Organization
FACULTY MEDICAL GROUP OF LLUSM
Active
Other names
LLU FACULTY MED. GR. /RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO PEVERINI M.D. (PRESIDENT)
(909) 558-7448
Entity
Organization
Contact information
Practice address
81 HIGHLAND SPRINGS AVE STE 102, BEAUMONT, CA 92223-3170
(909) 558-3016
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-3016
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
03/31/2010
Last updated
03/31/2010
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