| Entity Name: | NEISA I. DIAZ, M.D., LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Jun 2013 (12 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L13000087865 |
| FEI/EIN Number | 35-2481187 |
| Address: | 13501 ICOT BLVD., SUITE 114, CLEARWATER, FL, 33760, US |
| Mail Address: | 13501 ICOT BLVD., SUITE 114, CLEARWATER, FL, 33760, US |
| ZIP code: | 33760 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659713261 | 2013-07-24 | 2013-07-24 | 13501 ICOT BLVD, SUITE 114, CLEARWATER, FL, 337603729, US | 13501 ICOT BLVD, SUITE 114, CLEARWATER, FL, 337603729, US | |||||||||||||||||||||||||
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| Phone | +1 727-754-7880 |
| Fax | 7277547885 |
Authorized person
| Name | NEISA I DIAZ |
| Role | OWNER |
| Phone | 7277547880 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 97050 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277721500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Diaz Neisa IM.D. | Agent | 13501 ICOT BLVD, CLEARWATER, FL, 337603729 |
| Name | Role | Address |
|---|---|---|
| DIAZ NEISA I | Manager | 13501 ICOT BLVD., CLEARWATER, FL, 33760 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-05-01 | Diaz, Neisa I, M.D. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-19 | 13501 ICOT BLVD, SUITE 114, CLEARWATER, FL 33760-3729 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-02-17 |
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-02-09 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-03-04 |
| ANNUAL REPORT | 2014-03-20 |
| Florida Limited Liability | 2013-06-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
