| Entity Name: | PALM BEACH BOTOX LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Mar 2016 (9 years ago) |
| Document Number: | L16000063884 |
| FEI/EIN Number | 36-4836428 |
| Address: | 16244 S MILITARY TRAIL, STE 150, DELRAY BEACH, FL, 33484 |
| Mail Address: | 16244 S MILITARY TRAIL, STE 150, DELRAY BEACH, FL, 33484 |
| ZIP code: | 33484 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801303920 | 2018-01-10 | 2018-03-17 | 16244 S MILITARY TRL STE 150, DELRAY BEACH, FL, 334846505, US | 16244 S MILITARY TRL STE 150, DELRAY BEACH, FL, 334846505, US | |||||||||||||||||||||||||||
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| Phone | +1 561-638-8872 |
| Fax | 5616388874 |
Authorized person
| Name | DR. SAMUEL FARHAN SIDDIQUI |
| Role | PRESIDENT |
| Phone | 5617159800 |
Taxonomy
| Taxonomy Code | 204D00000X - Neuromusculoskeletal Medicine & OMM Physician |
| Is Primary | No |
| Taxonomy Code | 2081N0008X - Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | 72476 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Siddiqui Samuel | Agent | 16244 S MILITARY TRAIL, DELRAY BEACH, FL, 33484 |
| Name | Role | Address |
|---|---|---|
| Siddiqui Samuel | Manager | 16244 S MILITARY TRAIL, DELRAY BEACH, FL, 33484 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000051711 | MEDICAL CANNABIS CLINICS OF FLORIDA | ACTIVE | 2020-05-11 | 2025-12-31 | No data | 16244 S MILITARY TRAIL, STE 150, DELRAY BEACH, FL, 33484 |
| G19000039661 | CENTER FOR NEUROLOGY | EXPIRED | 2019-03-27 | 2024-12-31 | No data | 16244 S MILITARY TRAIL, STE 150, DELRAY BEACH, FL, 33484 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2017-01-23 | Siddiqui, Samuel | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-06-17 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-01-23 |
| Florida Limited Liability | 2016-03-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
