Personalized Pediatric Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PERSONALIZED PEDIATRIC LABORATORIES LLC

Practice address

1744 Berkeley St
Santa Monica, CA 90404-4105

Phone

(725) 240-0608

Fax

(888) 356-3518

NPI assigned

May 16, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Manalo

Title

Laboratory Supervisor

Phone

(619) 253-2923

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1194416628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 BERKELEY ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044105",
            "telephone_number": "725-240-0608",
            "fax_number": "888-356-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1744 BERKELEY ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044105",
            "telephone_number": "725-240-0608",
            "fax_number": "888-356-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED PEDIATRIC LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "MANALO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "LABORATORY SUPERVISOR",
        "authorized_official_telephone_number": "619-253-2923"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Rosalie Perrella, MD
• Catita Perron, L.C.S.W.
• Pamela Diane Perry-Hunter, M.D.
• Madeline Claire Perry
• Arash Pershen, D.C.
• Peter B. Hirsch, MD, Inc.
• Peter G Alexakis M D a Medical Corporation
• Peter M Birnstein MD Prof Corp Family Practice Assoc
• Peter M Loisides MD, Inc
• John Peters

• Clinical Medical Laboratory in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.