| Entity Name: | RENACER MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jun 2022 (3 years ago) |
| Document Number: | L22000290109 |
| FEI/EIN Number | 883021998 |
| Address: | 1647 SW 27 AVE, MIAMI, FL, 33145, US |
| Mail Address: | 1647 SW 27 AVE, MIAMI, FL, 33145, US |
| ZIP code: | 33145 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639801491 | 2022-06-29 | 2022-06-29 | 1647 SW 27TH AVE, MIAMI, FL, 331452044, US | 1647 SW 27TH AVE, MIAMI, FL, 331452044, US | |||||||||||||||
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| Phone | +1 305-456-6205 |
| Fax | 3054566207 |
Authorized person
| Name | MARIANELA DE LA PORTILLA |
| Role | AMBR |
| Phone | 3054566205 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MARIANELA DE LA PORTILLA | Agent | 1647 SW 27 AVE, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| Diaz Alexei | Admi | 1647 SW 27 AVE, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| MARIANELA DE LA PORTILLA | Authorized Member | 1647 SW 27 AVE, MIAMI, FL, 33145 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-04-27 |
| Florida Limited Liability | 2022-06-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
