| Entity Name: | ADVANCED SURGICAL & WEIGHT LOSS INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Aug 2013 (11 years ago) |
| Document Number: | L13000118024 |
| FEI/EIN Number | 46-3469645 |
| Address: | 3165 Suntree Blvd, Rockledge, FL, 32955, US |
| Mail Address: | 3165 Suntree Blvd, Rockledge, FL, 32955, US |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376965822 | 2014-01-16 | 2024-06-12 | 3165 SUNTREE BLVD STE 101, ROCKLEDGE, FL, 329555720, US | 3165 SUNTREE BLVD STE 101, ROCKLEDGE, FL, 329555720, US | |||||||||||||||||||||||||
|
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| Phone | +1 321-549-2000 |
| Fax | 3215492142 |
Authorized person
| Name | DIEGO VELARDE |
| Role | OWNER |
| Phone | 3215492000 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME 94651 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000052100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VELARDE DIEGO | Agent | 3165 Suntree Blvd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| VELARDE DIEGO | Dr | 3165 Suntree Blvd, Rockledge, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-18 | 3165 Suntree Blvd, Ste 101, Rockledge, FL 32955 | No data |
| CHANGE OF MAILING ADDRESS | 2018-01-18 | 3165 Suntree Blvd, Ste 101, Rockledge, FL 32955 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-18 | 3165 Suntree Blvd, Ste 101, Rockledge, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-07-12 |
| ANNUAL REPORT | 2015-03-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
