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General NPI Number Information
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NPI Number | 1215329313
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Entity Type | Organization
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Legal Business Name | PERSONALIZED PEDIATRICS LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 12621 NW 8TH CT
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4425
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Country | US
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Telephone | 954-632-2791
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Fax | 954-752-7845
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Provider Business Mailing Address
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Address Line | 1440 CORAL RIDGE DR # 121
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-5433
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Country | US
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Telephone | 954-632-2791
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Fax | 954-752-7845
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | DR. EDNA L TELLO
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Credential | M.D.
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Telephone | 954-632-2791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME80694
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License Number State | FL
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