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
11360 MT VIEW AVE STE B, LOMA LINDA, CA 92354-3834
(909) 558-2830
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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