| Entity Name: | INTEGRATED MIND MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Mar 2015 (10 years ago) |
| Document Number: | L15000042531 |
| FEI/EIN Number | 47-3383715 |
| Address: | 1946 TYLER ST, HOLLYWOOD, FL 33020 |
| Mail Address: | 1946 TYLER ST, HOLLYWOOD, FL 33020 |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730575549 | 2015-04-08 | 2015-04-08 | 1946 TYLER ST, SUITE 14, HOLLYWOOD, FL, 330204517, US | 1946 TYLER ST, SUITE 14, HOLLYWOOD, FL, 330204517, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 754-210-5359 |
| Fax | 7542105363 |
Authorized person
| Name | MENCIA GOMEZ |
| Role | MD |
| Phone | 7542105359 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME121955 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Gomez, Mencia M | Agent | 1946 TYLER ST, HOLLYWOOD, FL 33020 |
| Name | Role | Address |
|---|---|---|
| DE VARGAS, MENCIA GOMEZ | Member | 1946 TYLER ST, HOLLYWOOD, FL 33020 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-12 | 1946 TYLER ST, HOLLYWOOD, FL 33020 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-12 | 1946 TYLER ST, HOLLYWOOD, FL 33020 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-12 | 1946 TYLER ST, HOLLYWOOD, FL 33020 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-03-15 | Gomez, Mencia M | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| Florida Limited Liability | 2015-03-09 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
