| Entity Name: | JESUS MONTESANO MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Feb 2021 (4 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 02 Jun 2021 (4 years ago) |
| Document Number: | L21000070193 |
| FEI/EIN Number | 872635372 |
| Mail Address: | 1000 NW 57 Ct., Miami, FL, 33126, US |
| Address: | 664 EAST 25TH STREET, SUITE 101, HIALEAH, FL, 33013, US |
| ZIP code: | 33013 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043563513 | 2012-10-22 | 2023-05-08 | 1000 NW 57TH CT STE 400, MIAMI, FL, 331263292, US | 664 E 25TH ST, SUITE 101, HIALEAH, FL, 330133805, US | |||||||||||||||||||||||||||
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| Phone | +1 305-649-8100 |
| Fax | 3058350550 |
| Phone | +1 305-835-7625 |
Authorized person
| Name | JOSEPH N DE VERA |
| Role | RA |
| Phone | 7862008305 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME 57047 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 064494300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| De Vera Joseph NEsq. | Agent | 1000 NW 57 Ct., Miami, FL, 33126 |
| Name | Role | Address |
|---|---|---|
| Interamerican Medical Center Group, L.L.C. | Member | 1000 NW 57 Ct., MIAMI, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 664 EAST 25TH STREET, SUITE 101, HIALEAH, FL 33013 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-29 | De Vera, Joseph Nicholas, Esq. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-29 | 1000 NW 57 Ct., 400, Miami, FL 33126 | No data |
| LC STMNT OF RA/RO CHG | 2021-06-02 | No data | No data |
| CONVERSION | 2021-02-10 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS S39720. CONVERSION NUMBER 100000210551 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-04-29 |
| CORLCRACHG | 2021-06-02 |
| Florida Limited Liability | 2021-02-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
