| Entity Name: | MULBERRY MEDICAL GROUP, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Nov 2002 (22 years ago) |
| Date of dissolution: | 17 Aug 2011 (13 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Aug 2011 (13 years ago) |
| Document Number: | P02000117421 |
| FEI/EIN Number | 450490879 |
| Address: | 8489 SE 165 MULBERRY LANE, LADY LAKE, FL, 32162 |
| Mail Address: | P.O. BOX 587, OXFORD, FL, 34484 |
| ZIP code: | 32162 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417132465 | 2008-01-08 | 2010-08-23 | PO BOX 587, OXFORD, FL, 344840587, US | 8489 SE 165TH MULBERRY LN, THE VILLAGES, FL, 321625847, US | |||||||||||||||||||
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| Phone | +1 352-259-7900 |
| Fax | 3522597966 |
Authorized person
| Name | DR. GUILLERMO B AVECILLA |
| Role | PRESIDENT |
| Phone | 3522597900 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME80865 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| AVECILLA JOSEPHINE M | Agent | 8489 SE 165 MULBERRY LANE, THE VILLAGES, FL, 32162 |
| Name | Role | Address |
|---|---|---|
| AVECILLA JOSEPHINE M | President | 8489 SE 165 MULBERRY LANE, THE VILLAGES, FL, 32162 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2011-08-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-13 | AVECILLA, JOSEPHINE M | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-03-03 | 8489 SE 165 MULBERRY LANE, LADY LAKE, FL 32162 | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-03 | 8489 SE 165 MULBERRY LANE, LADY LAKE, FL 32162 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-03-03 | 8489 SE 165 MULBERRY LANE, THE VILLAGES, FL 32162 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2011-08-17 |
| ANNUAL REPORT | 2011-04-13 |
| ANNUAL REPORT | 2010-02-22 |
| ANNUAL REPORT | 2009-04-20 |
| ANNUAL REPORT | 2008-04-22 |
| ANNUAL REPORT | 2007-07-09 |
| ANNUAL REPORT | 2006-03-21 |
| ANNUAL REPORT | 2005-04-22 |
| ANNUAL REPORT | 2004-03-11 |
| ANNUAL REPORT | 2003-03-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
