| Entity Name: | DOMINION VASCULAR SURGICAL SPECIALISTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Jun 2024 (9 months ago) |
| Document Number: | L24000241413 |
| Address: | 4300 W LAKE MARY BLVD STE 1010, LAKE MARY, FL 32746 |
| Mail Address: | 4300 W LAKE MARY BLVD STE 1010, LAKE MARY, FL 32746 |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134966286 | 2024-07-15 | 2024-07-15 | 917 RINEHART RD STE 2041, LAKE MARY, FL, 327464806, US | 917 RINEHART RD STE 2041, LAKE MARY, FL, 327464806, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 347-829-0399 |
Authorized person
| Name | DR. OLUBUNMI OLATAYO ESAN |
| Role | DR. |
| Phone | 3478290399 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ, ARLEEN | Agent | 504 BEECHWOOD AVE, ALTAMONTE SPRINGS, FL 32714 |
| Name | Role | Address |
|---|---|---|
| OLATAYO ESAN, OLUBUNMI | Authorized Member | 4300 W LAKE MARY BLVD STE 1010, LAKE MARY, FL 32746 |
| Name | Role | Address |
|---|---|---|
| VICTORIA ESAN, MONISOLA | Member | 4300 W LAKE MARY BLVD STE 1010, LAKE MARY, FL 32746 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-06-03 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
