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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 MD (PRESIDENT)
(909) 651-5582
Entity
Organization
Contact information
Practice address
328 COMMERCIAL RD STE 101, SAN BERNARDINO, CA 92408-3766
(909) 558-6222
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
—
NULL
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
11/29/2018
Last updated
07/19/2019
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