# FACULTY PHYSICIANS AND SURGEONS OF LLUSM

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

## Provider details

- **NPI number:** 1962452714
- **Authorized official:** RICARDO PEVERINI M.D. (PRESIDENT)
- **Authorized official phone:** (909) 558-7448

## Contact information

- **Practice address:** 2195 CLUB CENTER DR, SUITE A-L, SAN BERNARDINO, CA 92408-4170
- **Practice address phone:** (909) 558-2154
- **Mailing address:** FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
- **Mailing address phone:** (909) 558-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 02/02/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0069027 | — | CA |
| 05 | — | GR006902V | — | CA |