| Entity Name: | SOUTHEAST WELLNESS LANE CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Mar 2019 (6 years ago) |
| Document Number: | P19000021050 |
| FEI/EIN Number | 83-3989947 |
| Address: | 13265 SW 39TH ST, DAVIE, FL, 33330, US |
| Mail Address: | 13265 SW 39TH ST, DAVIE, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962962316 | 2019-03-21 | 2019-03-21 | 13265 SW 39TH ST, DAVIE, FL, 333304748, US | 13265 SW 39TH ST, DAVIE, FL, 333304748, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 786-493-2293 |
Authorized person
| Name | DR. YURI SALAS ESPINOSA |
| Role | PRESIDENT |
| Phone | 7864932293 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006456700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALAS ESPINOSA YURI | Agent | 13265 SW 39TH ST, DAVIE, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| SALAS ESPINOSA YURI | President | 13265 SW 39TH ST, DAVIE, FL, 33330 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-07-27 |
| ANNUAL REPORT | 2020-02-19 |
| Domestic Profit | 2019-03-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
