Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI MD (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
1505 WILSON TERRACE, SUITE 155, GLENDALE, CA 91206-4071
(909) 558-3636
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
(909) 651-4586
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/20/2015
Last updated
07/19/2019
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