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
328 COMMERCIAL RD STE 101, SAN BERNARDINO, CA 92408-3766
(909) 558-6222
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
11/29/2018
Last updated
07/19/2019
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