Personalized Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME80694 Issued in FL

Legal business name

PERSONALIZED PEDIATRICS LLC

Practice address

12621 NW 8TH CT
Coral Springs, FL 33071-4425

Phone

(954) 632-2791

Fax

(954) 752-7845

NPI assigned

Feb 26, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Edna L Tello, M.D.NPI 1528078508

Title

Owner/Founder

Phone

(954) 632-2791

Specialties & licenses 1

Addresses

Other identifiers 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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edna Lillian Tello, M.D.

  • Pediatrics Physician
  • Coral Springs, FL
  • NPI 1528078508
  NPD (past) Authorized official

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1215329313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 CORAL RIDGE DR # 121",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330715433",
            "telephone_number": "954-632-2791",
            "fax_number": "954-752-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12621 NW 8TH CT",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330714425",
            "telephone_number": "954-632-2791",
            "fax_number": "954-752-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "TELLO",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/FOUNDER",
        "authorized_official_telephone_number": "954-632-2791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME80694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2606259",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Perfect Balance Healthcare, PLLC
• Perfect Smiles of South Florida, LLC
• Avinash Persad, DO
• Bibi F. Persaud, R.N.
• Christopher Yoo Yung Kyoo Perseo, R.PH, PHARM D.
• Perugorria MD PA
• Yamirka Perugorria, MD
• Jonathan Meltz Perwien, M.D.
• Pestana and Pestana, MD, PA
• Pestana Comprehensive Wellness

• Pediatrics Physician in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.