| Entity Name: | RSM PLASTIC SURGERY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Jun 2018 (7 years ago) |
| Document Number: | P18000050112 |
| FEI/EIN Number | 83-0795914 |
| Address: | 7901 4th St N, STE 300, St. Petersburg, FL 33702 |
| Mail Address: | 7901 4th St N, STE 300, St. Petersburg, FL 33702 |
| ZIP code: | 33702 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790271096 | 2018-07-10 | 2019-08-21 | 3300 WEST LAKE MARY BLVD, SUITE 210, LAKE MARY, FL, 32746, US | 3300 W LAKE MARY BLVD STE 210, LAKE MARY, FL, 327463499, US | |||||||||||||||||||||||||
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| Phone | +1 407-632-1010 |
| Phone | +1 863-899-9736 |
Authorized person
| Name | KANDICE KING |
| Role | CREDENTIALING SPECIALIST |
| Phone | 8472283303 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | ME136100 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1235420886 |
| State | CT |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| SAWH-MARTINEZ, RAJENDRA | Director | 7901 4th St N, STE 300 St. Petersburg, FL 33702 |
| Name | Role | Address |
|---|---|---|
| SAWH-MARTINEZ, RAJENDRA | President | 7901 4th St N, STE 300 St. Petersburg, FL 33702 |
| Name | Role | Address |
|---|---|---|
| SAWH-MARTINEZ, RAJENDRA | Secretary | 7901 4th St N, STE 300 St. Petersburg, FL 33702 |
| Name | Role | Address |
|---|---|---|
| SAWH-MARTINEZ, RAJENDRA | Treasurer | 7901 4th St N, STE 300 St. Petersburg, FL 33702 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000015490 | REFORME AT RSM PLASTIC SURGERY | ACTIVE | 2024-01-28 | 2029-12-31 | No data | 2629 EDGEWATER DR, ORLANDO, FL, 32804 |
| G18000066543 | RAJENDRA SAWH-MARTINEZ, MD, MHS | EXPIRED | 2018-06-08 | 2023-12-31 | No data | 764 QUINNIPIAC AVE, NEW HAVEN, CT, 06513 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-21 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-21 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-21 | Northwest Registered Agent LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-21 | 7901 4th St N, STE 300, St. Petersburg, FL 33702 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-01-16 |
| Reg. Agent Change | 2019-05-16 |
| ANNUAL REPORT | 2019-05-07 |
| Domestic Profit | 2018-06-01 |
Date of last update: 17 Feb 2025
Sources: Florida Department of State
