| Entity Name: | LOUISE M. BENVENUTO, M.D., P.L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Oct 2022 (2 years ago) |
| Document Number: | L22000447439 |
| FEI/EIN Number | 92-0748469 |
| Address: | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| Mail Address: | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| ZIP code: | 33409 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114636412 | 2022-11-16 | 2022-11-16 | 2532 OKEECHOBEE BLVD, WEST PALM BEACH, FL, 334094006, US | 2532 OKEECHOBEE BLVD, WEST PALM BEACH, FL, 334094006, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 561-712-7888 |
| Fax | 5616974445 |
Authorized person
| Name | DR. LOUISE MARY BENVENUTO M.D. |
| Role | PHYSICIAN PROVIDER |
| Phone | 5612141462 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1992013031 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BENVENUTO, LOUISE M, M.D. | Agent | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| Name | Role | Address |
|---|---|---|
| BENVENUTO, LOUISE M, M.D. | Manager | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| VILLAMIZAR, JOHN J | Manager | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| ASSUIED, JEAN P | Manager | 2532 OKEECHOBEE BLVD., WEST PALM BEACH, FL 33409 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-16 |
| ANNUAL REPORT | 2023-03-20 |
| Florida Limited Liability | 2022-10-17 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
