| Entity Name: | JUNGSIL K. CUSIMANO MD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Jan 2019 (6 years ago) |
| Date of dissolution: | 13 Aug 2019 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 13 Aug 2019 (5 years ago) |
| Document Number: | P19000001457 |
| FEI/EIN Number | 833068517 |
| Address: | 3608 BALLASTONE DR., LAND O LAKES, FL, 34638, US |
| Mail Address: | 3608 BALLASTONE DR., LAND O LAKES, FL, 34638, US |
| ZIP code: | 34638 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801350608 | 2019-01-25 | 2019-01-25 | 3608 BALLASTONE DR, LAND O LAKES, FL, 346388069, US | 18842 N DALE MABRY HWY, LUTZ, FL, 335484978, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 607-206-2007 |
| Phone | +1 813-536-2542 |
| Fax | 8135362544 |
Authorized person
| Name | DR. JUNGSIL K CUSIMANO |
| Role | PRESIDENT |
| Phone | 6072062007 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CUSIMANO THOMAS WJR. | Agent | 3608 BALLASTONE DR., LAND O LAKES, FL, 34638 |
| Name | Role | Address |
|---|---|---|
| CUSIMANO JUNGSIL KMD | President | 3608 BALLASTONE DR., LAND O LAKES, FL, 34638 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000004436 | AVIVA INTEGRATIVE MEDICINE | EXPIRED | 2019-01-09 | 2024-12-31 | No data | 3608 BALLASTONE DR., LAND O LAKES, FL, 34638 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-08-13 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-08-13 |
| Domestic Profit | 2019-01-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
