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Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI M.D. (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
18182 HIGHWAY 18, SUITE 104, APPLE VALLEY, CA 92307-2200
(760) 475-6965
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Enumeration date
04/03/2008
Last updated
01/13/2025
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