| Entity Name: | PROACTIVE MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Jun 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 17 Oct 2022 (2 years ago) |
| Document Number: | L22000263692 |
| FEI/EIN Number | 88-2788562 |
| Address: | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33308 |
| Mail Address: | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225765241 | 2022-08-02 | 2024-01-01 | 5353 N FEDERAL HWY STE 400, FORT LAUDERDALE, FL, 333083244, US | 5353 N FEDERAL HWY STE 400, FORT LAUDERDALE, FL, 333083244, US | |||||||||||||||||||||
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| Phone | +1 954-938-2843 |
| Fax | 9542006689 |
Authorized person
| Name | MR. RICARDO ALEXANDER ZAMBRANO |
| Role | OWNER |
| Phone | 9549382843 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TEXAS MEDICAL LICENSE |
| Number | U5083 |
| State | TX |
| Name | Role | Address |
|---|---|---|
| ZAMBRANO, RICARDO A | Agent | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33437 |
| Name | Role | Address |
|---|---|---|
| ZAMBRANO, RICARDO A | President | 5353 N. FEDERAL HIGHWAY,, SUITE 400 FORT LAUDERDALE, FL 33308 |
| Name | Role | Address |
|---|---|---|
| CEVALLOS, JOSE G | Vice President | 5353 N. FEDERAL HIGHWAY,, SUITE 400 FORT LAUDERDALE, FL 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-09-13 | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33308 | No data |
| CHANGE OF MAILING ADDRESS | 2023-09-13 | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33308 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-09-13 | 5353 N. FEDERAL HIGHWAY, 400, FORT LAUDERDALE, FL 33437 | No data |
| LC AMENDMENT | 2022-10-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-12 |
| AMENDED ANNUAL REPORT | 2023-09-13 |
| AMENDED ANNUAL REPORT | 2023-06-06 |
| ANNUAL REPORT | 2023-01-30 |
| LC Amendment | 2022-10-17 |
| Florida Limited Liability | 2022-06-09 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
