| Entity Name: | MOUNT DORA MEDICAL INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 May 2023 (2 years ago) |
| Document Number: | L23000237524 |
| FEI/EIN Number | 93-1597542 |
| Address: | 1898 N. DONNELLY ST., MT DORA, FL, 32757 |
| Mail Address: | 1898 N. DONNELLY ST., MT DORA, FL, 32757 |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912691593 | 2023-06-06 | 2023-08-22 | 1898 N DONNELLY ST, MOUNT DORA, FL, 327572820, US | 1898 N DONNELLY ST, MOUNT DORA, FL, 327572820, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 352-720-3149 |
| Fax | 3528004054 |
Authorized person
| Name | CAITLYN PAIGE WHITEHEAD |
| Role | ADMINISTRATOR |
| Phone | 3524450778 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FARINAS ALFREDO | Agent | 1755 LAKE TERRACE DR, EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| FARINAS ALFREDO | President | 1755 LAKE TERRACE DR, EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| FARINAS FLOR | Vice President | 1755 LAKE TERRACE DR, EUSTIS, FL, 32726 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2025-01-30 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-01 | 1755 LAKE TERRACE DR, EUSTIS, FL 32726 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| Florida Limited Liability | 2023-05-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
