| Entity Name: | CLEOPATRA GORDON PUSEY, MD P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 20 Oct 2008 (16 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 21 Aug 2020 (5 years ago) |
| Document Number: | P08000094655 |
| FEI/EIN Number | 30-0510314 |
| Address: | 222 S FLAMINGO RD, PEMBROKE PINES, FL 33027 |
| Mail Address: | P.O. BOX 260816, PEMBROKE PINES, FL 33026 |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740502228 | 2010-02-24 | 2017-02-28 | 222 S FLAMINGO RD, PEMBROKE PINES, FL, 330271721, US | 700 N HIATUS RD, SUITE 213, PEMBROKE PINES, FL, 330265206, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-392-9026 |
| Fax | 9543572353 |
Authorized person
| Name | DR. CLEOPATRA TAMARIA GORDON PUSEY |
| Role | PRESIDENT |
| Phone | 9543929026 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 146LM |
| State | FL |
| Issuer | MEDICAID |
| Number | 281390401 |
| State | FL |
| Issuer | MEDICAID |
| Number | 281390402 |
| State | FL |
| Issuer | MEDICAID |
| Number | 281390400 |
| State | FL |
| Issuer | AVMED |
| Number | 311776 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Pusey, Bramwell Burnett, VP | Agent | 222 S FLAMINGO RD, PEMBROKE PINES, FL 33027 |
| Name | Role | Address |
|---|---|---|
| GORDON-PUSEY, CLEOPATRA TM.D. | President | P.O. BOX, 260816 PEMBROKE PINES, FL 33026 |
| Name | Role | Address |
|---|---|---|
| PUSEY, BRAMWELL BURNETT | Vice President | P.O. BOX, 260816 PEMBROKE PINES, FL 33026 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000068602 | LIFE IS BEAUTIFUL, M.D. | ACTIVE | 2010-07-26 | 2025-12-31 | No data | P.O. BOX 260816, PEMBROKE PINES, FL, 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-04-11 | Pusey, Bramwell Burnett, VP | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-11 | 222 S FLAMINGO RD, PEMBROKE PINES, FL 33027 | No data |
| AMENDMENT | 2020-08-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-01 | 222 S FLAMINGO RD, PEMBROKE PINES, FL 33027 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-23 | 222 S FLAMINGO RD, PEMBROKE PINES, FL 33027 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-21 |
| Amendment | 2020-08-21 |
| ANNUAL REPORT | 2020-05-19 |
| ANNUAL REPORT | 2019-03-09 |
| ANNUAL REPORT | 2018-03-31 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-02-26 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6822517807 | 2020-06-02 | 0455 | PPP | 222 S Flamingo Road 700 N Hiatus Road, Pembroke Pines, FL, 33026 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 24 Feb 2025
Sources: Florida Department of State
