| Entity Name: | MARK W. LASTARZA, M.D., PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Jul 2001 (24 years ago) |
| Date of dissolution: | 06 Dec 2017 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Dec 2017 (7 years ago) |
| Document Number: | P01000076127 |
| FEI/EIN Number | 593733086 |
| Address: | 335 CLYDE MORRIS BLVD, STE 290, ORMOND BEACH, FL, 32174, US |
| Mail Address: | 335 CLYDE MORRIS BLVD, STE 290, ORMOND BEACH, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043623598 | 2014-06-03 | 2016-02-25 | 335 CLYDE MORRIS BLVD, SUITE 290, ORMOND BEACH, FL, 321743181, US | 335 CLYDE MORRIS BLVD, SUITE 290, ORMOND BEACH, FL, 321743181, US | |||||||||||||||||||
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| Phone | +1 386-672-3219 |
| Fax | 3866723160 |
Authorized person
| Name | DR. MARK LASTARZA |
| Role | DIRECTOR |
| Phone | 3866723219 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME75627 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LASTARZA MARK W | Agent | 335 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| LASTARZA MARK W | Director | 335 CLYDE MORRIS BLVD, SUITE 290, ORMOND BEACH, FL, 32174 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-12-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2012-02-09 | LASTARZA, MARK W | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-02-20 | 335 CLYDE MORRIS BLVD, STE 290, ORMOND BEACH, FL 32174 | No data |
| CHANGE OF MAILING ADDRESS | 2006-02-20 | 335 CLYDE MORRIS BLVD, STE 290, ORMOND BEACH, FL 32174 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-02-20 | 335 CLYDE MORRIS BLVD, STE 290, ORMOND BEACH, FL 32174 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-03-10 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-03-06 |
| ANNUAL REPORT | 2012-02-09 |
| ANNUAL REPORT | 2011-02-07 |
| ANNUAL REPORT | 2010-03-12 |
| ANNUAL REPORT | 2009-03-17 |
| ANNUAL REPORT | 2008-02-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
