| Entity Name: | BODHI TRADITIONAL CHINESE MEDICINE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Mar 2017 (8 years ago) |
| Document Number: | P17000029494 |
| FEI/EIN Number | 82-1098585 |
| Address: | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 |
| Mail Address: | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871013649 | 2017-06-22 | 2019-08-08 | 476 HIGHWAY A1A STE 2B, SATELLITE BEACH, FL, 329372331, US | 476 HIGHWAY A1A STE 8B, SATELLITE BEACH, FL, 329372331, US | |||||||||||||||||||||
|
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| Phone | +1 321-312-0771 |
Authorized person
| Name | DR. ANDREA IZQUIERDO |
| Role | DR. OF CHINESE MEDICINE |
| Phone | 3213120771 |
Taxonomy
| Taxonomy Code | 171100000X - Acupuncturist |
| License Number | AP3822 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PERSONAL NPI |
| Number | 1972031169 |
| Name | Role | Address |
|---|---|---|
| IZQUIERDO, ANDREA | Agent | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 |
| Name | Role | Address |
|---|---|---|
| IZQUIERDO, ANDREA | President | 304 S Harbor City Blvd, Suite 101 Melbourne, FL 32901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-22 | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-22 | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-22 | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-16 | IZQUIERDO, ANDREA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-06-16 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-04-29 |
| Domestic Profit | 2017-03-30 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
