| Entity Name: | PERSONALIZED PEDIATRICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Jan 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Jun 2014 (11 years ago) |
| Document Number: | L05000004597 |
| FEI/EIN Number | 412168812 |
| Address: | 12621 NW 8TH COURT, CORAL SPRINGS, FL, 33071, US |
| Mail Address: | 1440 CORAL RIDGE DR., #121, CORAL SPRINGS, FL, 33071, US |
| ZIP code: | 33071 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215329313 | 2015-02-26 | 2015-02-26 | 1440 CORAL RIDGE DR # 121, CORAL SPRINGS, FL, 330715433, US | 12621 NW 8TH CT, CORAL SPRINGS, FL, 330714425, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 954-632-2791 |
| Fax | 9547527845 |
Authorized person
| Name | DR. EDNA L TELLO |
| Role | OWNER/FOUNDER |
| Phone | 9546322791 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME80694 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2606259 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TELLO EDNA L | Agent | 12621 NW 8TH COURT, CORAL SPRINGS, FL, 33071 |
| Name | Role | Address |
|---|---|---|
| TELLO EDNA | President | 12621 NW 8TH COURT, CORAL SPRINGS, FL, 33071 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2014-06-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-08-27 | 12621 NW 8TH COURT, CORAL SPRINGS, FL 33071 | No data |
| CANCEL ADM DISS/REV | 2009-08-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-08-27 | 12621 NW 8TH COURT, CORAL SPRINGS, FL 33071 | No data |
| CHANGE OF MAILING ADDRESS | 2009-08-27 | 12621 NW 8TH COURT, CORAL SPRINGS, FL 33071 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-01-11 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-01-07 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-07 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1070088504 | 2021-02-18 | 0455 | PPS | 12621 NW 8th Ct 12621 Nw 8th Ct, Coral Springs, FL, 33071-4425 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 7664497703 | 2020-05-01 | 0455 | PPP | 12621 NW 8TH CT, CORAL SPRINGS, FL, 33071-4425 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 02 Feb 2025
Sources: Florida Department of State
