| Entity Name: | INDIRA MARMOLEJOS, MD. PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 23 Dec 2010 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Nov 2013 (11 years ago) |
| Document Number: | P10000103039 |
| FEI/EIN Number | 27-4369422 |
| Address: | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 |
| Mail Address: | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 |
| ZIP code: | 33445 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174829121 | 2011-02-08 | 2016-07-21 | 6238 W ATLANTIC AVE, SUITE 2, DELRAY BEACH, FL, 334843501, US | 6238 W ATLANTIC AVE, SUITE 2, DELRAY BEACH, FL, 334843501, US | |||||||||||||||||||||||||
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| Phone | +1 561-404-9845 |
| Fax | 5614049849 |
Authorized person
| Name | INDIRA MARIBEL MARMOLEJOS |
| Role | PRESIDENT |
| Phone | 5614049845 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | ME99093 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001469700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARMOLEJOS, INDIRA M | Agent | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 |
| Name | Role | Address |
|---|---|---|
| MARMOLEJOS, INDIRA M | President | 2605 W ATLANTIC AVE, D101 DELRAY BEACH, FL 33445 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000054612 | PALM BEACH INFECTIOUS DISEASES | ACTIVE | 2021-04-21 | 2026-12-31 | No data | 6238 W ATLANTIC AVE, #2, DELRAY BEACH, FL, 33484 |
| G10000118560 | PALM BEACH INFECTIOUS DISEASES | EXPIRED | 2010-12-27 | 2015-12-31 | No data | 2150 LAKE IDA RD #5, DELRAY BEACH, FL, 33445 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-24 | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-24 | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-24 | 2605 W ATLANTIC AVE, D101, DELRAY BEACH, FL 33445 | No data |
| REINSTATEMENT | 2013-11-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-24 |
| ANNUAL REPORT | 2021-02-16 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-03-29 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 23 Feb 2025
Sources: Florida Department of State
