| Entity Name: | FAMILY MEDICAL GROUP HOLLYWOOD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Sep 2023 (a year ago) |
| Document Number: | L23000444774 |
| FEI/EIN Number | 93-3624429 |
| Address: | 3800 Johnson Street Suite G, Hollywood, FL 33021 |
| Mail Address: | 3800 Johnson Street Suite G, Hollywood, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801647169 | 2024-03-27 | 2024-03-27 | 3800 JOHNSON ST STE G, HOLLYWOOD, FL, 330216030, US | 3800 JOHNSON ST STE G, HOLLYWOOD, FL, 330216030, US | |||||||||||||||||||||
|
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| Phone | +1 954-324-4080 |
Authorized person
| Name | LIZSANDRA RODRIGUEZ |
| Role | OWNER |
| Phone | 9543244080 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Name | Role |
|---|---|
| LJIR ENTERPRISES LLC | Agent |
| Name | Role |
|---|---|
| LJIR ENTERPRISES LLC | Authorized Member |
| FMG PARTNERS GROUP CORP | Authorized Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-28 | 3800 Johnson Street Suite G, Hollywood, FL 33021 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-28 | 3800 Johnson Street Suite G, Hollywood, FL 33021 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-03-28 | LJIR Enterprises LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-28 | 9000 SW 137 Ave, Suite 201, Miami, FL 33186 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-28 |
| Florida Limited Liability | 2023-09-26 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
