| Entity Name: | BENESSERE MEDICAL INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Sep 2022 (2 years ago) |
| Document Number: | L22000397779 |
| FEI/EIN Number | 92-0447122 |
| Address: | 790 NW 107 AVE, 301, MIAMI, FL, 33172 |
| Mail Address: | 790 NW 107 AVE, 301, MIAMI, FL, 33172 |
| ZIP code: | 33172 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578288916 | 2022-10-07 | 2022-10-07 | 790 NW 107TH AVE STE 301, MIAMI, FL, 331723160, US | 790 NW 107TH AVE STE 301, MIAMI, FL, 331723160, US | |||||||||||||||||||
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| Phone | +1 786-953-6559 |
Authorized person
| Name | CARLOS DIAZ |
| Role | PART OWNER |
| Phone | 7865061786 |
Taxonomy
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106809400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLAUDIA MARTINEZ | Agent | 790 NW 107 AVE, MIAMI, FL, 33172 |
| Name | Role | Address |
|---|---|---|
| CARLOS DIAZ | Manager | 790 NW 107 AVE SUITE 301, MIAMI, FL, 33172 |
| MENENDEZ ARCIA ALDO | Manager | 790 NW 107 AVE, MIAMI, FL, 33172 |
| CARLOS GONZALEZ INC. | Manager | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-01-17 |
| Florida Limited Liability | 2022-09-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
