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  5. JORGE O. DIAZ, M.D., P.A.

JORGE O. DIAZ, M.D., P.A.

Company Details

Entity Name: JORGE O. DIAZ, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Aug 2005 (19 years ago)
Document Number: P05000112605
FEI/EIN Number 203337822
Address: 1331 SOUTH INTERNATIONAL PARKWAY, 1261, LAKE MARY, FL, 32746, US
Mail Address: 5224 W SR 46, 376, SANFORD, FL, 32771
ZIP code: 32746
County: Seminole
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2023 203337822 2024-07-28 JORGE O. DIAZ, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 5224 W. STATE ROAD 46, #376, SANFORD, FL, 32771

Signature of
Role Plan administrator
Date 2024-07-28
Name of individual signing JORGE DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2022 203337822 2023-08-07 JORGE O. DIAZ, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 5224 W. STATE ROAD 46, #376, SANFORD, FL, 32771

Signature of
Role Plan administrator
Date 2023-08-07
Name of individual signing JORGE DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2021 203337822 2022-06-14 JORGE O. DIAZ, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2022-06-14
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2020 203337822 2021-03-31 JORGE O. DIAZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2021-03-31
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2019 203337822 2020-04-01 JORGE O. DIAZ, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2020-04-01
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2018 203337822 2019-02-21 JORGE O. DIAZ, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2019-02-21
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2017 203337822 2018-06-11 JORGE O. DIAZ, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2018-06-11
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2016 203337822 2017-03-01 JORGE O. DIAZ, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 SOUTH INTERNATIONAL PARKWAY, SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2017-03-01
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2015 203337822 2016-05-29 JORGE O. DIAZ, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1331 S. INTERNATIONAL PKWY., SUITE 1261, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2016-05-29
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature
JORGE O. DIAZ, M.D., P.A. 401(K) PROFIT SHARING PLAN 2014 203337822 2015-06-22 JORGE O. DIAZ, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 4074444848
Plan sponsor’s address 1355 S. INTERNATIONAL PKWY., SUITE 1451, LAKE MARY, FL, 32746

Signature of
Role Plan administrator
Date 2015-06-22
Name of individual signing JORGE O. DIAZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DIAZ JORGE O Agent 1331 SOUTH INTERNATIONAL PARKWAY, LAKE MARY, FL, 32746

President

Name Role Address
DIAZ JORGE OM.D. President 1331 SOUTH INTERNATIONAL PARKWAY, LAKE MARY, FL, 32746

Director

Name Role Address
DIAZ JORGE OM.D. Director 1331 SOUTH INTERNATIONAL PARKWAY, LAKE MARY, FL, 32746

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2015-01-12 1331 SOUTH INTERNATIONAL PARKWAY, 1261, LAKE MARY, FL 32746 No data
REGISTERED AGENT ADDRESS CHANGED 2015-01-12 1331 SOUTH INTERNATIONAL PARKWAY, 1261, LAKE MARY, FL 32746 No data
CHANGE OF MAILING ADDRESS 2010-04-05 1331 SOUTH INTERNATIONAL PARKWAY, 1261, LAKE MARY, FL 32746 No data
REGISTERED AGENT NAME CHANGED 2007-04-08 DIAZ, JORGE OM.D No data

Documents

Name Date
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-02-01
ANNUAL REPORT 2022-03-02
ANNUAL REPORT 2021-01-26
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-01-27
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-03-02
ANNUAL REPORT 2015-01-12

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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