Organization
FACULTY MEDICAL GROUP 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
3762 TIBBETTS ST, RIVERSIDE, CA 92506-2605
(909) 558-3111
Mailing address
54701 FILE NUMBER, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
—
Other
Enumeration date
01/17/2007
Last updated
05/05/2009
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