| Entity Name: | ORTHOTIC & PROSTHETIC CLINIC OF TAMPA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Jun 2023 (2 years ago) |
| Document Number: | L23000287635 |
| FEI/EIN Number | 931922404 |
| Mail Address: | 2754 NW 27TH AVE, BOCA RATON, FL, 33434, US |
| Address: | 34760 US Highway 19 N, Palm Harbor, FL, 34684, US |
| ZIP code: | 34684 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497530810 | 2023-08-25 | 2024-06-14 | 2754 NW 27TH AVE, BOCA RATON, FL, 334343692, US | 34760 US HIGHWAY 19 N, PALM HARBOR, FL, 346842120, US | |||||||||||||||||||||
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| Phone | +1 305-812-5087 |
| Phone | +1 813-466-5006 |
| Fax | 8135318385 |
Authorized person
| Name | MR. RAFAEL AGUSTIN DIAZ ABREU |
| Role | OWNER / AMBR |
| Phone | 3058125087 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DIAZ ABREU RAFAEL A | Agent | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| Name | Role | Address |
|---|---|---|
| DIAZ ABREU RAFAEL A | Authorized Member | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| JIMENEZ LUBRANO ROBERTO JOSE | Authorized Member | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000120965 | ORTHOTIC & PROSTHETIC CLINICS OF AMERICA | ACTIVE | 2023-09-29 | 2028-12-31 | No data | 2754 NW 27TH AVENUE, BOCA RATON, FL, 33434 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-31 | 34760 US Highway 19 N, Palm Harbor, FL 34684 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| Florida Limited Liability | 2023-06-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
