NPIMap

Organization Active NPI

Kidz Pediatrics, PA

  • Pediatrics Physician
  • Angier, NC
National Provider Identifier
1417112756
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2004 00397 Issued in NC
Legal business name
KIDZ PEDIATRICS, PA
Practice address
285 W Dora St
Angier, NC 27501-9542
Phone
(919) 639-9995
NPI assigned
Jul 25, 2008
Last updated
Apr 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Authorized official

Name
Lourdes Pereda, MDNPI 1609869437
Title
Board Director
Phone
(910) 489-5456

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2004 00397 NC Primary

Addresses

Primary practice location

285 W Dora St
Angier, NC 27501-9542

Mailing address

285 W Dora St
Angier, NC 27501-9542
Phone (919) 639-9995

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1088464Kidz Pediatrics PA285 W Dora Street, Angier, NC 27501Certificate of waiverAug 25, 2026

National Provider Directory

National Provider Directory

Locations

285 W Dora St
Angier, NC 27501
Phone (919) 639-9995

728 N Raleigh St
Ste A1
Angier, NC 27501
Phone (919) 639-9995

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1417112756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 W DORA ST",
            "city": "ANGIER",
            "state": "NC",
            "postal_code": "275019542",
            "telephone_number": "919-639-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 W DORA ST",
            "city": "ANGIER",
            "state": "NC",
            "postal_code": "275019542",
            "telephone_number": "919-639-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZ PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "PEREDA",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_title_or_position": "BOARD DIRECTOR",
        "authorized_official_telephone_number": "910-489-5456",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2004 00397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Angier, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.