| Entity Name: | PEYSAF WORTHALTER, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 03 Mar 1989 (36 years ago) |
| Document Number: | K70173 |
| FEI/EIN Number | 65-0107204 |
| Address: | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 |
| Mail Address: | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 |
| ZIP code: | 33180 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104032739 | 2007-05-14 | 2007-09-10 | 20824 W DIXIE HWY, MIAMI, FL, 331801147, US | 20824 W DIXIE HWY, MIAMI, FL, 331801147, US | |||||||||||||||||||||
|
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| Phone | +1 305-654-0907 |
| Fax | 3059990011 |
Authorized person
| Name | PEYSAF WORTHALTER |
| Role | PRESIDENT |
| Phone | 3056540907 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 96159 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WORTHALTER, PEYSAF | Agent | 20824 W. DIXIE HIGHWAY, MIAMI, FL 33180 |
| Name | Role | Address |
|---|---|---|
| Worthalter, Peysaf, Dr. | Director | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 |
| Name | Role | Address |
|---|---|---|
| Worthalter, Peysaf, Dr. | President | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2005-02-28 | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 | No data |
| CHANGE OF MAILING ADDRESS | 2005-02-28 | 20824 W DIXIE HIGHWAY, NORTH MIAMI BEACH, FL 33180 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-02-04 | 20824 W. DIXIE HIGHWAY, MIAMI, FL 33180 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-22 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-02-05 |
| ANNUAL REPORT | 2017-02-03 |
| ANNUAL REPORT | 2016-02-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
