# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083863914
- **Authorized official:** DR. RICARDO PEVERINI (PRESIDENT)
- **Authorized official phone:** (909) 558-7448

## Contact information

- **Practice address:** 685 N 13TH AVE STE 11, UPLAND, CA 91786-4963
- **Practice address phone:** (909) 579-6721
- **Mailing address:** FILE \# 54701, LOS ANGELES, CA 90074-0001
- **Mailing address phone:** (909) 558-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | CA | Yes |

## Other

- **Enumeration date:** 09/16/2008
- **Last updated:** 09/16/2008