| Entity Name: | FAMILY MEDICAL AND WELLNESS CENTER , LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Oct 2007 (17 years ago) |
| Last Event: | LC ARTICLE OF CORRECTION |
| Event Date Filed: | 15 Nov 2007 (17 years ago) |
| Document Number: | L07000105229 |
| FEI/EIN Number | 261344629 |
| Address: | 12983 SOUTHERN BLVD, SUITE 102, LOXAHATCHEE, FL, 33470, US |
| Mail Address: | 12983 SOUTHERN BLVD, SUITE 102, LOXAHATCHEE, FL, 33470, US |
| ZIP code: | 33470 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942479795 | 2008-02-26 | 2012-06-08 | 10111 FOREST HILL BLVD, SUITE 230, WELLINGTON, FL, 334146108, US | 10111 FOREST HILL BLVD, SUITE 230, WELLINGTON, FL, 334146108, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 561-721-1953 |
| Fax | 5617212257 |
Authorized person
| Name | DR. VANESSA VIZCAINO |
| Role | PRESIDENT |
| Phone | 5617211953 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME 87499 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1295797140 |
| State | FL |
| Issuer | NPI |
| Number | 1730140211 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VIZCAINO VANESSA | Agent | 306 VENICE BLVD, ROYAL PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| VIZCAINO VANESSA | Managing Member | 306 VENICE BLVD, ROYAL PALM BEACH, FL, 33411 |
| GLOVER LESLEY N | Managing Member | 2061 VININGS CIRCLE, WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-04-23 | VIZCAINO, VANESSA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-23 | 306 VENICE BLVD, ROYAL PALM BEACH, FL 33411 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-05-04 | 12983 SOUTHERN BLVD, SUITE 102, LOXAHATCHEE, FL 33470 | No data |
| CHANGE OF MAILING ADDRESS | 2016-05-04 | 12983 SOUTHERN BLVD, SUITE 102, LOXAHATCHEE, FL 33470 | No data |
| LC ARTICLE OF CORRECTION | 2007-11-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-07-20 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-25 |
| AMENDED ANNUAL REPORT | 2016-05-04 |
| ANNUAL REPORT | 2016-04-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
