| Entity Name: | VIERA FAMILY PRACTICE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 14 Mar 2006 (19 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P06000037389 |
| FEI/EIN Number | 204487664 |
| Address: | 8095 SPYGLASS HILL RD., 105, MELBOURNE, FL, 32940 |
| Mail Address: | 8095 SPYGLASS HILL RD., 105, MELBOURNE, FL, 32940 |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073546701 | 2006-07-08 | 2018-06-21 | 8095 SPYGLASS HILL RD, SUITE 105, MELBOURNE, FL, 329408290, US | 8095 SPYGLASS HILL RD, SUITE 105, MELBOURNE, FL, 329408290, US | |||||||||||||||||||
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| Phone | +1 321-242-7005 |
| Fax | 3212427009 |
Authorized person
| Name | DR. MAHMOUD MOSTAFAVI |
| Role | PHYSICIAN |
| Phone | 3212427005 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME85423 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LOMBARD SHERRI A | Agent | 8085 SPYGLASS HILL RD., VIERA, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| MAHMOUD MOSTAFAVI D | President | 1248 TIPPERARY DRIVE, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-04-03 | 8095 SPYGLASS HILL RD., 105, MELBOURNE, FL 32940 | No data |
| CHANGE OF MAILING ADDRESS | 2007-04-03 | 8095 SPYGLASS HILL RD., 105, MELBOURNE, FL 32940 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-14 |
| ANNUAL REPORT | 2012-01-15 |
| ANNUAL REPORT | 2011-03-01 |
| ANNUAL REPORT | 2010-05-12 |
| ANNUAL REPORT | 2009-04-20 |
| ANNUAL REPORT | 2008-04-15 |
| ANNUAL REPORT | 2007-04-03 |
| Domestic Profit | 2006-03-14 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
