Search icon

EAGLE DERMATOLOGY, PLLC

Company claim

Is this your business?

Get access!

Company Details

Name: EAGLE DERMATOLOGY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Dec 2017 (8 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 582678
Place of Formation: IDAHO
File Number: 582678
ZIP code: 83616
County: Ada County
Principal Address: 372 S EAGLE RD #126 EAGLE, ID 83616
Mailing Address: 372 S EAGLE RD # 126 EAGLE, ID 83616-5908

Agent

Name Role Address
REGISTERED AGENTS INC Agent 784 S CLEARWATER LOOP STE R, POST FALLS, ID 83854

Manager

Name Role Address Appointed On Resigned On
Jennifer A Guerrero Manager 372 S EAGLE ROAD, EAGLE, ID 83616 2023-11-07 2023-11-07

Member

Name Role Address Appointed On
Gabriel G Guerrero Member 372 S EAGLE ROAD, EAGLE, ID 83616 2020-11-18

National Provider Identifier

NPI Number:
1417456385

Authorized Person:

Name:
MRS. JENNIFER ANNETTE GUERRERO
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary:
No
Selected Taxonomy:
207ND0900X - Dermatopathology Physician
Is Primary:
No
Selected Taxonomy:
207NI0002X - Clinical & Laboratory Dermatological Immunology Physician
Is Primary:
No
Selected Taxonomy:
207NP0225X - Pediatric Dermatology Physician
Is Primary:
No
Selected Taxonomy:
207NS0135X - Procedural Dermatology Physician
Is Primary:
No

Contacts:

Fax:
2083912130

Filing

Filing Name Filing Number Filing date
Annual Report 0005977558 2024-11-11
Annual Report 0005470422 2023-11-07
Annual Report 0004974700 2022-11-04
Annual Report 0004476035 2021-11-03
Annual Report 0004070365 2020-11-18

USAspending Awards / Financial Assistance

Date:
2020-05-02
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
45619.00
Total Face Value Of Loan:
45619.00
Date:
2020-04-20
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
328900.00
Total Face Value Of Loan:
328900.00
Date:
2020-04-11
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
7000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
45619
Current Approval Amount:
45619
Race:
White
Ethnicity:
Hispanic or Latino
Gender:
Female Owned
Veteran:
Non-Veteran
Forgiveness Amount:
45992.7

Reviews Leave a review

This company hasn't received any reviews.

Date of last update: 04 Jul 2025

Sources: Idaho Secretary of State