| Entity Name: | SPACE COAST UROLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
SPACE COAST UROLOGY, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 27 Oct 2004 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 03 Jan 2022 (3 years ago) |
| Document Number: | L04000078681 |
| FEI/EIN Number |
201788773
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4420 S Hopkins Ave, TITUSVILLE, FL, 32780, US |
| Mail Address: | 4420 S Hopkins Ave, TITUSVILLE, FL, 32780, US |
| ZIP code: | 32780 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336337690 | 2007-10-11 | 2009-03-13 | 2203 GARDEN ST, TITUSVILLE, FL, 327962577, US | 2203 GARDEN ST, TITUSVILLE, FL, 327962577, US | |||||||||||||||||||||||||
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| Phone | +1 321-268-4693 |
| Fax | 3212684696 |
Authorized person
| Name | DR. JUSTO GONZALEZ |
| Role | UROLOGIST |
| Phone | 3212684693 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME67177 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271696800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ JUSTO M | Managing Member | 4420 S Hopkins Ave, TITUSVILLE, FL, 32780 |
| GONZALEZ JUSTO M | Agent | 4420 S Hopkins Ave, TITUSVILLE, FL, 32780 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-03 | 4420 S Hopkins Ave, TITUSVILLE, FL 32780 | - |
| REINSTATEMENT | 2022-01-03 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-03 | 4420 S Hopkins Ave, TITUSVILLE, FL 32780 | - |
| CHANGE OF MAILING ADDRESS | 2022-01-03 | 4420 S Hopkins Ave, TITUSVILLE, FL 32780 | - |
| REGISTERED AGENT NAME CHANGED | 2022-01-03 | GONZALEZ, JUSTO M.D. | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | - | - |
| REINSTATEMENT | 2012-08-20 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | - | - |
| CANCEL ADM DISS/REV | 2007-10-11 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-07-13 |
| REINSTATEMENT | 2022-01-03 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-05-07 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-03-16 |
| ANNUAL REPORT | 2014-06-20 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6134717401 | 2020-05-14 | 0455 | PPP | 2203 Garden Street, TITUSVILLE, FL, 32796-2577 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1710208502 | 2021-02-19 | 0455 | PPS | 2203 Garden St, Titusville, FL, 32796-2577 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Mar 2025
Sources: Florida Department of State
