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
900 E WASHINGTON ST STE 200, COLTON, CA 92324-4192
(909) 558-4000
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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