| Entity Name: | MIND, BODY & SOUL PSYCHIATRY, P.A |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Nov 2009 (15 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 24 Apr 2023 (2 years ago) |
| Document Number: | P09000090432 |
| FEI/EIN Number | 27-1396619 |
| Address: | 900 SW 196th Ave., PEMBROKE PINES, FL, 33029, US |
| Mail Address: | 900 SW 196th Ave., Pembroke Pines, FL, 33029, US |
| ZIP code: | 33029 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740045004 | 2024-02-15 | 2024-02-15 | 20984 UPTOWN AVE APT 105, BOCA RATON, FL, 334286579, US | 20984 UPTOWN AVE APT 105, BOCA RATON, FL, 334286579, US | |||||||||||||
|
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| Phone | +1 954-546-2707 |
Authorized person
| Name | DR. DIANA SOFIA GLACCUM-GAVAGNI |
| Role | OWNER/PSYCHIATRIST |
| Phone | 9545462707 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Glaccum-Gavagni Diana SDr. | Agent | 900 SW 196th Ave., Pembroke Pines, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| GLACCUM-GAVAGNI DIANA SDR. | President | 900 SW 196th Ave., Pembroke Pines, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| Glaccum-Gavagni Diana SDr. | Secretary | 900 SW 196th Ave., Pembroke Pines, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| Glaccum-Gavagni Diana SDr. | Treasurer | 900 SW 196 Ave., Pembroke Pines, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-21 | 900 SW 196th Ave., PEMBROKE PINES, FL 33029 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-21 | 900 SW 196th Ave., Pembroke Pines, FL 33029 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-21 | 900 SW 196th Ave., PEMBROKE PINES, FL 33029 | No data |
| NAME CHANGE AMENDMENT | 2023-04-24 | MIND, BODY & SOUL PSYCHIATRY, P.A | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-30 | Glaccum-Gavagni, Diana Sofia, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| Name Change | 2023-04-24 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
