| Entity Name: | BLUESHINE MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Jul 2024 (7 months ago) |
| Document Number: | L24000314343 |
| Address: | 140 SANTA BARBARA BLVD, SUITE 121, CAPE CORAL, FL, 33991, US |
| Mail Address: | 140 SANTA BARBARA BLVD, SUITE 121, CAPE CORAL, FL, 33991, US |
| ZIP code: | 33991 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053138099 | 2024-09-23 | 2024-09-23 | 205 NW 15TH PL, CAPE CORAL, FL, 339937747, US | 140 SANTA BARBARA BLVD STE 121, CAPE CORAL, FL, 339912160, US | |||||||||||||||
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| Phone | +1 561-762-1660 |
| Phone | +1 305-790-6544 |
Authorized person
| Name | DR. JOSE GUSTAVO CEVALLOS |
| Role | PROVIDER |
| Phone | 3057906544 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ARMENTEROS MARISEL | Agent | 1911 NW 15TH TER, CAPE CORAL, FL, 33993 |
| Name | Role |
|---|---|
| JOSE G CEVALLOS MD-PA | Manager |
| BLUESHINE MEDICAL PARTNERS LLC | Manager |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-07-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
