| Entity Name: | GAIA FUNCTIONAL MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Jul 2024 (7 months ago) |
| Document Number: | L24000296526 |
| Address: | 701 21ST ST, STE101, VERO BEACH, FL, 32960, US |
| Mail Address: | 246 21ST AVE, VERO BEACH, FL, 32962, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144054123 | 2024-08-30 | 2024-08-30 | 701 21ST ST STE 101, VERO BEACH, FL, 329605419, US | 701 21ST ST STE 101, VERO BEACH, FL, 329605419, US | |||||||||||||
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| Phone | +1 772-356-0620 |
Authorized person
| Name | MS. JESSICA OLAVARRIA |
| Role | OWNER/OPERATOR |
| Phone | 7723560620 |
Taxonomy
| Taxonomy Code | 202D00000X - Integrative Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| OLAVARRIA JESSICA D | Agent | 701 21ST ST, STE101, VERO BEACH, FL, 32960 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-07-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
