| Entity Name: | PERSONALIZED MEDICINE INSTITUTE, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Oct 2018 (6 years ago) |
| Document Number: | L18000250371 |
| FEI/EIN Number | 83-2367049 |
| Mail Address: | 4765 SW 148th AVE, DAVIE, FL, 33330, US |
| Address: | 4765 SW 148th. Avenue, Davie, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376011551 | 2018-11-06 | 2020-03-28 | 6030 REESE RD APT 404, DAVIE, FL, 333141243, US | 4765 SW 148TH AVE STE 404, DAVIE, FL, 333302128, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 203-300-0147 |
| Fax | 9546344293 |
Authorized person
| Name | IVEL CRISTINA DE FREITAS |
| Role | OWNER |
| Phone | 2033000147 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INTERNAL MEDICINE |
| Number | ME107216 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Fernandez Maximo Dr. | Agent | 4765 SW 148th AVE, DAVIE, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ MAXIMO J | Manager | 4765 SW 148th AVE, DAVIE, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-18 | 4765 SW 148th. Avenue, Suite 404, Davie, FL 33330 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-18 | 4765 SW 148th. Avenue, Suite 404, Davie, FL 33330 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-18 | 4765 SW 148th AVE, Suite 404, DAVIE, FL 33330 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-25 | Fernandez, Maximo, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-03-18 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-03-03 |
| Florida Limited Liability | 2018-10-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
