# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1669016499
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 651-5582

## Contact information

- **Practice address:** 900 E WASHINGTON ST STE 200, COLTON, CA 92324-4192
- **Practice address phone:** (909) 558-4000
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-4701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | NULL | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | — | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 207XX0801X | Orthopaedic Trauma Physician | — | NULL | — |
| 207XX0801X | Orthopaedic Trauma Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 11/05/2019
- **Last updated:** 11/05/2019