| Entity Name: | ORTHOTIC & PROSTHETIC CLINIC OF JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 2023 (a year ago) |
| Document Number: | L23000518765 |
| FEI/EIN Number | 93-4505579 |
| Address: | 11512 Lake Mead Ave, Jacksonville, FL, 32256, US |
| Mail Address: | 2754 NW 27TH AVE, BOCA RATON, FL, 33434, US |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942067939 | 2024-03-05 | 2024-03-05 | 2754 NW 27TH AVE, BOCA RATON, FL, 334343692, US | 11512 LAKE MEAD AVE UNIT 404, JACKSONVILLE, FL, 322569687, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 305-812-5087 |
| Phone | +1 904-231-8440 |
| Fax | 9042318441 |
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 AGUSTIN | Agent | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| Name | Role | Address |
|---|---|---|
| DIAZ ABREU RAFAEL AGUSTIN | Authorized Member | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| JIMENEZ LUBRANO ROBERTO J | Authorized Member | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000037701 | ORTHOTIC & PROSTHETIC CLINICS OF AMERICA | ACTIVE | 2024-03-14 | 2029-12-31 | No data | 2754 NW 27TH AVE, BOCA RATON, FL, 33434 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-24 | 11512 Lake Mead Ave, Unit 404, Jacksonville, FL 32256 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| Florida Limited Liability | 2023-11-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
