| Entity Name: | REJUVA DERMATOLOGY & VEIN CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Nov 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 24 Aug 2021 (3 years ago) |
| Document Number: | L20000367258 |
| FEI/EIN Number | 85-4139221 |
| Mail Address: | 2389 East Venice Avenue, Venice, FL, 34292, US |
| Address: | 395 Commercial Court, Venice, FL, 34292, US |
| ZIP code: | 34292 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316522691 | 2021-03-17 | 2024-10-23 | 2389 E VENICE AVE UNIT 510, VENICE, FL, 342922465, US | 395 COMMERCIAL CT STE C, VENICE, FL, 342921651, US | |||||||||||||||||||||||||||
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| Phone | +1 941-529-0070 |
| Fax | 9415290539 |
Authorized person
| Name | DR. GOLTA RASOULI |
| Role | CO-PRESENDENT |
| Phone | 9415290070 |
Taxonomy
| Taxonomy Code | 202K00000X - Phlebology Physician |
| Is Primary | No |
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| RASOULI GOLTA | Agent | 395 Commercial Court, Venice, FL, 34292 |
| Name | Role | Address |
|---|---|---|
| MAZLOOM SEAN | Manager | 2389 East Venice Avenue, Venice, FL, 34292 |
| RASOULI GOLTA | Manager | 2389 East Venice Avenue, Venice, FL, 34292 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000115606 | REJUVA DERMATOLOGY & VEIN CENTER | ACTIVE | 2021-09-08 | 2026-12-31 | No data | 2389 E. VENICE AVENUE, UNIT 510, VENICE, FL, 34292 |
| G21000115684 | REJUVA DERMATOLOGY, VEIN & SKIN CANCER CENTER | ACTIVE | 2021-09-08 | 2026-12-31 | No data | 2389 E. VENICE AVENUE, UNIT 510, VENICE, FL, 34292 |
| G20000154461 | DERMATOLOGY ASSOCIATES | ACTIVE | 2020-12-05 | 2025-12-31 | No data | 1576 BELLA CRUZ DRIVE, #264, LADY LAKE, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-22 | 395 Commercial Court, Suite C, Venice, FL 34292 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-22 | 395 Commercial Court, Suite C, Venice, FL 34292 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-22 | 395 Commercial Court, Suite C, Venice, FL 34292 | No data |
| LC AMENDMENT | 2021-08-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-01-22 |
| LC Amendment | 2021-08-24 |
| ANNUAL REPORT | 2021-04-29 |
| Florida Limited Liability | 2020-11-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
