# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1487124798
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 651-5582

## Contact information

- **Practice address:** 328 COMMERCIAL RD STE 101, SAN BERNARDINO, CA 92408-3766
- **Practice address phone:** (909) 558-6222
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
- **Mailing address phone:** (909) 558-4000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PT0002X | Medical Toxicology (Emergency Medicine) Physician | — | NULL | Yes |
| 207PT0002X | Medical Toxicology (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2018
- **Last updated:** 07/19/2019