| Entity Name: | SUNRISE INTRACOASTAL PLASTIC SURGERY CENTER PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Apr 2022 (3 years ago) |
| Document Number: | P22000034352 |
| FEI/EIN Number | 881898488 |
| Address: | 910 NE 26TH AVE, FT. LAUDERDALE, FL, 33304, US |
| Mail Address: | 910 NE 26TH AVE, FT. LAUDERDALE, FL, 33304, US |
| ZIP code: | 33304 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558008599 | 2022-05-19 | 2022-05-19 | 910 NE 26TH AVE, FORT LAUDERDALE, FL, 333043607, US | 910 NE 26TH AVE, FORT LAUDERDALE, FL, 333043607, US | |||||||||||||||||||
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| Phone | +1 954-533-8029 |
Authorized person
| Name | JUANA DE LA GARZA |
| Role | AUTHORIZED OFFICIAL |
| Phone | 5491475499 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | OSR105 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHEUNG MICHAEL | Agent | 910 NE 26TH AVE, FT. LAUDERDALE, FL, 33304 |
| Name | Role | Address |
|---|---|---|
| CHEUNG MICHAEL | Authorized Member | 910 NE 26TH AVE, FT. LAUDERDALE, FL, 33304 |
| LOW CHRISTOPHER | Authorized Member | 910 NE 26TH AVE, FT. LAUDERDALE, FL, 33304 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-10 |
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-23 |
| Domestic Profit | 2022-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
