Organization
FACULTY MEDICAL GROUP OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI MD (PRESIDENT FACULTY MEDICAL GROUP OF)
(909) 558-7448
Entity
Organization
Contact information
Practice address
11234 ANDERSON ST, A 108, LOMA LINDA, CA 92354-2804
(909) 558-4344
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068913
—
CA
Enumeration date
06/02/2006
Last updated
07/27/2010
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