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TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER PLLC

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Company Details

Name: TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 15 Dec 2017 (8 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 582353
Place of Formation: IDAHO
File Number: 582353
ZIP code: 83713
County: Ada County
Principal Address: 6051 N EAGLE RD BOISE, ID 83713
Mailing Address: DUSTIN PORTELA 2535 E FAIRVIEW AVE MERIDIAN, ID 83642-1308

Agent

Name Role Address
DUSTIN PORTELA Agent 2535 E FAIRVIEW AVE, MERIDIAN, ID 83642

Manager

Name Role Address Appointed On
Dustin R Portela Manager 2535 E FAIRVIEW AVE, MERIDIAN, ID 83642 2020-11-03

National Provider Identifier

NPI Number:
1598271645
Certification Date:
2024-04-03

Authorized Person:

Name:
DUSTIN R PORTELA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
2085194333
Fax:
2082059134

Form 5500 Series

Employer Identification Number (EIN):
823774905
Plan Year:
2023
Number Of Participants:
21
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
20
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
0
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005957697 2024-11-03
Annual Report Amendment 0005952272 2024-10-28
Change of Registered Office/Agent/Both (by Entity) 0005828534 2024-08-01
Change of Registered Office/Agent/Both (by Entity) 0005709476 2024-05-01
Statement of Change of Business Mailing Address 0005645124 2024-03-12

Paycheck Protection Program

Date Approved:
2020-04-08
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
165827
Current Approval Amount:
165827
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
167545.15

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Date of last update: 04 Jul 2025

Sources: Idaho Secretary of State