| Entity Name: | KIDNEY DOCTOR, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Jun 2017 (8 years ago) |
| Document Number: | P17000048094 |
| FEI/EIN Number | 82-1854202 |
| Address: | 3608 W EUCLID AVE, TAMPA, FL, 33629, US |
| Mail Address: | 3608 W EUCLID AVE, TAMPA, FL, 33629, US |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871008508 | 2017-12-04 | 2017-12-04 | 111 N 12TH ST UNIT 1424, TAMPA, FL, 336023674, US | 4710 N HABANA AVE STE 300, TAMPA, FL, 336147151, US | |||||||||||||||||||||||
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| Phone | +1 407-718-6568 |
| Phone | +1 813-873-1016 |
| Fax | 8138742813 |
Authorized person
| Name | OTTO OSTOLAZA-GARCIA |
| Role | OWNER/PRESIDENT |
| Phone | 8138731016 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010280100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ACCOUNTING MANAGEMENT AND ADVISORY SERVICE | Agent | 615 CHANNELSIDE DRIVE, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| OSTOLAZA GARCIA OTTO | President | 3608 W EUCLID AVE, TAMPA, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| OSTOLAZA GARCIA OTTO | Director | 3608 W EUCLID AVE, TAMPA, FL, 33629 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-02-24 | ACCOUNTING MANAGEMENT AND ADVISORY SERVICES INC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-24 | 615 CHANNELSIDE DRIVE, SUITE 207, TAMPA, FL 33602 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-08 | 3608 W EUCLID AVE, TAMPA, FL 33629 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-08 | 3608 W EUCLID AVE, TAMPA, FL 33629 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-01-14 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-01-08 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-01-10 |
| Domestic Profit | 2017-06-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
