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Palma Family Practice LLC

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Company Details

Name: Palma Family Practice LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 08 Jan 2021 (4 years ago)
Financial Date End: 31 Jan 2025
Date dissolved: 26 Apr 2025
Entity Number: 4134172
Place of Formation: IDAHO
File Number: 742180
ZIP code: 83402
County: Bonneville County
Principal Address: 2155 RENDEZVOUS RD IDAHO FALLS, ID 83402
Mailing Address: SANDY PALMA 130 S BROADWAY ST # B IDAHO FALLS, ID 83402

Agent

Name Role Address
SANDY PALMA Agent 2155 RENDEZVOUS RD, IDAHO FALLS, ID 83402

Member

Name Role Address Appointed On
Rodrigo Palma Member 130 S BROADWAY # B, BLACKFOOT, ID 83221 2022-02-26

Manager

Name Role Address Appointed On
Sandy Palma Manager 2155 RENDEZVOUS RD, IDAHO FALLS, ID 83402 2023-12-28

National Provider Identifier

NPI Number:
1649012972
Certification Date:
2024-06-07

Authorized Person:

Name:
SANDY PALMA
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
171400000X - Health & Wellness Coach
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0006219548 2025-04-26
Annual Report 0005529226 2023-12-28
Application for Reinstatement 0005361683 2023-08-15
Dissolution/Revocation - Administrative 0005198144 2023-04-13
Annual Report 0004624030 2022-02-26

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Date of last update: 15 Jun 2025

Sources: Idaho Secretary of State