| Entity Name: | AAIA-TAMPA BAY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Nov 2021 (3 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 05 Nov 2021 (3 years ago) |
| Document Number: | L21000476564 |
| FEI/EIN Number | 65-0596228 |
| Address: | 3645 MADACA LN, TAMPA, FL, 33618, US |
| Mail Address: | 3645 MADACA LN, TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730198037 | 2006-08-05 | 2022-07-07 | 3645 MADACA LN, TAMPA, FL, 336182048, US | 3645 MADACA LN, TAMPA, FL, 336182048, US | |||||||||||||||||||||
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| Phone | +1 813-969-0116 |
| Fax | 8139693794 |
Authorized person
| Name | MRS. TINA DOMINGUEZ |
| Role | OFFICE ADMINISTRATOR |
| Phone | 8139690116 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 260084600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Hatab Ammar | Agent | 3645 MADACA LN, TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| Hatab Ammar | Manager | 3645 MADACA LN, TAMPA, FL, 33618 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000059595 | JOSE CARLOS DOMINGUEZ, JR., M.D. | ACTIVE | 2022-05-11 | 2027-12-31 | No data | 3645 MADACA LANE, TAMPA, FL, 33618 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-08-02 | Hatab, Ammar | No data |
| CONVERSION | 2021-11-05 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P95000049436. CONVERSION NUMBER 300000219853 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-11 |
| ANNUAL REPORT | 2023-02-02 |
| AMENDED ANNUAL REPORT | 2022-08-02 |
| ANNUAL REPORT | 2022-03-01 |
| Florida Limited Liability | 2021-11-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
