| Entity Name: | INNOVATION PODIATRY AESTHETIC & REGENERATIVE MEDICINE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Dec 2018 (6 years ago) |
| Document Number: | L18000283430 |
| FEI/EIN Number | 83-2799368 |
| Address: | 1117 ASTURIA AVENUE, CORAL GABLES, FL, 33134, US |
| Mail Address: | 1117 ASTURIA AVE, CORAL GABLES, FL, 33134, US |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194297143 | 2018-12-31 | 2020-07-23 | 1117 ASTURIA AVE, CORAL GABLES, FL, 331344733, US | 209 NE 95TH ST STE 6, MIAMI SHORES, FL, 331382745, US | |||||||||||||||||||
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| Phone | +1 407-668-8833 |
Authorized person
| Name | VALERIA ALFANO GUERRIERO |
| Role | PODIATRIST |
| Phone | 4076688833 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1497225379 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALFANO VALERIA S | Agent | 1117 Asturia Avenue, Coral gables, FL, 33134 |
| Name | Role | Address |
|---|---|---|
| ALFANO VALERIA S | Authorized Member | 1117 Asturia Avenue, Coral gables, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-07-28 | 1117 ASTURIA AVENUE, CORAL GABLES, FL 33134 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-13 | 1117 ASTURIA AVENUE, CORAL GABLES, FL 33134 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-13 | 1117 Asturia Avenue, Coral gables, FL 33134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-16 |
| ANNUAL REPORT | 2024-01-12 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-13 |
| ANNUAL REPORT | 2019-04-30 |
| Florida Limited Liability | 2018-12-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
