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
11234 ANDERSON ST STE 1617, LOMA LINDA, CA 92354-2804
(909) 558-4200
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207SG0205X
Ph.D. Medical Genetics Physician
—
—
207ZC0006X
Clinical Pathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
11/05/2008
Last updated
09/19/2023
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