# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1316599640
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 651-5582

## Contact information

- **Practice address:** 1801 N BROADWAY, SANTA ANA, CA 92706-2607
- **Practice address phone:** (909) 558-3636
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
- **Mailing address phone:** (909) 651-4352
- **Mailing address fax:** (909) 651-4586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204F00000X | Transplant Surgery Physician | — | NULL | Yes |
| 204F00000X | Transplant Surgery Physician | — | — | Yes |
| 207RT0003X | Transplant Hepatology Physician | — | NULL | — |
| 207RT0003X | Transplant Hepatology Physician | — | — | — |
| 2080T0004X | Pediatric Transplant Hepatology Physician | — | NULL | — |
| 2080T0004X | Pediatric Transplant Hepatology Physician | — | — | — |

## Other

- **Enumeration date:** 07/16/2019
- **Last updated:** 07/22/2019