| Entity Name: | WHITE SANDS MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 Oct 2023 (a year ago) |
| Document Number: | M23000013624 |
| FEI/EIN Number | 93-3674482 |
| Address: | 1702 OHIO AVE, LYNN HAVEN, FL 32444 |
| Mail Address: | 1702 OHIO AVE, LYNN HAVEN, FL 32444 |
| ZIP code: | 32444 |
| County: | Bay |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801676531 | 2023-10-02 | 2023-10-02 | 1702 OHIO AVE, LYNN HAVEN, FL, 324444290, US | 1702 OHIO AVE, LYNN HAVEN, FL, 324444290, US | |||||||||||||||
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| Phone | +1 850-647-8825 |
| Fax | 8502488825 |
Authorized person
| Name | DR. FARID BRAD MOZAFFARI |
| Role | PRESIDENT |
| Phone | 8506478825 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HOWELL CPA GROUP | Agent | 408 W BALDWIN RD, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| MOZAFFARI, FARID | Manager | 1702 OHIO AVE, LYNN HAVEN, FL 32444 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000131518 | PLASTIC SURGERY INSTITUTE & SPA | ACTIVE | 2023-10-25 | 2028-12-31 | No data | 1702 OHIO AVE, LYNN HAVEN, FL, 32444 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| Foreign Limited | 2023-10-24 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
