| Entity Name: | BLUE LAGOON MEDICAL CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 11 May 2015 (10 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P15000042472 |
| Address: | 4355 W 16 AVE, 211A, HIALEAH, FL 33012 |
| Mail Address: | 4355 W 16 AVE, 211A, HIALEAH, FL 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083097281 | 2015-07-07 | 2015-07-08 | 4355 W 16TH AVE STE 211A, HIALEAH, FL, 330127670, US | 4355 W 16TH AVE STE 211A, HIALEAH, FL, 330127670, US | |||||||||||||||||||||||
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| Phone | +1 786-304-9107 |
| Fax | 7863640230 |
Authorized person
| Name | RICARDO MONTPELLER ACOSTA |
| Role | PRESIDENT |
| Phone | 7863049107 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| ACOSTA, RICARDO | Agent | 4355 W 16 AVE, 211 A, HIALEAH, FL 33012 |
| Name | Role | Address |
|---|---|---|
| GRINAN PUERTO, MARVIN | President | 4355 W 16 AVE STE 211A, HIALEAH, FL 33012 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| AMENDMENT | 2015-11-18 | No data | No data |
| Name | Date |
|---|---|
| Amendment | 2015-11-18 |
| Domestic Profit | 2015-05-11 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
