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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
25865 BARTON RD, STE 101, LOMA LINDA, CA 92354-3895
(909) 558-3636
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111

Taxonomy

Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0068911
CA
Enumeration date
05/25/2006
Last updated
02/27/2009
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