| Entity Name: | DR. LISA LICEAGA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 May 2023 (2 years ago) |
| Document Number: | L23000242716 |
| FEI/EIN Number | 93-1433057 |
| Address: | 12386 STATE ROAD 535, SUITE 105, ORLANDO, FL 32836 |
| Mail Address: | 12386 STATE ROAD 535, SUITE 105, ORLANDO, FL 32836 |
| ZIP code: | 32836 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447944830 | 2023-06-07 | 2023-06-07 | 12386 STATE ROAD 535 # 105, ORLANDO, FL, 328366701, US | 831 S STATE ROAD 434, ALTAMONTE SPRINGS, FL, 327143502, US | |||||||||||||||||
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| Phone | +1 407-801-3295 |
| Fax | 4109077757 |
| Phone | +1 407-587-8600 |
Authorized person
| Name | DR. LISA LICEAGA |
| Role | PHYSICIAN |
| Phone | 9492752718 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ZENBUSINESS INC. | Agent |
| Name | Role | Address |
|---|---|---|
| LICEAGA, LISA | Manager | 12386 STATE ROAD 535, SUITE 105, ORLANDO, FL 32836 |
| Name | Role | Address |
|---|---|---|
| Burrell, Marc | Authorized Member | 12386 STATE ROAD 535, SUITE 105 ORLANDO, FL 32836 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| Florida Limited Liability | 2023-05-17 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
