| Entity Name: | MIMOSA FAMILY HEALTH PC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Jul 2021 (4 years ago) |
| Document Number: | P21000063956 |
| FEI/EIN Number | 87-1715856 |
| Address: | 960 W 41ST STREET, SUITE 312, MIAMI BEACH, FL, 33140 |
| Mail Address: | 200 WALLABOUT STREET, SUITE 1C, BROOKLYN, NY, 11206 |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629743562 | 2021-08-12 | 2021-08-12 | 200 WALLABOUT ST STE 1C, BROOKLYN, NY, 112065561, US | 960 W 41ST ST STE 312, MIAMI BEACH, FL, 331403348, US | |||||||||||||
|
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| Phone | +1 718-486-9800 |
Authorized person
| Name | YECHIEL ZAGELBAUM |
| Role | DO |
| Phone | 7184869800 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ZAGELBAUM YECHIEL | Agent | 960 W 41ST STREET, MIAMI BEACH, FL, 33140 |
| Name | Role | Address |
|---|---|---|
| ZAGELBAUM YECHIEL | President | 200 WALLABOUT STREET, SUITE 1C, BROOKLYN, NY, 11206 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-14 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-08-28 |
| Domestic Profit | 2021-07-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
