| Entity Name: | PALM BEACH INTEGRATIVE MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Mar 2009 (16 years ago) |
| Document Number: | L09000023694 |
| FEI/EIN Number | 264430435 |
| Address: | 11951 US Highway 1, Suite 105, North Palm Beach, FL, 33408, US |
| Mail Address: | 11951 US Highway 1, Suite 105, North Palm Beach, FL, 33408, US |
| ZIP code: | 33408 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417283706 | 2009-10-22 | 2009-10-22 | 836 JEFFERY ST, BOCA RATON, FL, 334874105, US | 836 JEFFERY ST, BOCA RATON, FL, 334874105, US | |||||||||||||||||
|
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| Phone | +1 561-537-2603 |
Authorized person
| Name | DR. JOHN DELUCA |
| Role | MGR |
| Phone | 5615372603 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME102199 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DELUCA JOHN M | Agent | 11951 US Highway 1, North Palm Beach, FL, 33408 |
| Name | Role | Address |
|---|---|---|
| DELUCA JOHN M | Managing Member | 11951 US Highway 1, North Palm Beach, FL, 33408 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000055001 | OPTIMAL FUNCTION MEDICAL GROUP | ACTIVE | 2023-05-01 | 2028-12-31 | No data | 11951 US HIGHWAY 1, SUITE 105, NORTH PALM BEACH, FL, 33408 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-26 | 11951 US Highway 1, Suite 105, North Palm Beach, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-26 | 11951 US Highway 1, Suite 105, North Palm Beach, FL 33408 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-26 | 11951 US Highway 1, Suite 105, North Palm Beach, FL 33408 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-02-26 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-03 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-09-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
