| Entity Name: | MWL PB-BR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Jul 2021 (4 years ago) |
| Document Number: | L21000333186 |
| FEI/EIN Number | 36-4995671 |
| Address: | 1511 N. WEST SHORE BLVD., 750, TAMPA, FL 33607 |
| Mail Address: | 2466 E Commercial Blvd, 101, Fort Lauderdale, FL 33308 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578210332 | 2022-03-02 | 2022-03-02 | 2466 E COMMERCIAL BLVD STE 101, FORT LAUDERDALE, FL, 333084011, US | 2466 E COMMERCIAL BLVD STE 101, FORT LAUDERDALE, FL, 333084011, US | |||||||||||||||||||||
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| Phone | +1 754-216-7177 |
Authorized person
| Name | MS. MELISSA SOMMERVILLE |
| Role | OWNER |
| Phone | 4073833848 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RB0002X - Obesity Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SILVA, ALBERT P | Agent | 1511 N. WEST SHORE BLVD., 750, TAMPA, FL 33607 |
| Name | Role | Address |
|---|---|---|
| SOMMERVILLE, MELISSA | Manager | 2466 E Commercial Blvd, 101 Fort Lauderdale, FL 33308 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000031548 | MEDI WEIGHTLOSS OF FORT LAUDERDALE | ACTIVE | 2022-03-10 | 2027-12-31 | No data | 2466 EAST COMMERCIAL BLVD,STE 101, FORT LAUDERDALE, FL, 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 1511 N. WEST SHORE BLVD., 750, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-05-01 |
| Florida Limited Liability | 2021-07-22 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
