| Entity Name: | CARLOS A. VIZCARRA MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jun 2006 (19 years ago) |
| Document Number: | P06000086743 |
| FEI/EIN Number | 205117679 |
| Address: | 13000 US HIGHWAY 1, 4, SEBASTIAN, FL, 32958, US |
| Mail Address: | 13000 US HIGHWAY 1, 4, SEBASTIAN, FL, 32958, US |
| ZIP code: | 32958 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437248754 | 2006-10-12 | 2020-08-22 | 3897 PEACOCK DR, MELBOURNE, FL, 329049516, US | 13837 US HIGHWAY 1, SEBASTIAN, FL, 329583232, US | |||||||||||||||||||||
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| Phone | +1 321-373-1160 |
| Phone | +1 772-589-9188 |
| Fax | 7725899187 |
Authorized person
| Name | DR. CARLOS ANDRES VIZCARRA |
| Role | PRESIDENT |
| Phone | 7725899188 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME 931719 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VIZCARRA CARLOS A | Agent | 1525 EAGLES CIRCLE, SEBASTIAN, FL, 32958 |
| Name | Role | Address |
|---|---|---|
| VIZCARRA CARLOS A | President | 1525 EAGLES CIRCLE, SEBASTIAN, FL, 32958 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-29 | 13000 US HIGHWAY 1, 4, SEBASTIAN, FL 32958 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-29 | 13000 US HIGHWAY 1, 4, SEBASTIAN, FL 32958 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-09 | 1525 EAGLES CIRCLE, SEBASTIAN, FL 32958 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-04-18 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-05-21 |
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-03-24 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-04-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
