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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) 558-7445
Entity
Organization
Contact information
Practice address
901 SAN BERNARDINO RD, UPLAND, CA 91786-4912
(909) 558-4000
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0120X
Pediatric Surgery Physician
Primary
—
NULL
2086S0120X
Pediatric 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
08/28/2014
Last updated
07/19/2019
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