| Entity Name: | SPACE COAST PEDIATRICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Mar 2024 (a year ago) |
| Document Number: | L24000124193 |
| Address: | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL, 33702, US |
| Mail Address: | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL, 33702, US |
| ZIP code: | 33702 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346081189 | 2024-06-05 | 2024-10-25 | 8045 SPYGLASS HILL RD STE 105, VIERA, FL, 329408567, US | 8045 SPYGLASS HILL RD STE 105, VIERA, FL, 329408567, US | |||||||||||||||||||||
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| Phone | +1 772-269-1904 |
| Phone | +1 321-467-1660 |
Authorized person
| Name | ARLEENE SEPULVEDA |
| Role | PEDIATRICIAN |
| Phone | 7722691904 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1770813552 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| CANDELARIO JOSE | Manager | 7901 4TH ST N SUITE 300, ST. PETERSBURG, FL, 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-04-01 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2025-04-01 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-01 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-01 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
