VICENTE S VERZOSA MD PA
Osteopathic Medicine at 11 St, Lake Wales, FL

License number
Florida 17538
Category
Osteopathic Medicine
Type
Cardiovascular Disease
Owner
Name: DR. VICENTE S VERZOSA MD
Title: PRESIDENT
Phone: (863) 324-7755
Address
Address
410 S 11Th St, Lake Wales, FL 33853
National Provider ID: 1750550679
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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VICENTE S. VERZOSA, M.D., PA

Lake Wales, FL

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Dec 28, 1999
Inactive since:
Sep 27, 2013
Addresses:
240 E Park Ave, Lake Wales, FL 33853 (Physical)
Lake Wales, FL 33859 (Mailing)
435 S 11 St, Lake Wales, FL 33853
PO Box 466, Lake Wales, FL 33859
4031 Ashton Clb Dr, Lake Wales, FL 33859
State ID:
P99000110991
Business type:
Florida Profit Corporation
President, Treasurer, Director, Secretarys:
Pers Rep Of Estate Eduardo S. Verzosa Director, President, Secretary, Treasurer, inactive, 136 Marina Dr, Bullard, TX 75757 (Physical),Vicente S. Verzosa President, Treasurer, Director, Secretary, inactive
Agent:
James Weaver,240 E Park Ave, Lake Wales, FL 33853 (Physical)
EIN:
593614835

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