| Entity Name: | SOUTH FLORIDA MED GROUP, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jan 2022 (3 years ago) |
| Document Number: | L22000033505 |
| FEI/EIN Number | 92-0416035 |
| Address: | 16969 NW 67th Ave, MIAMI LAKES, FL, 33015, US |
| Mail Address: | 16969 NW 67th Ave, MIAMI LAKES, FL, 33015, US |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841975984 | 2023-06-16 | 2024-08-27 | 16969 NW 67TH AVE STE 205, HIALEAH, FL, 330154294, US | 16969 NW 67TH AVE STE 205, HIALEAH, FL, 330154294, US | |||||||||||||||||||||||||||||
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| Phone | +1 786-860-8844 |
Authorized person
| Name | DANIEL CABRERA |
| Role | OFFICE MANAGER |
| Phone | 7868608844 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CABRERA STEPHANIE M | Agent | 16820 NW 74 AVENUE, MIAMI, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| CABRERA STEPHANIE M | Manager | 16820 NW 74 AVENUE, MIAMI, FL, 33015 |
| CABRERA DANIEL C | Manager | 16820 NW 74 AVENUE, MIAMI, FL, 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-29 | 16969 NW 67th Ave, Ste 205, MIAMI LAKES, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2023-06-29 | 16969 NW 67th Ave, Ste 205, MIAMI LAKES, FL 33015 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-03-31 |
| Florida Limited Liability | 2022-01-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
