| Entity Name: | VAG SPECIALIST LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Mar 2019 (6 years ago) |
| Document Number: | L19000069429 |
| FEI/EIN Number | 83-4057065 |
| Address: | 401 SE Osceola St., 200a, Stuart, FL, 34994, US |
| Mail Address: | 401 SE Osceola St., 200a, Stuart, FL, 34994, US |
| ZIP code: | 34994 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265100069 | 2021-09-06 | 2021-09-06 | 401 SE OSCEOLA ST STE 200A, STUART, FL, 349942503, US | 401 SE OSCEOLA ST STE 200A, STUART, FL, 349942503, US | |||||||||||||||||||||||||
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| Phone | +1 561-318-0252 |
| Fax | 5617440735 |
Authorized person
| Name | MARIA NIETO |
| Role | MANAGING MEMBER |
| Phone | 4123985059 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207VF0040X - Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017290600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NIETO MARIA L | Agent | 401 SE Osceola St., Stuart, FL, 34994 |
| Name | Role | Address |
|---|---|---|
| Nieto Maria | Auth | 401 SE Osceola St., Stuart, FL, 34994 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-05 | 401 SE Osceola St., 200a, Stuart, FL 34994 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-05 | 401 SE Osceola St., 200a, Stuart, FL 34994 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-05 | 401 SE Osceola St., 200a, Stuart, FL 34994 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-22 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-03-05 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-03-24 |
| Florida Limited Liability | 2019-03-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
