING ADDRESS	2020-03-25	21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL 33433	-
REGISTERED AGENT NAME CHANGED	2020-03-25	ABN LAW, PLLC	-
REGISTERED AGENT ADDRESS CHANGED	2020-03-25	2390 TAMIAMI TRAIL N, SUITE 214, NAPLES, FL 34103	-

Debts

Document Number	Status	Case Number	Name of Court	Date of Entry	Expiration Date	Amount Due	Plaintiff
J22000263261	TERMINATED	1000000922312	PALM BEACH	2022-05-04	2032-06-01	$ 675.69	STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149

Documents

Name	Date
ANNUAL REPORT	2020-03-25
Florida Limited Liability	2019-10-21

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Date of last update: 02 Aug 2025

Sources: Florida Department of State