| Entity Name: | FAMILY INTEGRATIVE MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jul 2022 (3 years ago) |
| Document Number: | L22000317696 |
| FEI/EIN Number | 88-4115791 |
| Address: | 11251 SOUTH ORANGE BLOSSOM TRAIL, 102, ORLANDO, FL, 32837 |
| Mail Address: | 11251 SOUTH ORANGE BLOSSOM TRAIL, 101, Orlando, FL, 32837, US |
| ZIP code: | 32837 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609597301 | 2022-09-09 | 2022-09-09 | 11251 S ORANGE BLOSSOM TRL STE 101, ORLANDO, FL, 328379297, US | 11251 S ORANGE BLOSSOM TRL STE 102, ORLANDO, FL, 328379297, US | |||||||||||||||||||
|
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| Phone | +1 407-501-6841 |
| Fax | 4075422243 |
Authorized person
| Name | HERIBERTO L. RIVERA |
| Role | CO-OWNER |
| Phone | 4072883371 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RIVERA HERIBERTO L | Agent | 11251 SOUTH ORANGE BLOSSOM TRAIL, ORLANDO, FL, 32837 |
| Name | Role | Address |
|---|---|---|
| RIVERA HERIBERTO L | Chief Executive Officer | 11251 SOUTH ORANGE BLOSSOM TRAIL, STE 101., ORLANDO, FL, 32837 |
| Name | Role | Address |
|---|---|---|
| LOPES OSVALDO A | Chief Financial Officer | 11251 SOUTH ORANGE BLOSSOM TRAIL, STE. 101, ORLANDO, FL, 32837 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-29 | 11251 SOUTH ORANGE BLOSSOM TRAIL, 102, ORLANDO, FL 32837 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-29 |
| Florida Limited Liability | 2022-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
