| Entity Name: | SIERRA VISTA MEDICAL PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Oct 2021 (3 years ago) |
| Document Number: | P21000090304 |
| FEI/EIN Number | 87-3132703 |
| Address: | 3111 INNOVATION DR, ST CLOUD, FL, 34769, US |
| Mail Address: | 3111 INNOVATION DR, ST CLOUD, FL, 34769, US |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437809555 | 2022-03-24 | 2022-11-29 | 3111 INNOVATION DR, SAINT CLOUD, FL, 347696501, US | 3111 INNOVATION DR, SAINT CLOUD, FL, 347696501, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 407-593-2389 |
| Fax | 4073050141 |
| Phone | +1 561-961-4804 |
Authorized person
| Name | MARYSLENNI GIL |
| Role | PARTNER |
| Phone | 4075932389 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GARCIA LUIS | Agent | 3111 INNOVATION DR, ST CLOUD, FL, 34769 |
| Name | Role | Address |
|---|---|---|
| GARCIA LUIS | President | 3111 INNOVATION DR, ST CLOUD, FL, 34769 |
| GIL MARYSLENNI | President | 3111 INNOVATION DR, ST CLOUD, FL, 34769 |
| PEREZ JUAN S | President | 3111 INNOVATION DR, ST CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-14 | 3111 INNOVATION DR, ST CLOUD, FL 34769 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-14 | 3111 INNOVATION DR, ST CLOUD, FL 34769 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-14 | 3111 INNOVATION DR, ST CLOUD, FL 34769 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-31 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-03-14 |
| Domestic Profit | 2021-10-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
