| Entity Name: | VIPSYCH PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Oct 2010 (14 years ago) |
| Document Number: | L10000110542 |
| FEI/EIN Number | 274268731 |
| Address: | 5895 LAKE MELROSE DR., ORLANDO, FL, 32829, US |
| Mail Address: | 5895 LAKE MELROSE DR., ORLANDO, FL, 32829, US |
| ZIP code: | 32829 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760810550 | 2013-10-15 | 2013-10-15 | 5895 LAKE MELROSE DR, ORLANDO, FL, 328297690, US | 5895 LAKE MELROSE DR, ORLANDO, FL, 328297690, US | |||||||||||||||||||||||
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| Phone | +1 407-932-4261 |
Authorized person
| Name | DR. CARLOS H RUIZ |
| Role | M.D |
| Phone | 4078324261 |
Taxonomy
| Taxonomy Code | 273R00000X - Psychiatric Hospital Unit |
| License Number | ME 80316 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261229100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RUIZ CARLOS | Agent | 5895 LAKE MELROSE DR., ORLANDO, FL, 32829 |
| Name | Role | Address |
|---|---|---|
| RUIZ CARLOS | Managing Member | 5895 LAKE MELROSE DR., ORLANDO, FL, 32829 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-03-06 |
| ANNUAL REPORT | 2016-02-08 |
| ANNUAL REPORT | 2015-02-21 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
