| Entity Name: | ICOM SUNRISE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Apr 2021 (4 years ago) |
| Document Number: | L21000200865 |
| FEI/EIN Number | 86-3873994 |
| Address: | 12651 W SUNRISE BLVD., SUNRISE, FL, 33323, US |
| Mail Address: | 12651 W SUNRISE BLVD., SUNRISE, FL, 33323, US |
| ZIP code: | 33323 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093585853 | 2024-01-03 | 2024-01-03 | 611 NE 13TH ST, FT LAUDERDALE, FL, 333041109, US | 12651 W SUNRISE BLVD, SUNRISE, FL, 333230906, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 305-409-5392 |
| Phone | +1 954-356-2721 |
| Fax | 7862214442 |
Authorized person
| Name | TATIANA SANTIAGO HERZOG |
| Role | DENTIST |
| Phone | 9543562721 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HERZOG TATIANA S | Agent | 5201 NE 33rd AVE, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| HERZOG TATIANA S | Authorized Member | 5201 NE 33rd AVE, FORT LAUDERDALE, FL, 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-24 | 5201 NE 33rd AVE, FORT LAUDERDALE, FL 33308 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-27 | 12651 W SUNRISE BLVD., 304, SUNRISE, FL 33323 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-27 | 12651 W SUNRISE BLVD., 304, SUNRISE, FL 33323 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-01-27 |
| Florida Limited Liability | 2021-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
