Organization
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI MD (PRESIDENT)
(909) 558-7445
Entity
Organization
Contact information
Practice address
901 SAN BERNARDINO RD, UPLAND, CA 91786-4912
(909) 558-4000
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
2086S0120X
Pediatric Surgery Physician
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/28/2014
Last updated
07/19/2019
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