# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1861892705
- **Authorized official:** RICARDO PEVERINI MD (PRESIDENT)
- **Authorized official phone:** (909) 558-7445

## Contact information

- **Practice address:** 901 SAN BERNARDINO RD, UPLAND, CA 91786-4912
- **Practice address phone:** (909) 558-4000
- **Mailing address:** FILE \# 54701, LOS ANGELES, CA 90074-4701
- **Mailing address phone:** (909) 558-4000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |
| 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