| Entity Name: | MICHAEL DIAZ M.D. P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jan 2002 (23 years ago) |
| Document Number: | P02000002342 |
| FEI/EIN Number | 260022867 |
| Address: | 1513 SOUTH HARBOR CITY BLVD, MELBOURNE, FL, 32901, US |
| Mail Address: | 1513 SOUTH HARBOR CITY BLVD, MELBOURNE, FL, 32901, US |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962958397 | 2016-08-26 | 2016-09-30 | 151 SOUTHHALL LN, STE 300, MAITLAND, FL, 327517176, US | 1513 S HARBOR CITY BLVD, MELBOURNE, FL, 329014681, US | |||||||||||||||||||
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| Phone | +1 407-875-2080 |
| Fax | 4076503455 |
| Phone | +1 321-951-2639 |
| Fax | 3219140938 |
Authorized person
| Name | MICHAEL DIAZ |
| Role | OWNER/PHYSICIAN |
| Phone | 3219512639 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CMS INTERNATIONAL ENTERPRISES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| DIAZ MICHAEL | Treasurer | 1513 South Harbor City Blvd, Melbourne, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| DIAZ MICHAEL | Director | 1513 South Harbor City Blvd, Melbourne, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| DIAZ MICHAEL | President | 1513 South Harbor City Blvd, Melbourne, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| DIAZ MICHAEL | Secretary | 1513 South Harbor City Blvd, Melbourne, FL, 32901 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
