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  5. ELVIN M. MENDEZ, M.D. P.A.

ELVIN M. MENDEZ, M.D. P.A.

Company Details

Entity Name: ELVIN M. MENDEZ, M.D. P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 04 Aug 2003 (22 years ago)
Date of dissolution: 03 Jan 2017 (8 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 03 Jan 2017 (8 years ago)
Document Number: P03000086121
FEI/EIN Number 200139272
Address: 3285 Tripoli Blvd, PUNTA GORDA, FL, 33950, US
Mail Address: P.O. BOX 511896, PUNTA GORDA, FL, 33951-1896
ZIP code: 33950
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1114911245 2005-09-05 2007-10-22 PO BOX 511896, PUNTA GORDA, FL, 339511896, US 3410 TAMIAMI TRL, A1, PORT CHARLOTTE, FL, 339528127, US

Contacts
Phone +1 941-255-3722
Fax 9412553723

Authorized person
Name DR. ELVIN M MENDEZ
Role OWNER
Phone 9412553722

Taxonomy
Taxonomy Code 207K00000X - Allergy & Immunology Physician
License Number ME64431
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS
Number 47861
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2015 200139272 2016-08-12 ELVIN M. MENDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Signature of
Role Plan administrator
Date 2016-08-12
Name of individual signing ELVIN M. MENDEZ, M.D.
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2015 200139272 2016-08-12 ELVIN M. MENDEZ, M.D., P.A. 5
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Signature of
Role Plan administrator
Date 2016-08-12
Name of individual signing ELVIN M. MENDEZ, M.D.
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2014 200139272 2015-07-29 ELVIN M. MENDEZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing ELVIN M. MENDEZ, M.D.
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2013 200139272 2014-10-07 ELVIN M. MENDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Signature of
Role Plan administrator
Date 2014-10-07
Name of individual signing ELVIN M. MENDEZ, M.D.
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2012 200139272 2013-09-30 ELVIN M. MENDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Signature of
Role Plan administrator
Date 2013-09-30
Name of individual signing ELVIN M. MENDEZ, M.D.
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2011 200139272 2012-02-20 ELVIN M. MENDEZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Plan administrator’s name and address
Administrator’s EIN 200139272
Plan administrator’s name ELVIN M. MENDEZ, M.D., P.A.
Plan administrator’s address PO BOX 511896, PUNTA GORDA, FL, 339511896
Administrator’s telephone number 9412553722

Signature of
Role Plan administrator
Date 2012-02-20
Name of individual signing JACQUELINE WILLIAMS
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2010 200139272 2011-06-02 ELVIN M. MENDEZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address PO BOX 511896, PUNTA GORDA, FL, 339511896

Plan administrator’s name and address
Administrator’s EIN 200139272
Plan administrator’s name ELVIN M. MENDEZ, M.D., P.A.
Plan administrator’s address PO BOX 511896, PUNTA GORDA, FL, 339511896
Administrator’s telephone number 9412553722

Signature of
Role Plan administrator
Date 2011-06-02
Name of individual signing JACQUELINE WILLIAMS
Valid signature Filed with authorized/valid electronic signature
ELVIN M. MENDEZ, M.D., P.A. PROFIT SHARING PLAN 2009 200139272 2010-10-15 ELVIN M. MENDEZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 9412553722
Plan sponsor’s address P.O. BOX 511896, PUNTA GORDA, FL, 339511896

Plan administrator’s name and address
Administrator’s EIN 200139272
Plan administrator’s name ELVIN M. MENDEZ, M.D., P.A.
Plan administrator’s address P.O. BOX 511896, PUNTA GORDA, FL, 339511896
Administrator’s telephone number 9412553722

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing JACQUELINE WILLIAMS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MENDEZ ELVIN M Agent 3285 TRIPOLI BLVD, PUNTA GORDA, FL, 33950

President

Name Role Address
MENDEZ ELVIN M President P.O. BOX 511896, PUNTA GORDA, FL, 339511896

Secretary

Name Role Address
MENDEZ ELVIN M Secretary P.O. BOX 511896, PUNTA GORDA, FL, 339511896

Treasurer

Name Role Address
MENDEZ ELVIN M Treasurer P.O. BOX 511896, PUNTA GORDA, FL, 339511896

Director

Name Role Address
MENDEZ ELVIN M Director P.O. BOX 511896, PUNTA GORDA, FL, 339511896

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2017-01-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2016-03-09 3285 Tripoli Blvd, PUNTA GORDA, FL 33950 No data
REGISTERED AGENT ADDRESS CHANGED 2016-03-09 3285 TRIPOLI BLVD, PUNTA GORDA, FL 33950 No data

Documents

Name Date
Voluntary Dissolution 2017-01-03
ANNUAL REPORT 2016-03-09
ANNUAL REPORT 2015-01-14
ANNUAL REPORT 2014-02-26
ANNUAL REPORT 2013-01-27
ANNUAL REPORT 2012-01-08
ANNUAL REPORT 2011-01-30
ANNUAL REPORT 2010-04-16
ANNUAL REPORT 2009-01-19
ANNUAL REPORT 2008-01-31

Related by officers

MENDEZ ELVIN M

PALMITA MEDICAL, LLC

Related by address

P.O. BOX 511896, PUNTA GORDA, FL, 33951-1896

PAMELA PAPOLA, M.D. P.A.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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