Personalized Pediatric Laboratories LLC
Clinical Medical Laboratory in Santa Monica, CA. Organization (NPI-2).
Details
- NPI
- 1194416628
- Entity type
- Organization (NPI-2)
- Legal business name
- Personalized Pediatric Laboratories LLC
- Organization subpart
- No
- Enumeration date
- May 16, 2023
- Certification date
- May 18, 2023
- Last updated
- May 18, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - INDEPENDENT CLINICAL LABORATORY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | – | – | Yes |
Practice location
1744 Berkeley StSanta Monica, CA 90404-4105
Phone 725-240-0608 · Fax 888-356-3518
Mailing address
1744 Berkeley StSanta Monica, CA 90404-4105
Phone 725-240-0608 · Fax 888-356-3518
Authorized official
Michelle Manalo
Laboratory Supervisor
6192532923
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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