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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) 558-7448
Entity
Organization
Contact information
Practice address
1505 WILSON TERRACE, SUITE 155, GLENDALE, CA 91206-4071
(909) 558-3636
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
(909) 651-4586
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
NULL
204F00000X
Transplant Surgery Physician
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/20/2015
Last updated
07/19/2019
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