| Entity Name: | REVIVIFY DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 21 Oct 2019 (5 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 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 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699319988 | 2019-10-30 | 2020-08-19 | 21301 POWERLINE RD STE 108, BOCA RATON, FL, 334332388, US | 21301 POWERLINE RD # 108, BOCA RATON, FL, 334332388, US | |||||||||||||||
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| Phone | +1 561-877-8675 |
| Fax | 5616721365 |
Authorized person
| Name | DENISE M. GUEVARA |
| Role | MEDICAL DIRECTOR |
| Phone | 5618778675 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| REVIVIFY DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 842474824 | 2024-06-07 | REVIVIFY DERMATOLOGY LLC | 0 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-07 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2016-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9547297917 |
| Plan sponsor’s address | 21301 POWERLINE RD STE 108, BOCA RATON, FL, 33433 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-27 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2016-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9547297917 |
| Plan sponsor’s address | 21301 POWERLINE RD STE 108, BOCA RATON, FL, 33433 |
Signature of
| Role | Plan administrator |
| Date | 2022-09-13 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2016-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9547297917 |
| Plan sponsor’s address | 21301 POWERLINE RD STE 108, BOCA RATON, FL, 33433 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-19 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| ABN LAW, PLLC | Agent |
| Name | Role |
|---|---|
| CANES EIGHTEEN, LLC | Manager |
| DENISE GUEVARA, D.O., P.A. | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000088131 | REVIVIFY DERMATOLOGY | ACTIVE | 2020-07-24 | 2025-12-31 | No data | 21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL, 33433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-25 | 21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL 33433 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-25 | 21301 POWERLINE ROAD, SUITE 108, BOCA RATON, FL 33433 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-03-25 | ABN LAW, PLLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-25 | 2390 TAMIAMI TRAIL N, SUITE 214, NAPLES, FL 34103 | No data |
| 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 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-03-25 |
| Florida Limited Liability | 2019-10-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
