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
8599 HAVEN AVE STE 102&210, RANCHO CUCAMONGA, CA 91730-4849
(909) 558-2806
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 651-4352
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
—
—
207RA0002X
Adult Congenital Heart Disease Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VC0200X
Critical Care Medicine (Obstetrics & Gynecology) Physician
—
—
207VG0400X
Gynecology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
Other
Enumeration date
01/18/2022
Last updated
02/10/2022
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