| Entity Name: | RDM PROFESSIONAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 29 May 2018 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2021 (3 years ago) |
| Document Number: | P18000048700 |
| FEI/EIN Number | 83-0717402 |
| Address: | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Mail Address: | 437 SW ROSEMARY DR, LAKE CITY, FL 32024 |
| ZIP code: | 32024 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699322867 | 2019-08-22 | 2019-08-22 | 437 SW ROSEMARY DR, LAKE CITY, FL, 320246715, US | 437 SW ROSEMARY DR, LAKE CITY, FL, 320246715, US | |||||||||||||||||||||
|
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| Phone | +1 973-610-6389 |
| Fax | 3869354331 |
Authorized person
| Name | ROLANDO DOMINGUEZ MUSTAFA |
| Role | OWNER / MEDICAL DIRECTOR |
| Phone | 9736106389 |
Taxonomy
| Taxonomy Code | 207RA0000X - Adolescent Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015321200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Dominguez Mustafa, Rolando | Agent | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Name | Role | Address |
|---|---|---|
| DOMINGUEZ-MUSTAFA, ROLANDO | President | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Name | Role | Address |
|---|---|---|
| JAYO FARELL, EVELIN | Vice President | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Name | Role | Address |
|---|---|---|
| JAYO FARELL, EVELIN | Secretary | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Name | Role | Address |
|---|---|---|
| DOMINGUEZ-MUSTAFA, ROLANDO | Treasurer | 437 SW ROSEMARY DR, Lake City, FL 32024 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000149036 | RDM MAGNOLIA PRACTICE CARE | ACTIVE | 2024-12-09 | 2029-12-31 | No data | 437 SW ROSEMARY DR, LAKE CITY, FL, 32024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-09-28 | Dominguez Mustafa, Rolando | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-25 | 437 SW ROSEMARY DR, Lake City, FL 32024 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-25 | 437 SW ROSEMARY DR, Lake City, FL 32024 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-25 | 437 SW ROSEMARY DR, Lake City, FL 32024 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-05-11 |
| ANNUAL REPORT | 2022-07-15 |
| REINSTATEMENT | 2021-09-28 |
| ANNUAL REPORT | 2020-04-06 |
| ANNUAL REPORT | 2019-04-25 |
| Domestic Profit | 2018-05-29 |
Date of last update: 17 Feb 2025
Sources: Florida Department of State
