| Entity Name: | 90 MINUTE LABORATORY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Oct 2022 (2 years ago) |
| Document Number: | L22000458154 |
| FEI/EIN Number | 88-4304370 |
| Address: | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550, US |
| Mail Address: | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550, US |
| ZIP code: | 32550 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588349161 | 2023-06-20 | 2024-04-16 | 11903 PANAMA CITY BEACH PKWY UNIT B, PANAMA CITY BEACH, FL, 324072621, US | 11903 PANAMA CITY BEACH PKWY # B, PANAMA CITY, FL, 324072605, US | |||||||||||||||||
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| Phone | +1 850-284-6117 |
| Fax | 8503734930 |
| Phone | +1 850-353-0187 |
Authorized person
| Name | RICHARD WESTENBARGER |
| Role | PARTNER |
| Phone | 8502846117 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FARAH LAW | Agent | 6550 ST. AUGUSTINE ROAD, SUITE 103, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| RAYMOND GUTIERREZ, M.D. | Manager | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550 |
| HUY BAO NGUYEN, M.D. | Manager | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550 |
| RICHARD LEE WESTENBARGER, M.D. | Manager | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000027350 | SYNC LABORATORIES | ACTIVE | 2023-02-28 | 2028-12-31 | No data | 755 GRAND BOULEVARD, SUITE B 105-81, MIRAMAR, FL, 32550 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-13 |
| Florida Limited Liability | 2022-10-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
