| Entity Name: | PORT ORANGE PEDIATRICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Mar 2006 (19 years ago) |
| Document Number: | P06000033581 |
| FEI/EIN Number | 900307107 |
| Address: | 1728 DUNLAWTON AVENUE, SUITE 1, PORT ORANGE, FL, 32127, US |
| Mail Address: | 1728 DUNLAWTON AVENUE, SUITE 1, PORT ORANGE, FL, 32127, US |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902084064 | 2008-01-31 | 2022-01-26 | 1728 DUNLAWTON AVE STE 1, PORT ORANGE, FL, 321272923, US | 1720 DUNLAWTON AVE, SUITE 1, PORT ORANGE, FL, 321272915, US | |||||||||||||||||||
|
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| Phone | +1 386-322-5390 |
| Fax | 3863225391 |
Authorized person
| Name | RUBEN J LOPEZ |
| Role | PRESIDENT |
| Phone | 3863225390 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME0068668 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LOPEZ RUBEN J | Agent | 2100 Spruce Creek Circle West, PORT ORANGE, FL, 32128 |
| Name | Role | Address |
|---|---|---|
| LOPEZ RUBEN JDr. | President | 2100 Spruce Creek Circle West, PORT ORANGE, FL, 32128 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2013-01-17 | 2100 Spruce Creek Circle West, PORT ORANGE, FL 32128 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-04 | 1728 DUNLAWTON AVENUE, SUITE 1, PORT ORANGE, FL 32127 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-04 | 1728 DUNLAWTON AVENUE, SUITE 1, PORT ORANGE, FL 32127 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J20000153946 | TERMINATED | 1000000863171 | VOLUSIA | 2020-03-05 | 2030-03-11 | $ 338.91 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, DAYTONA BEACH SERVICE CENTER, 1180 N WILLIAMSON BLVD STE 160, DAYTONA BEACH FL321148179 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
