# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1457301285
- **Authorized official:** RICARDO PEVERINI M.D. (PRESIDENT)
- **Authorized official phone:** (909) 558-7448

## Contact information

- **Practice address:** 4515 CENTRAL AVE, SUITE 101, RIVERSIDE, CA 92506-2374
- **Practice address phone:** (951) 784-4713
- **Practice address fax:** (909) 558-3905
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
- **Mailing address phone:** (909) 558-3111
- **Mailing address fax:** (909) 558-3905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 09/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0091662 | — | CA |