# FACULTY MEDICAL GROUP OF LLUSM

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

## Provider details

- **NPI number:** 1619314168
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 558-7448

## Contact information

- **Practice address:** 69844 HIGHWAY 111, SUITE A & B, RANCHO MIRAGE, CA 92270-2849
- **Practice address phone:** (909) 558-3636
- **Mailing address:** FILE \# 54701, LOS ANGELES, CA 90074-4701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204F00000X | Transplant Surgery Physician | — | NULL | Yes |
| 204F00000X | Transplant Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/23/2013
- **Last updated:** 05/23/2013