| Entity Name: | SOUTH BAY NEUROLOGY AND TOTAL SPINE CARE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Mar 2001 (24 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P01000031526 |
| FEI/EIN Number | 593712347 |
| Address: | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL, 33573 |
| Mail Address: | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL, 33573 |
| ZIP code: | 33573 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831224872 | 2007-02-22 | 2020-08-22 | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL, 335736825, US | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL, 335736825, US | |||||||||||||||||||||||||||
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| Phone | +1 813-634-3323 |
| Fax | 8136344764 |
Authorized person
| Name | DR. CHRISTOPHER LINTAO VALENCIA |
| Role | PRESIDENT |
| Phone | 8136343323 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | 94898 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | CH9703 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VALENCIA CHRISTOPHER L | Agent | 4051 UPPER CREEK DR., SUN CITY CENTER, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| VALENCIA CHRISTOPHER L | Director | 4051 UPPER CREEK DR, STE 111, SUN CITY CENTER, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| VALENCIA CHRISTOPHER L | President | 4051 UPPER CREEK DR, STE 111, SUN CITY CENTER, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| VALENCIA CHRISTOPHER L | Secretary | 4051 UPPER CREEK DR, STE 111, SUN CITY CENTER, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| VALENCIA CHRISTOPHER L | Treasurer | 4051 UPPER CREEK DR, STE 111, SUN CITY CENTER, FL, 33573 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-03-22 | 4051 UPPER CREEK DR., SUITE 111, SUN CITY CENTER, FL 33573 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-08 | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL 33573 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-08 | 4051 UPPER CREEK DR, SUITE 111, SUN CITY CENTER, FL 33573 | No data |
| NAME CHANGE AMENDMENT | 2004-12-13 | SOUTH BAY NEUROLOGY AND TOTAL SPINE CARE, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-03-22 |
| ANNUAL REPORT | 2009-04-08 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-05-07 |
| ANNUAL REPORT | 2006-04-24 |
| ANNUAL REPORT | 2005-04-23 |
| Name Change | 2004-12-13 |
| ANNUAL REPORT | 2004-04-19 |
| ANNUAL REPORT | 2003-04-16 |
| ANNUAL REPORT | 2002-04-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
