Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI M.D. (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
18182 HIGHWAY 18, SUITE 104, APPLE VALLEY, CA 92307-2200
(760) 475-6965
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Enumeration date
04/03/2008
Last updated
01/13/2025
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