Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI MD (PRESIDENT)
(909) 651-5582
Entity
Organization
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(909) 558-4000
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
—
—
207ZC0006X
Clinical Pathology Physician
Primary
—
—
207ZC0500X
Cytopathology Physician
—
—
207ZD0900X
Dermatopathology (Pathology) Physician
—
—
207ZF0201X
Forensic Pathology Physician
—
—
207ZH0000X
Hematology (Pathology) Physician
—
—
207ZI0100X
Immunopathology Physician
—
—
207ZM0300X
Medical Microbiology Physician
—
—
207ZN0500X
Neuropathology Physician
—
—
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
207ZP0104X
Chemical Pathology Physician
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
207ZP0213X
Pediatric Pathology Physician
—
—
Other
Enumeration date
05/29/2019
Last updated
07/22/2019
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