| Entity Name: | SPACE COAST LUNG & SLEEP CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Feb 2016 (9 years ago) |
| Document Number: | L16000028287 |
| FEI/EIN Number | 81-1661468 |
| Address: | 788 SUNSET DR, MELBOURNE, FL, 32935, US |
| Mail Address: | PO BOX 540579, MERRITT ISLAND, FL, 32954, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629438635 | 2016-03-03 | 2016-03-03 | 205 N BANANA RIVER DR, SUITE 105, MERRITT ISLAND, FL, 329522596, US | 205 N BANANA RIVER DR, SUITE 105, MERRITT ISLAND, FL, 329522596, US | |||||||||||||||
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| Phone | +1 931-212-8192 |
Authorized person
| Name | MOHAMED MOATAZ TOBAN |
| Role | OWNER/PHYSICIAN |
| Phone | 9312128192 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TOBAN M. MOATAZ | Agent | 788 SUNSET DR, MELBOURNE, FL, 32935 |
| Name | Role | Address |
|---|---|---|
| TOBAN M. MOATAZ MD | Authorized Member | 788 SUNSET DR, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-05-01 | 788 SUNSET DR, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2018-05-01 | 788 SUNSET DR, MELBOURNE, FL 32935 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-05-01 | 788 SUNSET DR, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-20 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-24 |
| Florida Limited Liability | 2016-02-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
