Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO REVERINI MD (PRESIDENT)
(909) 558-7445
Entity
Organization
Contact information
Practice address
69844 HIGHWAY 111, SUITE A & B, RANCHO MIRAGE, CA 92270-2849
(909) 558-3636
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
—
Other
Enumeration date
10/22/2013
Last updated
07/19/2019
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