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
4646 BROCKTON AVE STE 103, RIVERSIDE, CA 92506-0103
(909) 558-3111
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
207YS0012X
Sleep Medicine (Otolaryngology) Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
207YX0901X
Otology & Neurotology Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/06/2020
Last updated
07/06/2020
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