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Santibanez PAC Idaho PLLC

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Company Details

Name: Santibanez PAC Idaho PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Nov 2023 (2 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 5455310
Place of Formation: IDAHO
File Number: 905797
ZIP code: 83404
County: Bonneville County
Principal Address: JORGE SANTIBANEZ 213 2860 CHANNING WAY IDAHO FALLS, ID 83404
Mailing Address: STE 240 5505 S 900 E MURRAY, UT 84117-7210

Member

Name Role Address Appointed On
Jorge Santibanez Member 5505 S 900 E, MURRAY, UT 84117-7210 2025-01-08

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1346015948
Certification Date:
2025-01-14

Authorized Person:

Name:
JULIE ROSER
Role:
VP OF OPERATIONS
Phone:

Taxonomy:

Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207RG0300X - Geriatric Medicine (Internal Medicine) Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Change of Registered Office/Agent/Both (by Entity) 0006056948 2025-01-23
Annual Report 0006057121 2025-01-08
Amendment to Certificate 0005478517 2023-11-14
Initial Filing 0005455310 2023-11-02

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Date of last update: 20 Jun 2025

Sources: Idaho Secretary of State