# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1700495363
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 651-5582

## Contact information

- **Practice address:** 1850 N RIVERSIDE AVE STE 160, RIALTO, CA 92376-8056
- **Practice address phone:** (909) 558-3016
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-4701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | — | NULL | Yes |
| 2085B0100X | Body Imaging Physician | — | — | Yes |
| 2085D0003X | Diagnostic Neuroimaging (Radiology) Physician | — | NULL | — |
| 2085D0003X | Diagnostic Neuroimaging (Radiology) Physician | — | — | — |
| 2085H0002X | Hospice and Palliative Medicine (Radiology) Physician | — | NULL | — |
| 2085H0002X | Hospice and Palliative Medicine (Radiology) Physician | — | — | — |
| 2085N0700X | Neuroradiology Physician | — | NULL | — |
| 2085N0700X | Neuroradiology Physician | — | — | — |
| 2085N0904X | Nuclear Radiology Physician | — | NULL | — |
| 2085N0904X | Nuclear Radiology Physician | — | — | — |
| 2085P0229X | Pediatric Radiology Physician | — | NULL | — |
| 2085P0229X | Pediatric Radiology Physician | — | — | — |
| 2085R0001X | Radiation Oncology Physician | — | NULL | — |
| 2085R0001X | Radiation Oncology Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085R0203X | Therapeutic Radiology Physician | — | NULL | — |
| 2085R0203X | Therapeutic Radiology Physician | — | — | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 2085R0205X | Radiological Physics Physician | — | NULL | — |
| 2085R0205X | Radiological Physics Physician | — | — | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | NULL | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | — | — |

## Other

- **Enumeration date:** 07/29/2020
- **Last updated:** 07/29/2020