Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI M.D. (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
1686 BARTON RD, REDLANDS, CA 92373-7761
(909) 558-4505
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-0001
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPS000760
—
CA
05
—
GR0069028
—
CA
Enumeration date
05/11/2006
Last updated
05/21/2025
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