| Entity Name: | BAY AREA NEURO CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Jul 1992 (33 years ago) |
| Document Number: | V54180 |
| FEI/EIN Number | 59-3138074 |
| Address: | 6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617 |
| Mail Address: | 6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617 |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194889709 | 2006-12-20 | 2020-08-22 | 6275 E FOWLER AVE, TEMPLE TERRACE, FL, 33617, US | 6275 E FOWLER AVE, TEMPLE TERRACE, FL, 33617, US | |||||||||||||||||||||
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| Phone | +1 813-985-3773 |
| Fax | 8139847171 |
Authorized person
| Name | JOSE VICENTE BUSTAMANTE |
| Role | PRESIDENT |
| Phone | 8139853773 |
Taxonomy
| Taxonomy Code | 225700000X - Massage Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | C5112 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOSE V BUSTAMANNE | Agent | 11008 RIDGE DALE N RD, TEMPLE TERRRACE, FL 33617 |
| Name | Role | Address |
|---|---|---|
| BUSTAMANTE, JOSE V. | President | 11008 RIDSEDALE RD., TAMPA, FL 33617 |
| Name | Role | Address |
|---|---|---|
| BUSTAMANTE, JOSE V. | Secretary | 11008 RIDSEDALE RD., TAMPA, FL 33617 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2003-01-21 | 11008 RIDGE DALE N RD, TEMPLE TERRRACE, FL 33617 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2000-03-21 | 6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617 | No data |
| CHANGE OF MAILING ADDRESS | 2000-03-21 | 6275 E FOWLER AVE, TEMPLE TERRACE, FL 33617 | No data |
| REGISTERED AGENT NAME CHANGED | 1996-04-11 | JOSE V BUSTAMANNE | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-01-11 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-12 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
