| Entity Name: | CENTER FOR INDIVIDUALIZED MEDICINE AND AGE MANAGEMENT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 16 Nov 2012 (12 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P12000095487 |
| FEI/EIN Number | 46-1499784 |
| Address: | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 |
| Mail Address: | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 |
| ZIP code: | 32828 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447689203 | 2013-11-02 | 2013-11-02 | 11616 LAKE UNDERHILL RD, STE 205, ORLANDO, FL, 328254463, US | 11616 LAKE UNDERHILL RD, STE 205, ORLANDO, FL, 328254463, US | |||||||||||||||||||
|
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| Phone | +1 407-273-7399 |
| Fax | 4072731928 |
Authorized person
| Name | DR. MILDRED DONIS-RIVERA |
| Role | OSNER/PRESIDENT |
| Phone | 4072737399 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME55637 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Donis Silva, Mildred, Dr. | Agent | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 |
| Name | Role | Address |
|---|---|---|
| DONIS RIVERA, MILDRED, MD | President | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000029355 | CIMA | EXPIRED | 2015-03-20 | 2020-12-31 | No data | CENTER FOR INDIVIDUALIZED MEDICINE AND A, 11616 LAKE UNDERHILL RD, ORLANDO, FL, 32825 |
| G13000104939 | CIMA | EXPIRED | 2013-10-24 | 2018-12-31 | No data | 11616 LAKE UNDERHILL RD, SUITE 205, ORLANDO, FL, 32825 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-30 | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-30 | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-30 | 12007 Lake Shadow Brook Lane, ORLANDO, FL 32828 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-04-26 | Donis Silva, Mildred, Dr. | No data |
| REINSTATEMENT | 2016-11-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REINSTATEMENT | 2013-10-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-26 |
| REINSTATEMENT | 2016-11-09 |
| ANNUAL REPORT | 2015-08-20 |
| ANNUAL REPORT | 2014-04-15 |
| REINSTATEMENT | 2013-10-21 |
| Domestic Profit | 2012-11-16 |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
